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PubMed1995

[The result of reoperation for lung cancer].

Twenty four patients with recurrent or multiple lung cancer were reoperated in our center. Five-year survival rate was 20% for 11 patients with recurrent, while was 25% for 13 patients with multiple after reoperation. The patients with limited operation had well survival and there was no significant difference in procedure. However all four patients with N2 had poor prognosis. Seven patients (29%) had the post reoperative complication in pulmonary system. All of them had the impairment of pulmonary function (FEV1.0% was less than 50%) or more than 75% perfusion ratio, measured with pulmonary perfusion scintigraphy, in the side of the reoperation.

Adenocarcinoma↗
PubMed1994

[Reoperation in differentiated carcinoma of the thyroid gland].

A series of 112 patients reoperated on for differentiated thyroid cancer is analyzed; 60 patients (38 with papillary and 22 with follicular cancer) underwent ex-principio to completion of a non total thyroidectomy and 52 (37 with papillary and 15 with follicular cancer) to repeat surgery for local relapse. At a mean follow-up of 8.7 years, all the 38 patients with papillary cancer reoperated on for completion are alive and disease-free, while of those with follicular cancer 4 are dead, 2 are alive with carcinoma and 16 (72.7%) are disease free. A reoperation for relapse was performed on the thyroid in 11, on the thyroid and nodes in 23 patients (all had initially received partial thyroidectomy), and on nodes alone in 28 patients. At a mean follow-up of 10.2 years, 20 patients (54%) with papillary and 7 (46.6%) with follicular cancer are alive and disease-free, 8 patients with papillary and 1 with follicular cancer are alive with disease and the remainder are dead due to the tumour. Although there is no sure evidence that total thyroidectomy provides higher survival and fewer recurrences, since many factors, predominantly age influence the prognosis, total thyroidectomy is recommended as a minimal procedure to avoid less safe and less radical subsequent reoperation.

Adenocarcinoma, Follicular↗
PubMed1995

[Experiences of reoperative coronary artery bypass grafting by left thoracotomy without aortic clamping].

We reported two cases which had reoperative coronary artery bypass grafting (CABG) through the left thoracotomy approach without aortic clamping with good results. Case 1. A 50-year-old man, who underwent a double CABG to left anterior descending coronary artery (LAD) and right coronary artery (RCA) in 1983, had a recurrent unstable angina due to new significant stenosis of the diagonal branch (DG) and obtuse marginal branch (OM) in 1989. He was reoperated upon, having a new double CABG to DG and OM through the left thoracotomy using hypothermic ventricular fibrillation without aortic clamping for the myocardial protection without any blood transfusion. Case 2. A 61-year-old man, who underwent a double CABG to LAD and RCA in 1982, had a recurrent unstable angina and a left ventricular aneurysm in 1991. He had a reoperation of a single CABG to OM combined with left ventricular aneurysmectomy by the same approach. Both cases showed satisfactory recoveries of the left ventricular function in the early postoperative period and patent grafts on postoperative angiograms. The left thoracotomy approach is a preferable alternative to median resternotomy for the reoperative CABG to OM, DG and left ventricular aneurysmectomy.

Angina, Unstable↗
PubMed1994

[Reoperation of hip endoprostheses].

Experiences gained in 106 reoperations of 88 patients following 1968 total and 18 Wagner arthroplasties, performed in the Department of the authors between 30. 05. 1969. and 30. 06. 1991., are described. They think that after the THR yearly control and radiological examinations are necessary. Radiological signs in symptomless patients do not mean operative indication, in these cases regular control is thought to be even more important. Big loss of bone with loosening makes reoperation in symptomless patients necessary as with the progression of bone destruction the danger of fracture increases and the possibility of reimplantation becomes dubious. In dubious cases bone scintigraphy may be of help. The technical solutions used by them are described. At the planning of reoperation the age of the patient, the state of the acetabulum and femur are considered. Under 60 years of age and at loosening with big bone loss cementless prosthesis and bone transplantation are suggested. The most important is thought to be to reach stable fixation. Attention is called that the performance of reoperation needs good technical skills.

Adult↗
PubMed1994

[Reoperations for valvular heart disease through repeated median sternotomy incision].

One thousand and three hundred patients underwent open heart surgery for acquired valvular diseases in our hospital from 1952 through December 1993. There were 105 reoperative cases through repeated median sternotomy incision and 52 cases of prosthetic valve replacement by the same operator in the last 5 years. We studied technical procedures by these reoperative experience. There was only one case (1.9%) of hospital death in replacement cases. We believe that repeated open heart surgery for acquired valvular diseases should be done prior to deterioration of patient's clinical condition. We had to pay attention to facilitate mobilization of right atrium and aortic root in the aortic and mitral valvular reoperations. To decrease operative mortality of prosthetic valve replacement, each operative techniques were necessary by the reasons for reoperation.

Adolescent↗
PubMed1994

Persistent and recurrent sporadic primary hyperparathyroidism: histopathology, complications, and results of reoperation.

BACKGROUND: Our purpose was to analyze the causes of persistent and recurrent sporadic primary hyperparathyroidism (PD and RD). METHODS: The histopathology, complications, and results of reoperation were studied. Five hundred sixty-eight patients with primary hyperparathyroidism were operated on initially by one surgeon and underwent follow-up examination for 3.7 +/- 3.8 years. During the operation, all parathyroids were sought and confirmed by biopsy. Enlarged glands were resected, and subtotal parathyroidectomy was done for multiglandular disease (hyperplasia). RESULTS: The cure rate after the initial surgical procedure was 96.4%, PD = 2.8% (16 of 568). At reoperation (10 of 16), nine of 10 were cured (90%) (two adenomas, six hyperplasias, one lung carcinoma). RD was documented (at years 4, 4, 10, 15, 16) in five (0.9%) patients, one with parathyroid carcinoma and four with hyperplasia. Thirty-five patients with PD and two patients with RD were referred for reoperation: 17 with adenomas (eight mediastinal) and 18 with hyperplasias (one mediastinal gland). Preoperative calcium level was higher for PD (12.57 mg/dl) and RD (13.89 mg/dl) versus all cases (12.19 mg/dl) (p < 0.03 and p < 0.0005, respectively). After reoperation, normocalcemia was achieved in 47 (92.%) of 51 patients with PD or RD. Transient hypocalcemia occurred in 22% of patients (permanent, 2.0%) and transient hoarseness in 2.0% of patients (no permanent nerve damage). Permanent hypocalcemia and nerve damage after 568 initial operations were 0% and 0%, respectively. Two perioperative deaths occurred. CONCLUSIONS: We conclude that inadequate neck exploration or resection of hyperplastic tissue accounts for most cases of PD and RD. Optimal results necessitate intraoperative identification of all parathyroids whenever possible, with minimal morbidity.

Adult↗
PubMed1994

[Reoperation for obstructed extracardiac conduit after Rastelli operation--an autogenous tissue reconstruction (Danielson) method].

Eight patients with a mean age of 13.0 years underwent reoperation for obstructed extracardiac dacron conduit with xenograft valve at a mean of 7 years after Rastelli operation. In two patients, infective endocarditis of the stenotic conduit was the main indication for the reoperation. Diagnoses included 3 tetralogy of Fallot with pulmonary atresia, 3 d-TGA (III), 1 truncus arteriosus, and 1 corrected TGA. The conduit was completely excised leaving the posterior half of the autogenous external peel of conduit as the new outflow bed and a monocusped patch was then placed. Operations were mostly carried out allowing the heart to continue to beat. One patient with c-TGA who underwent concomitant replacement of aortic and left A-V values died in the hospital 4 months postoperatively. In other 7 patients, systolic pressure gradient across the right ventricular outflow decreased from a mean of 80.3 mmHg to 16.0 mmHg. Postoperative pulmonary regurgitation by UCG were trivial in 3 and grade III in 3 patients. One patient required re-reoperation late postoperatively for re-stenosis due to contracture of Golaski outflow patch. Three patients did not require any homologous blood during either the operation or the rest of the hospital stay. The results suggests that this method is a simple and effective option for reoperation of obstructed extracardiac dacron conduits late after Rastelli operation.

Adolescent↗
PubMed1994

[The causes responsible for recurrence of pituitary adenomas and an evaluation of reoperation effects].

Four hundred and twenty one cases of transfrontal removal of pituitary adenomas were presented. Of these 23 had recurrence of tumor which was confirmed by reoperation and histopathological examination. The rate of recurrence decreased while the patients' age increased. Incomplete removal of the tumor tissue was one of the most important causes of recurrence. Invasiveness was another important cause. Most of the tumors in this series were large and had pathologically proven invasiveness. At the reoperations, there were evidences of worse invasiveness, especially the infiltration of adenomas into the capsules and adjacent structures. There was a case of Nelson's syndrome, suggesting the endocrine causes of recurrence. Apparent adhesion and topographic disorders were found during reoperation, improvement of visual impairment decreased obviously, and the mortality rate increased; therefore, the reoperations should be decided with great deliberation.

Adenoma, Chromophobe↗
PubMed1993

[Reoperations on heart valve prosthesis. Apropos of 99 cases].

From March 1977 to November 1988, 99 patients were reoperated on after a first valvular replacement. Mean delay between the two operations was 53 months (10 days to 18 years). The patients were reoperated on mainly for mechanical disinsertion (30), bacterial endocarditis (25) and thrombosis (18 patients). Operative mortality was 11%, mainly following reoperation for bacterial endocarditis. Mean follow-up (85 patients) was 49 months (6 months-11 years). 75% were alive and doing well 4 years after reoperation and 66% at 6 years. Eight patients needed a third operation with two deaths.

Actuarial Analysis↗
PubMed1993

Reoperation after condylar revision total knee arthroplasty.

Reasons for reoperation after knee revision surgery are implant loosening, sepsis, extensor mechanism problems, fractures of bone or prosthetic components, wear debris, and limited range of motion. The purpose of this study was to review the complications requiring reoperation in a large number of condylar revision total knee arthroplasties to determine the incidence and outcome after treatment. Six hundred fifty-five condylar revision total knee arthroplasties performed during a ten-year period were retrospectively reviewed. Forty-six knees without a history of arthroplasty infection required a total of 60 reoperations after the revision surgery. A reoperation was performed for extensor mechanism or patellar problems in 19 knees (41%), component loosening in ten knees (22%), deep infection in nine knees (20%), wound problems in nine knees (20%), tibiofemoral instability in eight knees (17%), limited range of motion in four knees (8%), and particulate debris synovitis in one knee (2%). All patients were observed for an average of 7.5 years. Twenty-four knees (52%) were considered clinical failures because of pain, limited motion, instability, and sepsis. Awareness of these failure modes may help to prevent complications by strict attention at the time of revision surgery to protection of the patellar tendon attachment and collateral ligaments, balancing of the extensor mechanism, preservation of the patellar blood supply, proper component position and sizing, restoration of the mechanical axis, and use of more constrained implant designs.

Adult↗
PubMed1993

Cause and current management of reoperative hyperparathyroidism.

We reviewed 137 cases of hyperparathyroidism followed for 6-72 months to determine the reasons for failure and to outline the successful management of reoperative hyperparathyroidism. Of 127 patients treated initially at Thomas Jefferson University Hospital, three required reoperation (2.4%) and 10 were referred with recurrent or persistent hyperparathyroidism. Reasons for failure were a missed gland in eight cases (62%), an ectopic gland in two cases (15%), supernumerary glands in two cases (15%), and malignant degeneration of an autotransplant in one case (8%). One patient had shortterm hypoparathyroidism requiring vitamin D supplementation (5.6%), but there were no injuries to the recurrent laryngeal nerves. We conclude that adequate knowledge of the location of normal and ectopic glands with meticulous search will reduce most reoperations, and, with identification of all four glands and routine cervical thymectomy in multigland disease, the rate should be less than 5 per cent. Patients requiring reoperation should undergo noninvasive localization studies and, if equivocal, selective venous sampling for parathyroid hormone. The major complication rate should be less than 10 per cent.

Adult↗
PubMed1996

Unplanned reoperation for bleeding.

Thirty (0.46%) patients required one or more reoperations to control bleeding after 6499 elective surgical procedures. A specific bleeding site was identified in 10 (0.15%), and bleeding was diffuse in 20 (0.31%). Bleeding occurred despite normal prothrombin and partial thromboplastin times and adequate platelet counts in all 30 cases. Diffuse bleeding was associated with the preoperative use of aspirin alone or in combination with other nonsteroidal anti-inflammatory drugs (NSAIDS) in 19 of 20 patients (95%). None of the patients with a discrete bleeding point identified at reoperation were taking these products (P < 0.001). More than one reoperation was more often required in the patients with diffuse postoperative bleeding than those with a specific site of hemorrhage. Many of these subsequent procedures were required to manage infections that developed after the first reoperation to control bleeding. Intensive care unit use, length of intensive care unit stay, total hospital stay, and hospital charges were all significantly increased when diffuse postoperative bleeding was noted. Postoperative bleeding, especially when it is diffuse rather than from a specific bleeding point, significantly prolongs hospital stay and increases costs. Bleeding is not prevented by obtaining routine screening coagulation profiles. A medication history with special attention to the recent use of aspirin and NSAIDS is advised before elective operations. Delaying surgery until the antiplatelet effects of these drugs have worn off may be advisable.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

Pulmonary autograft reoperation: incidence and management.

BACKGROUND: Pulmonary autograft replacement of the aortic valve is accepted in the young, those with an active life style, and those who are not candidates for anticoagulation. However, concern remains about autograft or homograft valve failure. METHODS: One hundred ninety-five operative survivors of the Ross operation (August 1986 through December 1995) were reviewed for operative pathology and factors associated with reoperation or valve dysfunction. RESULTS: Actuarial freedom from reoperation (autograft or homograft) is 89% +/- 3% at 5 years, 92% +/- 3% for the autograft alone. Early autograft valve failures (< 6 months) were due to technical error in 2 patients and persistent endocarditis in 1. Late autograft valve failure (1 to 6.2 years) was due to aortic annulus dilatation in 5 patients, bacterial endocarditis in 1, and valve degeneration in 2. Six autograft valves were replaced and five were repaired. Five patients required reoperation for pulmonary homograft stenosis (1 to 5.4 years) involving obstruction of the conduit distal to the pulmonary valve. CONCLUSIONS: Pulmonary autograft replacement of the aortic valve has a low incidence of reoperation for autograft dysfunction or homograft obstruction. Autograft dysfunction can be corrected by autograft repair in patients with central insufficiency and aortic annular dilatation.

Actuarial Analysis↗
PubMed1996

Reoperation for carpal tunnel syndrome.

Although primary carpal tunnel release is usually successful, reoperation is needed in up to 3% of patients. Common indications of reoperation are previous incomplete surgery and postoperative fibrosis. Although most patients improve after reoperation, persistent systems are likely and failure is more frequent than after primary carpal tunnel surgery. Risk factors for failure following reoperation include the presence of an active Worker's Compensation claim, pain in the ulnar nerve distribution, and the absence of abnormality on preoperative EMG.

Carpal Tunnel Syndrome↗
PubMed1997

Complete atrioventricular septal defects: results of repair, risk factors, and freedom from reoperation.

BACKGROUND: Several perioperative risk factors influence outcomes after repair of complete atrioventricular septal defects. This study was conducted to determine their association with perioperative mortality and need for reoperation. METHOD AND RESULTS: Between July 1982 and February 1995, 363 children underwent defect repair (median age, 8.3 months; mean, 17.4+/-1.3). Tetralogy of Fallot was present in 21 patients, double-outlet right ventricle in 4, subaortic stenosis in 8, ventricular hypoplasia in 8, coarctation in 5, atrial isomerism in 2, and other congenital anomalies in 9. Down's syndrome was present in 235 (65%). One-patch technique was applied in 99, two-patch in 243. During repair, the anterior bridging leaflet was divided in 12, the posterior bridging leaflet in 31, both leaflets in 71, and neither in 249. Left atrioventricular valve (LAVV) cleft was closed partially in 181 and completely in 112. Early mortality was 10.5%; 10-year survival, 83% (95% confidence interval, 0.79 to 0.87). At 10 years, freedom from reoperation for LAVV repair was 86%; LAVV replacement, 90%; subaortic stenosis, 95%; residual ventricular septal defect, 97%; permanent pacemaker insertion, 98%; and other types of reoperation, 95%. At the time of operation, greater age, shorter ischemic time, absence of a double-orifice LAVV, and cleft closure were found to be significant independent predictors of survival. CONCLUSIONS: Repair of atrioventricular septal defects has acceptable early and late mortality and a low incidence of reoperation. Double-orifice LAVV remains a risk factor. Repairs that include complete cleft closure may confer better survival.

Follow-Up Studies↗
PubMed1994

[Reoperation for valvular heart diseases].

To elucidate the limitation of mitral valve reconstruction, 53 mitral disease patients (Mitral stenosis: 29, Mitral regurgitation: 24) undergoing reoperation late after valve reconstruction were studied, taking account of valvular lesions at initial operation. Reoperation rate after open mitral commissurotomy for mitral stenosis was higher in the patients with valvular regurgitation at initial operation than in those with severe subvalvular lesions or calcified valve. Reoperation rate for mitral regurgitation after mitral valvuloplasty was higher in the patients with stenotic fibrous degeneration or dilated annulus at initial operation than in those with torn chorda. Thus, these findings suggest that combined lesion of stenosis and regurgitation at initial operation may affect the reoperation rate in patients undergoing mitral valve reconstruction for either mitral stenosis or mitral regurgitation. Different approaches to the mitral valve through the left atrium and various techniques of the atriotomy have been practiced according to the need for a particular patients. The left atrium and the mitral valve can be exposed through median sternotomy followed by biatrial atriotomy or transplant approach. A correct approach and good exposure plays a key role in the success of redo surgical procedure for mitral valve disease.

Humans↗
PubMed1994

[Reoperations for prosthetic heart valves: operation techniques and determinant factors of operative mortality].

Between 1982 and 1993, 93 patients underwent reoperation for prosthetic heart valves at our hospital. There were 41 male and 52 female patients who ranged in age 2 to 70 years with a mean age of 47 years. Twenty-four patients were in New York Heart Association (NYHA) functional class II, 52 in class III, and 17 in class IV, preoperatively. The indications of reoperative valve surgery were primary tissue failure of a bioprosthesis in 57 patients, valve thrombosis in 10, nonstructural valve dysfunction in 12, cloth wear of a ball valve in 5, endocarditis in 5, and others in 4. In reoperation, the heart was not mobilized from the pericardium to prevent tearing the heart and great vessels. All operative procedures were performed through the pericardium which adhered tightly to the heart. Adequate myocardial protection was obtained without total dissection of the heart with cold crystalloid cardioplegic solution and topical cooling which was accomplished by filling the left pleural space with cold saline. The operative mortality was 7 of the 93 patients (7.5%), falling from 4/36 (11.1%) in 1982 through 1987 to 3/57 (5.3%) in 1988 through 1993. Advanced New York Heart Association functional class, prolonged cardiopulmonary bypass and aortic cross clamping times were the determinant factors of operative mortality. These results suggest that reoperation for dysfunctioning prosthetic heart valves should be performed before deterioration of the hemodynamic condition of the patient.

Adolescent↗
PubMed1994

[Experience of reoperations followed by repairs of abdominal aortic aneurysms].

We experienced 8 cases who required reoperations, including 2 re-redo operations, after repairs of infrarenal abdominal aortic aneurysms. Of 8 patients, one patient developed a new aneurysm due to atherosclerosis in thoraco-abdominal aorta involving all visceral arteries and other 7 patients had aneurysmal formations at proximal anastomotic sites, including 3 suprarenal, 2 juxtarenal and 2 infrarenal aortic lesions. Etiology at initial operation in patients who subsequently developed anastomotic aneurysms included vasculo-Behçet disease in 4, atherosclerosis in 2 and dissecting aortic aneurysms type III due to Marfan syndrome in 1. At reoperation, all who had vasculo-Behçet disease had ruptures of anastomotic sites and 2 patients underwent repairs of dehiscent patch, 1 extra-anatomic bypass between ascending and abdominal aorta and 1 interposition of graft. One patient who had graft infection after repair of abdominal aortic aneurysm required axillo-femoral bypass with removal of infected graft. A patient who had dehiscence of proximal anastomosis after repair of aortoiliac occlusive disease required interposition of graft. Two patients, Marfan syndrome and aneurysm in thoraco-abdominal aorta, underwent graft replacement of thoraco-abdominal aorta concomitant with reconstruction of all visceral arteries. There were 8 patients who required reoperations for aneurysms at distal anastomotic sites after repairs of abdominal aortic aneurysms. Five patients underwent repairs of new aneurysms, including replacement of total arch in 3, descending aorta in 1 and iliac artery in 1. In all cases, no hospital death was noted, however, late deaths were occurred in vasculo-Behçet disease, Marfan syndrome and graft infection. Thus, late result depends on etiology of disease. Although patients who requires reoperation after repair of abdominal aortic aneurysms have higher operative risk factors, early and late results are satisfactory compared to initial operations.

Adult↗