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At least 595 records · Page 33Linked to original sources
PubMed1997

Endometrial resection and late reoperation in the treatment of menorrhagia.

STUDY OBJECTIVE: To evaluate the effectiveness of transcervical resection of the endometrium and indications for late reoperation. DESIGN: Retrospective study. SETTING: Central hospital in northern Norway. PATIENTS: Two hundred fifty women (age 30-59 yrs) with dysfunctional bleeding. INTERVENTIONS: Hysteroscopic transcervical resection of the endometrium. MEASUREMENTS AND MAIN RESULTS: Success as measured by patient satisfaction at 3-month follow-up was 97% and at 4 to 48 months was 91.6%. Mean observation time was 24 months. Twenty-one women required further surgery. Repeat resection was performed in eight women (3.2%), of whom 95% were satisfied. Thirteen women (5.2%) had a hysterectomy. Late reoperation was performed in 7 patients (2.8%) due to recurrent unacceptable vaginal bleeding and in 14 (5.6%) due to late onset of pain. CONCLUSION: After endometrial resection, a definite subgroup (8.4%) of women developed late onset of pain or bleeding requiring reoperation.

Adult↗
PubMed2003

Parathyroid hormone venous sampling prior to reoperation for primary hyperparathyroidism.

BACKGROUND: The surgical cure rate for primary hyperparathyroidismis greater than 95%. For those who have recurrent or persistent disease, preoperative localization improves reoperation success rates. Selective parathyroid venous sampling (SPVS) for intact parathyroid hormone is particularly useful when non-invasive localization techniques are negative or inconclusive. METHODS: We present all known cases (n = 13)between 1994 and 2002 who had venous sampling for localization a tour institution prior to reoperation for recurrent or persistent primary hyperparathyroidism. Comparison was made with non-invasive localization procedures. Results of invasive and non-invasive localization were correlated with surgical findings. RESULTS: Of the nine reoperated cases, eight had positive correlations between SPVS and operative findings and histopathology. SPVS did not reveal the parathyroid hormone source in one case with negative non-invasive localization procedures. Comparisons between SPVS,computerized tomography (CT), and parathyroid scintigraphy (MIBI)as expressed in terms of true positive (TP), false positive (FP)and false negative (FN) were: SPVS - TP88.8%, FP 0%, FN 11.1%; CT - TP22.2%, FP 22.2%, FN 55.5%; and MIBI - TP33.3%, FP 0%, FN 66.6%. At least seven of the nine operated cases have been cured; another remained normocalcaemic 2 weeks after subtotal parathyroidectomy. CONCLUSION: In our institution SPVS has proven to be a valuable tool in cases with recurrent or persistent primary hyperparathyroidism and negative non-invasive localization procedures.

Adult↗
PubMed2002

Tubularized incised-plate urethroplasty for hypospadias reoperation.

OBJECTIVE: To review our preliminary results of tubularized incised-plate (TIP) urethroplasty for reoperative hypospadias repair. PATIENTS AND METHODS: The study comprised 15 patients, of whom eight had undergone a previous repair by techniques that included incision into the midline of the urethral plate, while in the remaining seven the midline of the plate had been left undisturbed. The meatus at reoperation was subcoronal or on the distal shaft in all but one boy, who had a midshaft hypospadias. All had previously undergone one attempt at hypospadias repair, except for one patient presenting after two failed 'meatal advancement and glanuloplasty incorporated' procedures. The TIP repair was undertaken as described for primary surgery, except that the dorsal dartos flaps for interposition between the neourethra and skin closure were available less often. RESULTS: TIP resulted in a functional neourethra and a cosmetically normal meatus in 13 of the 15 patients. One boy healed with a slightly rounded meatus and the other had wound dehiscence; fistulae developed in another two boys, giving three patients with complications. The fistulae occurred in boys whose original surgery did not include urethral plate incision, while the dehiscence was in a patient with partial excision of the plate during previous tubularized preputial flap repair. CONCLUSIONS: TIP urethroplasty can potentially be used for hypospadias reoperation. Previous incision of the urethral plate was not a contraindication in these selected cases in which the plate appeared supple. However, TIP repair should be avoided in repeat hypospadias surgery if the plate has been resected or is obviously scarred.

Adolescent↗
PubMed2000

Reoperation results of arterial involvement in Behçet's disease.

OBJECTIVES: to retrospectively evaluate the role of vascular interventions in Behçet's disease with arterial involvement. So far, little information is available on the surgical approach for arterial involvement in Behçet's disease. MATERIAL AND METHODS: between February 1989 and August 1997, among 178 patients with Behçet's disease referred to our clinic, vascular involvement was established in total of 67 patients (38%) which consisted of 59 venous (33%) and 12 (7%) arterial involvements requiring urgent surgical intervention. Primary arterial lesions were occlusive in one patient, aneurysm formation in nine or both in four. RESULTS: twelve primary operations and 12 reoperations were performed. The reasons for reoperations were anastomotic aneurysms, graft occlusion, occlusion of native vessel, graft infection, bleeding from anastomosis and aortoenteric fistula. First reoperation was performed after a mean period of 6.4 months (1-15 months). Postoperative follow-up was 12-60 months (mean 36 months) and three patients died during follow-up. CONCLUSIONS: the surgical results were not satisfactory because of progressive graft thrombosis and formation of new aneurysms at the anastomosis. Aggressive medical treatment should be combined when major vessel involvement occurs. All types of arterial punctures for angiography or blood gases should be minimised because of the risk of new aneurysm formation. Surgical intervention is indicated only in patients with a growing aneurysm, acute rupture or severe ischaemia.

Adolescent↗
PubMed2004

[Frequency of reoperations after amniotic membrane transplantation].

BACKGROUND: Retrospective evaluation of the frequency of reoperations after amniotic membrane transplantation for different pathologic entities. MATERIAL AND METHODS: We included 81 cases of amniotic membrane transplantation (AMT), which were operated on at the university eye clinic Tübingen since 1997 and which had been followed up for at least 12 months. Patient diagnoses were subdivided as follows: conjunctival defects after tumour excision (N = 2), bullous keratopathy (N = 5), external fistula after glaucoma filtering surgery (N = 3), recurrent pterygium (N = 5), symblepharon (N = 6), corneal ulcer with descemetocele (N = 3), non-perforated corneal ulcer (N = 51), perforated corneal ulcer (N = 1), other (n = 5). RESULTS: The overall reoperation rate was determined to be 42 % after a follow-up period of one year. Most frequently, a second AMT (N = 16) and a perforating keratoplasty (N = 16) were performed after the initial AMT. The following reoperation rates were determined for the subgroups: Conjunctival defects after tumour excision (0 %), Bullous keratopathy (60 %), External fistula after glaucoma filtering surgery (67 %), Recurrent pterygium (60 %), Symblepharon (67 %), Corneal ulcer with descemetocele (67 %), Non-perforated corneal ulcer (49 %), Perforated corneal ulcer (100 %). CONCLUSIONS: Particularly in patients with conjunctival defects after tumour excision and with non-perforated corneal ulcers, stabilisation of the ocular surface homeostasis can be achieved with a single amniotic membrane transplantation for at least one year.

Biological Dressings↗
PubMed2006

[Reoperations after LASIK].

BACKGROUND: Repeat operations after refractive surgery have increased in frequency during the past 10 years. The spectrum of the indications for repeat LASIK may have changed. METHODS: All cases of repeat operations after refractive surgery performed between May 1, 2004 and April 30, 2005 at the Institute of Refractive and Ophthalmic Surgery (IROC) were retrospectively investigated regarding indication for repeat surgery and visual and refractive results. The 1-month results were used to estimate the refractive and visual success rate. RESULTS: Of the 76 reoperations, 69 were performed as re-lifts, 3 eyes had new lamellae cut, and 3 cases needed keratoplasties. The reoperations took place 7.5 +/- 13 months after the primary operation (range 0.5 to 60 months). The most frequent indication was residual astigmatism of 0.5 D and more. Visual loss of more than 1 decimal line did not occur and unaided visual acuity increased from 0.64 to 1.05. No complications were reported, however, 3 eyes needed additional enhancement. CONCLUSIONS: Reoperations after LASIK performed as re-lifts appear to be effective and reasonably safe when using the technique described and respecting a residual stromal thickness of 280 microns.

Comorbidity↗
PubMed1988

The benefit patients derive from aortocoronary reoperation.

There is an increasing incidence of aorto coronary reoperation necessitated by intractable angina which averages 2% of 4676 initial bypass procedures. Graft obliteration, graft stenosis or progression of disease led to recurrence of symptoms in 96 patients (84 male, 12 female) who underwent a second operation. Not all occluded or stenotic bypasses were feasible for reoperation. Hospital mortality (30 days) was higher than after initial CABG, but could be reduced from 12.1% to 4.8%. Subjective and objective follow-up investigations were obtained in 77 of 84 survivors and demonstrate that successful reoperation is about 10% lower in patients with a malignant form of atherosclerosis (60%) than in patients who only suffer from occluded grafts or new proximal significant stenoses in previously unbypassed vessels (70%).

Adult↗
PubMed2000

Two-muscle surgery for congenital esotropia: rate of reoperation in patients with small versus large angles of deviation.

INTRODUCTION: Standard surgical treatment of congenital esotropia (CET) in patients with preoperative angles of deviation measuring </=50 PD is well defined. However, there is controversy over the management of larger angles of esotropia. Some surgeons prefer to operate on 3 or 4 horizontal rectus muscles, while others prefer to perform large recessions of the medial rectus muscles alone. The purpose of this study was to compare the rate of reoperation after bilateral medial rectus muscle recession of smaller angle (< or =50 PD) CET with the rate of reoperation after surgery for larger angle (>50 PD) CET. METHODS: Medical records of 102 patients who underwent bilateral medial rectus muscle recessions between January 1991 and December 1997 were reviewed. Patients were excluded if neurologic abnormalities or developmental delays were documented before the operation, if major structural abnormalities of the eye were present, or if less than 1-month follow-up after surgery was documented. The remaining 56 patients were assigned to either the larger angle (>50 PD) or smaller angle (< or =50 PD) group, based on the magnitude of their preoperative esotropia. Rates of reoperation for residual CET, for consecutive exotropia or dissociated horizontal deviation, or for dissociated vertical deviation with or without oblique muscle dysfunction were determined for each group. RESULTS: Forty of 56 patients (71%) were assigned to the smaller angle group and 16 of 56 patients (29%) to the larger angle group. In the larger angle group, 4 patients (25%) underwent surgery for residual esotropia. In the smaller angle group, 8 patients (19%) underwent surgery for residual esotropia, 8 (19%) underwent surgery for consecutive exotropia or dissociated horizontal deviation, and 8 (19%) underwent surgery for dissociated vertical deviation or oblique muscle dysfunction. CONCLUSION: The success rate for ocular realignment in patients with CET by using bilateral medial rectus muscle recession did not appear to diminish when applied to deviations greater than 50 PD as compared with smaller angle deviations. Surgery on 3 or 4 horizontal rectus muscles may be unnecessary in the treatment of patients with very large angles of CET.

Esotropia↗
PubMed2001

Early reoperation after vertical rectus muscle surgery.

PURPOSE: Adjustable suture strabismus surgery has a success rate between 90% and 94%. In some patients, undesirable deviations are noted in the first week after surgery. In this article, we describe a method of reoperation in the first week of the initial repair in an outpatient clinical setting. METHODS: A retrospective review of clinical records from 1990 to 1998 identified 7 patients who underwent reoperation of the original surgical procedure in a clinic setting. All patients had vertical deviations that were overcorrected and had a reversal of their diplopia. RESULTS: Follow-up ranged from 3 months to 59 months. All patients were free of diplopia and were either orthophoric or had small phoric deviations. CONCLUSIONS: Proper identification of patients with strabismus as a result of overcorrected adjustable sutures and prompt reoperation in the first week after surgery are possible and prevent the need for repeat anesthesia in the operating suite.

Adolescent↗
PubMed2000

Sestamibi/iodine subtraction single photon emission computed tomography in reoperative secondary hyperparathyroidism.

BACKGROUND: Sestamibi/iodine subtraction single photon emission computed tomography (SPECT) has been used successfully for the preoperative localization of adenomatous and hyperplastic parathyroid tissue in primary hyperparathyroidism, but the clinical usefulness of this technique in secondary hyperparathyroidism remains uncertain. The purpose of this study was to evaluate parathyroid localization that uses sestamibi/iodine subtraction SPECT in patients with secondary hyperparathyroidism before reoperative parathyroid surgery. METHODS: Fourteen consecutive patients with chronic renal failure and secondary hyperparathyroidism who had previously undergone total parathyroidectomy combined with parathyroid autotransplantation in a sternocleidomastoid muscle were studied. Before reoperation, each patient received 400 microCi of sodium iodide I 123 orally and 20 to 25 mCi of technetium Tc 99m ((99m)Tc)-sestamibi intravenously, followed by sestamibi/iodine subtraction SPECT of the neck and chest. At surgery, the location, weight, and histopathologic results of all identified parathyroid tissue were recorded. RESULTS: At surgery, 1 hyperplastic parathyroid gland was resected from each of 13 patients; including 1 undescended gland, 6 parathyroid autotransplants, and 5 mediastinal glands. The mean weight of the resected parathyroid glands was 1707 mg (range, 85-5300 mg). Sestamibi/iodine subtraction SPECT correctly identified and localized all 13 parathyroid glands (100% sensitivity) and was negative in the 1 patient whose surgery was unsuccessful. CONCLUSIONS: The (99m)Tc-sestamibi/(123)I subtraction SPECT is able to correctly localize hyperplastic parathyroid tissue in patients with secondary hyperparathyroidism who have previously undergone parathyroid surgery and is a clinically useful study before reoperation.

Adult↗
PubMed2000

Ultrasound and sestamibi scan as the only preoperative imaging tests in reoperation for parathyroid adenomas.

BACKGROUND: In an effort to determine an efficient algorithm for the evaluation of patients with parathyroid adenomas in the reoperative setting, we explored the combination of using ultrasound scans (US) and sestamibi scintigraphy as the only preoperative imaging tests. METHODS: We analyzed the outcomes of 62 consecutive patients who were treated between January 1995 and May 1999 and who were referred for persistent primary hyperparathyroidism after initial surgical exploration, at which time no abnormal parathyroid glands had been found. Although all patients underwent US, computed tomography scan, magnetic resonance imaging, and sestamibi scan, we analyzed the success of localization and reoperation using only the results of US and sestamibi scan. RESULTS: Sixty-one patients (98%) underwent curative reoperations. The sensitivity, positive predictive value, and accuracy for US were 90%, 86%, and 84%, respectively; the corresponding values for sestamibi imaging were 78%, 94%, and 74%, respectively. In 58 of 62 cases (94%) preoperative US and/or sestamibi scan accurately identified the adenoma. In 3 patients for whom combined US and sestamibi scan were inaccurate, 1 adenoma was found by intraoperative US in the strap muscle; 1 adenoma was found by blind cervical thymectomy, and 1 adenoma was found by planned sternotomy that was based on computed tomography findings. CONCLUSIONS: This study supports an algorithm of obtaining US and sestamibi scan as the initial and perhaps only preoperative localization tests for patients with primary hyperparathyroidism after failed operation, at which time no abnormal glands had been found.

Adenoma↗
PubMed2002

Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism.

BACKGROUND: Patients undergoing reoperative parathyroidectomy may develop severe transient or permanent hypoparathyroidism. This study's purpose was to determine the utility of intraoperative parathyroid hormone (IO-PTH) values in predicting the development of severe hypocalcemia for patients undergoing reoperation for primary hyperparathyroidism. METHODS: Between March 1999 and October 2001, 68 patients with persistent or recurrent hyperparathyroidism underwent reoperation using IO-PTH measurements. The maximum percent decrease and lowest actual PTH value obtained at surgery were compared to determine any correlation with the development of postoperative hypocalcemia requiring supplementation. RESULTS: Of 68 patients, 25 required calcium and calcitriol postoperatively and 43 did not. There was a significant difference between the 2 groups with respect to lowest IO-PTH value (18.4 +/- 2.6 vs 28.0 +/- 3.9 pg/mL; P =.02), percent decrease in IO-PTH (89% +/- 1% vs 80% +/- 3%; P =.03), and lowest postoperative ionized calcium (1.06 +/- 0.01 vs 1.19 +/- 0.01 mmol/L; P <.001). A percent decrease in IO-PTH of 84% or greater was found to be predictive of patients experiencing hypocalcemia requiring supplementation with a positive predictive value of 46% and a negative predictive value of 82%. CONCLUSIONS: Although a maximum percent decrease in IO-PTH of 84% or greater was associated with an increased incidence of postoperative hypocalcemia requiring supplementation in the 68-patient cohort, on further analysis the association was significant only for patients with multiglandular disease and not those with single adenomas. This value may be useful for identifying patients who will need closer postoperative monitoring or prophylactic supplementation.

Adult↗
PubMed2001

Reoperative coronary bypass surgery: effect of patent grafts and retrograde cardioplegia.

OBJECTIVE: To determine the effects of patent or diseased aorta-coronary bypass grafts and retrograde cardioplegia on mortality during reoperative coronary bypass surgery. METHODS: We conducted a retrospective review of prospectively gathered data, supplemented by systematic chart review, of all patients (n = 744) undergoing reoperative coronary bypass surgery at our institution between 1990 and 1997. Independent predictors of survival were determined by stepwise logistic regression analysis. RESULTS: At least one patent or stenosed graft to the left anterior descending artery was present in 50% of patients, to the circumflex territory in 27% of patients, and to the right coronary artery territory in 33% of patients. The previous left anterior descending graft was a saphenous vein in 82% and a left internal thoracic artery in 18% of patients. In-hospital mortality occurred in 42 (5.6%) patients. Patent or diseased grafts of any coronary artery territory did not significantly increase the risk of mortality. Retrograde cardioplegia use increased in more recent years, was more frequent in patients with stenosed grafts, and was associated with improved survival. Independent predictors of mortality were as follows (with odds ratios and 95% confidence intervals in parentheses): failure to use retrograde cardioplegia (odds ratio 2.81; 1.28-6.20), New York Heart Association class (odds ratio 2.69; 1.25-5.81), peripheral vascular disease (odds ratio 2.60; 1.25-5.41), and left ventricular grade (2.07; 1.31-3.27). CONCLUSIONS: In this series, patent or stenosed grafts were not associated with an increased risk of mortality during reoperative coronary bypass surgery, possibly because of increased use of retrograde cardioplegia in this patient group. We strongly recommend the routine use of retrograde cardioplegia during redo coronary bypass surgery.

Coronary Artery Bypass↗
PubMed2001

Single-stage reoperative repair of chronic type A aortic dissection by means of the arch-first technique.

OBJECTIVE: Management of the enlarged, chronically dissected aorta after previous repair of acute aortic dissection or after a previous cardiac operation may present a formidable technical challenge. Marked enlargement of the proximal descending thoracic aorta precludes safe use of staged procedures, including the elephant trunk technique. METHODS: Sixteen patients with chronic type A aortic dissection (mean age, 56 years) underwent resection of the ascending aorta, the aortic arch, and varying segments of the descending thoracic aorta. We used single-stage replacement, with perfusion of the aortic arch first to minimize the duration of brain ischemia, with a bilateral anterior thoracotomy (clamshell) incision. Eleven patients had undergone previous repair of acute type A dissection. Five patients had type A dissection after aortic valve replacement (2 patients) and coronary artery bypass (3 patients). Marked enlargement of the aorta distal to the left subclavian artery precluded a 2-stage repair. The mean interval between the initial and reoperative procedures was 62 months (range, 5-137 months). RESULTS: There was 1 (6.2%; 70% confidence limits, 0.3%-24.7%) hospital death. Four patients required reoperation for bleeding. One patient required a right ventricular assist device that was successfully removed. Six patients required assisted ventilation for more than 72 hours, and 3 patients required a tracheostomy. All were successfully weaned from ventilatory support. No patient had a stroke or other adverse neurologic outcome. CONCLUSION: The single-stage, arch-first replacement technique is a safe and effective procedure for patients who require extensive reoperations for chronic expanding type A dissection.

Adult↗
PubMed2000

Reoperations after cochlear implantation.

During the 14-year history of cochlear implantation at Semmelweis University, 95 implantations were performed. There were 15 reoperations, and 2 patients had been operated 3 times. All of the reoperated patients received round window or intracochlear MedE1 devices. Successful reinsertion of the electrode was performed without significant difficulty, though in some cases osteoneogenesis was found in the round window or in the scala tympani. None of the patients suffered any inner ear abnormalities due to the first implant, and even the patient with a third implant in the same ear had excellent results and obtained better discrimination scores with the new device. In the authors' opinion, on the basis of the accumulated experience of nearly 100 implantations and 15 reoperations, replacement of the early generation extracochlear implants is most advisable and can be accomplished without adverse effects.

Cochlear Implantation↗
PubMed1988

Reoperations for persistent and recurrent secondary hyperparathyroidism.

Forty-nine reoperations for persistent or recurrent secondary hyperparathyroidism (HPT) in 30 patients are reported. The patients are part of a total of 184 patients operated on for secondary HPT; 28 reoperations in 18 patients were performed in the neck or in the upper mediastinum for remaining glands. Eleven reoperations at the forearm autograft revealed hyperplasia of the grafted tissue as the reason for recurrent disease in seven patients; they were treated by excision of all grossly enlarged particles. Ten patients received autologous cryopreserved tissue because of permanent postoperative hypoparathyroidism. The rate of graft-dependent recurrent HPT was 7%, and inadequate graft function was found in 6% of the patients.

Adolescent↗
PubMed1990

Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients.

We analyzed trends in clinical, angiographic, and operative variables and documented long-term survival in 2509 consecutive patients who underwent reoperation for myocardial revascularization at The Cleveland Clinic during a 20-year period (1967 to 1987). The patients were grouped into four cohorts by year of surgery. This analysis showed that vein graft atherosclerosis has become the leading indication for reoperation, and patient age and interval between operations continue to increase. Mortality rates ranged from 2% to 5% and, despite increasing comorbidity, more extensive coronary atherosclerosis, and worse left ventricular function, the hospital mortality rate was 2.9% from 1985 to 1987. Perioperative new Q-wave myocardial infarction occurred in 7% to 8% of patients from 1967 to 1984 but decreased to 4% in the 1985 to 1987 period (p = 0.04). Internal thoracic artery graft usage in reoperations increased from 27% in the 1967 to 1978 period to 67% in the 1985 to 1987 period. Advanced age and presence of left main coronary artery disease adversely influenced late survival more consistently than other factors. Patients operated on in 1967 to 1978 had fewer risk factors, which explains their higher survival rate compared with more recent cohorts. Factors associated with improved 10-year actuarial survival included age younger than 65 years, mild angina, no major comorbidity, no left main coronary artery disease, good left ventricular performance, and an internal thoracic artery graft.

Coronary Artery Disease↗
PubMed1995

Planned reoperation for severe trauma.

OBJECTIVE: The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma. SUMMARY BACKGROUND DATA: Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries. METHOD: The authors review the literature. RESULTS: Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization. CONCLUSION: Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients.

Abdominal Injuries↗