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At least 649 records · Page 36Linked to original sources
PubMed1991

[Reoperation in failure of surgical treatment of sciatica].

39 patients have been reoperated on for failed lumbar discs. In this series enhanced MRI, enhanced CT scan and disco-CT have been used. These modern imaging means allowed a better assessment for the causes of failure; thus, only in 4 patients was a pure periradicular fibrosis disclosed. The results of reoperations are significantly better than those of a previous series of the same institution, where these imaging devices could not been used. 76% of the patients benefited from reoperation.

Adult↗
PubMed1991

[Reoperation of primary tissue failure of bioprosthesis in the mitral position].

The surgical results of 38 patients who underwent reoperation for primary tissue failure of bioprosthesis in the mitral position between May 1982 and June 1990 were analyzed to determine the risk factors affecting the hospital mortality. The type of bioprostheses requiring reoperation were Hancock valve in 21 patients, Liotta valve in 15 patients and Mitroflow valve in 2 patients. Twenty-five preoperative and perioperative variables were collected and analyzed by univariate statistics using chi 2 test or Student's test. Four of thirty eight patients died postoperatively in the hospital, yielding an overall mortality of 10.5%. The causes of hospital mortality were low output syndrome in 2 patients and multiple organ failure in 2 patients. By univariate analysis, male, NYHA IV class, prosthetic stenosis, hepatic failure, renal failure, and pulmonary failure were risk factors predictive of high hospital mortality. In spite of recent improvement of surgical technique and myocardial protection, the hospital mortality of patients with NYHA IV class and advanced organ failure still remains unacceptable. Therefore, it is essential to perform reoperation for primary tissue failure of bioprosthesis before severe myocardial decompensation occurs. To accomplish this goal, patients with bioprosthesis who survived beyond the certain time should be followed periodically using echocardiogram.

Adult↗
PubMed1990

[Reoperations in the management of clubfoot].

The results of 118 operations for club-foot are assessed, of these 57 were reoperations. It is stated that the relapse is most often the consequence of the insufficient primary operation and the relapse and the residual deformity are the more serious the more insufficient was the primary operation. The severity of the deformation is defined first of all by the position of the calcaneus. In milder cases the soft tissue operation only may be successful, in the more severe cases bony operation (Evans' operation in this series of the authors) has also to be performed. After their own primary operations reoperation was in 24 per cent necessary. The number of the bony operations was half of the soft tissue operations. The second and rarer case of the relapses was that the foot proved to be even originally rigid, not redressable, "rebel". First of all in these cases may multiple reoperations be necessary and the transposition of the anterior tibial muscle is also useful. The club-foot with a major dominant adduction deformity of the tarsometatarsal joint is thought to be a separate entity and it is corrected with tarsometatarsal capsulotomies or serial metatarsal osteotomies.

Clubfoot↗
PubMed1990

[Reoperations in bradyarrhythmic forms of disorders of heart conductivity].

Under analysis were causes of reoperations in bradyarrhythmic forms of disturbances of conductivity of the heart. 565 operations connected with electrocardiostimulation were performed on 276 patients. Reoperations in patients with the myocardial stimulation were made on 63 patients, with the endocardial stimulation--in 226 patients. Causes of reoperations were as follows: depletion of the source of ECS--31.5%; dislocation of the electrode--8.2%; damage of the electrode--15%, suppuration of the bed, decubitus of the stimulator--28.8%; competing rate--7.4%; break of the contact in the connecting system of the electrode and cardiostimulator--9.4%.

Bradycardia↗
PubMed1990

[Study on postoperative perforation in patients with chronic empyema--reoperated cases].

In 18 cases undergone reoperation because of perforation after the initial operation for primary and secondary chronic empyema during the period from 1974 through August 1986, we evaluated findings of fistula, procedures and causes of failure of the initial operation, and procedures and results of reoperation. Subjects consisted of 16 cases of chronic empyema complicated with pulmonary tuberculosis, 1 case of group III nontuberculous mycobacteriosis, and 1 case of chronic empyema secondary to pulmonary fibrosis. All patients had fistula at the initial operation. The initial operation was performed by Kinchu method in 8 cases, pulmonary detachment in 6 cases, and thoracic cavity reduction chiefly by a modification of Grow's method in 4 cases. The initial operation failed because of incomplete closure of the fistula in 11 cases (61%) and appearance of new fistula in 7 cases (39%). In reoperation, the fistula was closed by pedicle muscle plombage in 1 case undergone the initial operation by Kinchu method, while thoracic cavity reduction chiefly by a modification of Grow's method in all of the other 17 cases. After the operation, 15 patients (83%) were cured, 16 patients (89%) could be socially rehabilitated and 2 patients (11%) had recurrence of empyema. Two recurrent patients died from hepatitis and exacerbation of nontuberculous mycobacteriosis, respectively. Out of 10 patients undergone pedicle muscle plombage, 8 patients (80%) were cured. From these findings, we consider that the results of one stage operation can be improved by applying pedicle muscle plombage for closure of fistula after the initial operation following treatment with effective antibiotics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Reoperation of tetralogy of Fallot long after correction with aortic homograft: a case report].

Late results in the surgery for congenital heart disease repaired with external conduit have not yet been fully elucidated. We experienced a reoperation of tetralogy of Fallot (TF) that was previously repaired with an aortic homograft pretreated with beta-propiolactone for the reconstruction of right ventricular outflow tract. Ten years after correction of TF, right ventricular failure developed due to the regurgitation of tricuspid valve. At reoperation tricuspid annuloplasty was performed, and the valve of aortic homograft was also replaced with xenograft because of its uncertain durability. However, the resected valve had pliability with least degenerative change macroscopically. The postoperative course was smooth. The case was a rare one of late reoperation of TF due to the tricuspid valve regurgitation, and the case also indicated unexpected long durability of the valve cusp of the aortic homograft.

Adult↗
PubMed1989

[Improving continence by reoperation].

Between 1969 and 1988, 191 children underwent operations for anorectal anomalies in the Pediatric Surgical Department of Mainz University Hospital. Ninety-six had deep and 84 had intermediate or high malformations; the type was unknown in 11. Of these patients 53 had impaired continence and 8 still have a protective colostoma. 37 of the remaining 45 children had check-ups and reoperations (5 were deep types). After reoperation there was full continence in 14 patients, partial continence in 11, persisting incontinence in 11 and one case could not be assessed. Our results recommend reoperation using modern surgical methods of patients with continence.

Anus, Imperforate↗
PubMed1988

Prospective analysis of intraoperative and postoperative urinary cyclic adenosine 3',5'-monophosphate levels to predict outcome of patients undergoing reoperations for primary hyperparathyroidism.

Twenty-five consecutive patients with either persistent or recurrent symptomatic primary hyperparathyroidism after 36 prior operations were prospectively studied to compare the usefulness of intraoperative measurement of urinary cyclic adenosine monophosphate (UcAMP) levels with standard surgical procedures to predict outcome during tedious parathyroid reoperations. The criterion based on UcAMP to predict successful outcome was a 50% decline in intraoperative UcAMP levels from the median baseline level after removal of abnormal parathyroid tissue. Standard surgical criteria were resection of four abnormal glands for hyperplasia and resection of one abnormal gland and biopsy examination of one normal gland for adenoma. In 15 patients (60%) surgery was terminated on the basis of UcAMP criterion. In one patient elevated UcAMP levels never changed and correctly predicted unsuccessful surgery. In nine patients surgery was terminated on the basis of surgical criteria, and each of these patients had a successful outcome. Operative UcAMP levels dropped after the completion of the procedure in six of these latter nine patients. Three patients did not show a significant decrease in UcAMP levels despite successful surgery, and one patient displayed an early false-positive decrease in UcAMP level. The intraoperative UcAMP criterion accurately predicted outcome in 21 of 25 patients (84%). Sensitivity of the UcAMP criterion was 87% and specificity was 50%. The results indicate that by either method a reliable prediction of the outcome of reoperative parathyroid surgery may be made. Intraoperative determination of UcAMP levels will allow successful termination of the reoperation in some patients before operative identification of adequate parathyroid tissue necessary to confidently establish the pathologic diagnosis.

Cyclic AMP↗
PubMed1988

Recent results of reoperative surgery in medullary carcinoma of the thyroid.

Reoperative surgery of medullary carcinoma of the thyroid can be avoided by meticulous primary surgery. Reoperative surgery can succeed even if the tumour and its metastases are bilateral, as is often the case in hereditary cases. Even patients with numerous macroscopic metastases can show normaligation of their calcitonin (CT) levels in response to reoperative surgery. Patients with normal postoperative CT values after the combined short time Ca++ and pentagastrin test continued to show normal results when followed up for up to eight years.

Calcitonin↗
PubMed1988

[Reoperations in persistent and recurrent secondary hyperparathyroidism].

Among 181 patients who had been surgically treated in the Department of Surgery, Mainz University, for secondary hyperparathyroidism between 1975 and 1986, 33 had to be reoperated because of persistent or recurrent disease or because of failing autotransplanted tissue after total parathyroidectomy and autotransplantation. In 17 patients 26 reoperations had to be performed in the neck; in 9 patients, 3 of whom are already included in the group mentioned before, autotransplanted tissue had to be reduced eleven times. In another 10 patients autologous, cryopreserved tissue was replanted. 15 of the 17 patients reoperated in the neck became normocalcaemic, postoperatively, as well as 7 out of 9 patients in whom the autotransplanted tissue had been partially taken off. The results with replantation of cryopreserved tissue are being published in a separate article in this volume.

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed1987

Fifteen hundred coronary reoperations. Results and determinants of early and late survival.

Fifteen hundred consecutive patients undergoing a first reoperation for coronary revascularization were reviewed to determine early and late results and predictors of survival. Patients were subdivided into cohorts on the basis of the year of reoperation: Group A (1967 to 1978, 436 patients); Group B (1979 to 1981, 439 patients); and Group C (1982 to 1984, 625 patients). Overall operative mortality was 3.4% (51 deaths): 4.6%, 2.3%, and 3.4% for Groups A, B, and C, respectively. Group C had significantly more women (p = 0.01) and patients with triple-vessel disease, left main coronary artery stenosis (greater than or equal to 50%), abnormal left ventricular function, age greater than or equal to 70 years, and graft failure as a surgical indication (all p less than 0.001). The mean interval between operations increased from 50 months for Group A to 84 months for Group C. At reoperation, Group C patients received more grafts, more internal mammary artery grafts, and had a higher prevalence of complete revascularization (all p less than 0.001). Univariate and multivariate analyses identified left main stenosis (p less than 0.0001), Class III or IV symptoms (p = 0.0002), advanced age (p = 0.0006), Group A (p = 0.02), and incomplete revascularization (p = 0.004) as predictors of increased in-hospital mortality. Follow-up of in-hospital survivors (mean interval 54 months, range 13 to 171 months) documented a 5 year survival rate of 90% and a 10 year survival rate of 75%. Multivariate testing identified advanced age (p less than 0.0001), hypertension (p less than 0.0001), and abnormal left ventricular function (p less than 0.0001) as predictors of decreased late survival.

Aged↗
PubMed1986

Reoperations in esotropia surgery.

A retrospective review of the surgical records of 190 consecutive esotropia patients, with regard to the incidence of reoperation, is presented. More than one surgical procedure was required in 36% of the congenital esotropia patients followed for at least six months and in 52% of the congenital esotropia patients followed for a minimum of two years. Reoperation occurred in 9% of the partially accommodative esotropia patients and in 17% of the nonaccommodative esotropia patients. A decreasing incidence of reoperation is noted in more recent years.

Accommodation, Ocular↗
PubMed1986

Thoracic aorta as source of inflow in reoperation for occluded aortoiliac reconstruction.

We reviewed our experience with reoperations for recurrent obstruction occurring after aortoiliac or aortofemoral reconstruction. Patients who underwent successful transfemoral thrombectomy of the aortofemoral graft or femorofemoral crossover graft were excluded from the study. A more proximal source of inflow to revascularize the ischemic limbs was required in the remaining 35 patients. Bilateral reconstruction was performed in 22 patients. Operative indication was rest pain or necrosis in 36 limbs and severe claudication in 21 limbs. Preoperative ankle/brachial pressure index (API) ranged from 0.05 to 0.61. Thirteen patients (21 limbs, group I) underwent transabdominal reoperation. Since the transabdominal approach was considered hazardous because of multiple previous operations, the remaining patients underwent retroperitoneal descending thoracic aorta-femoral artery bypass (15 patients, 25 limbs; group II) or axillofemoral bypass graft (7 patients, 11 limbs; group III). No statistically significant difference was present between the three groups in regard to the operative indication, API, and angiographically determined outflow (analysis of variance, p greater than 0.2). Axillofemoral bypass was preferred in patients with severe chronic pulmonary disease. Postoperative deaths (2 of 35 patients) and morbidity (6 of 35 patients) had a similar incidence in the three groups (p greater than 0.2). Follow-up ranged from 3 to 120 months (mean 37 months). The 5-year actuarial patency rate was 80.5% for group I and 80.2% for group II. In group III it was statistically lower (32.9%, p less than 0.05). Serial measurement showed a significant decrease of API in group III compared with group I and group II. We conclude that retroperitoneal descending thoracic aorta-femoral artery bypass is a valid alternative to transabdominal reoperation when exposure or availability of the abdominal aorta poses a specific hazard and is preferable to axillofemoral bypass in terms of long-term patency and hemodynamic results.

Adult↗
PubMed1984

[Reoperations after surgical correction of tetralogy of Fallot].

Between 1970 and 1981, 40 patients (6%) were reoperated after surgical correction of Fallot's tetralogy. The average age of these patients was 7,5 years (range 2 months to 37 years). The usual anatomical form was present in 30 cases and severe forms accounted for the other 10 cases (pulmonary atresia with septal defect were excluded). The 40 patients were divided into 3 groups according to the anatomical lesions corrected at reoperation: Group I: 16 patients with a residual isolated VSD; Group II: 14 patients with one or two residual right heart anomalies (RRHA) but without a septal defect; Group III: 10 patients with a residual VSD and RRHA. The only clinical difference between the patients of these 3 groups was the delay of onset of symptoms: the patients with residual VSD (Groups I and III) often developed cardiac failure immediately, whilst in those without residual VSD (Group II) cardiac failure was usually observed secondarily. Four patients (10%) died early after reoperation (less than 1 month). Three others died later, two during a third operation. The total mortality was similar in the three groups. The surgical result was assessed clinically after an average follow-up of 4,5 +/- 3 years: patients with a residual isolated VSD (Group I) had the best long-term results. In 12 patients, M mode and 2D echocardiography showed normal left ventricular function but the ratio of end diastolic right ventricular and left ventricular dimensions was increased to an average of 0,72 +/- 0,2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Reoperation for obstructed pulmonary ventricle-pulmonary artery conduits. Early and late results.

Obstruction of pulmonary ventricle-pulmonary artery conduits can result from neointimal peel formation or valvular degeneration and calcification. To determine the risks and outcome of reoperation, we reviewed the records of 100 consecutive patients who had replacement of severely stenotic pulmonary ventricle-pulmonary artery conduits. At reoperation, the 70 male and 30 female patients had a mean age of 13.3 +/- 4.8 years. During operation, 37 homografts, 62 Dacron grafts with integral xenograft valves, and one nonvalved conduit were replaced with valved (80) or nonvalved (17) prostheses. The mean transconduit pressure gradient decreased from 81 +/- 26 mm Hg preoperatively to 7 +/- 8 mm Hg postoperatively (p less than 0.01). Concomitant cardiac valve replacement was performed in seven patients, and residual ventricular septal defect closure was accomplished in 28. Operative mortality (less than 30 days) was 7%, but there were no deaths among the 47 patients who had no associated defects. At 3 and 5 years postoperatively, probability of survival among patients dismissed from the hospital was 94% +/- 3% and 86% +/- 6%, respectively. In our experience, risk of reoperation for conduit obstruction alone is low, so that the effect of graft failure on overall survival is minimized.

Adolescent↗
PubMed1983

The morbidity and mortality of reoperation for coronary artery disease and analysis of late results with use of actuarial estimate of event-free interval.

To determine late survival and functional status after second revascularization procedures for coronary artery disease, we studied 106 consecutive patients operated on between June, 1969, and December, 1980. The mean age of the 96 men and 10 women was 49 +/- 8 years (range 22 to 65 years). Before reoperation, 101 patients (95%) were judged to be in New York Heart Association Class III or IV with angina, and 81 patients (76%) had three-vessel involvement. Angina recurrence was most commonly caused by bypass graft occlusion alone and in combination with progressive disease of the native arteries (60 patients, 57%). Three patients (2.8%) died within 30 days of reoperation; each death resulted from myocardial infarction. An average of 2.2 coronary arteries were bypassed in each patient. Complete follow-up data (mean 43 months) were available for 105 patients. Actuarial survival of patients dismissed alive is 94% at 5 years and 89% at 7 years. All late cardiac-related deaths occurred in patients with three-vessel disease. When recurrence of any angina, need for a third operation, and myocardial infarction are included with cardiac-related deaths, event-free survival is 28% at 5 years and 26% at 7 years. Late survival and functional status could not be predicted by the cause of recurrent angina or the presence of risk factors. Repeat myocardial revascularization can apparently be undertaken with low risk and with prospects for excellent long-term survival. After reoperation, recurrence of mild angina is not uncommon, but freedom from serious cardiac events and relief of severe symptoms were noted in more than 60% of patients 5 years later.

Actuarial Analysis↗
PubMed1984

Reoperation in patients with patent atherosclerotic coronary vein grafts. A different approach to a different disease.

Atherosclerotic changes are often noted in vein grafts at angiography 8 to 10 years after coronary artery grafting. Reoperation in these patients is hazardous, as manipulation of the grafts may loosen atheromatous debris and cause coronary embolization and myocardial infarction. A technique is described to avoid embolization of atheromatous material during reoperation in patients with patent atherosclerotic coronary vein grafts. This technique was carried out in six patients and compared to the standard technique of reoperation in similar patients. The incidence of complicated perioperative myocardial infarction (0/6 versus 5/12) and perioperative death (zero versus three) was lower when our new technique was used. This approach consists of minimal dissection for access to the right atrium and ascending aorta for cannulation, prompt ligation of all patent grafts at the start of cardiopulmonary bypass, cardioplegic infusion through the ascending aorta and subsequently also through newly inserted grafts using larger infusions until myocardial temperatures reach less than or equal to 15 degrees C, and single aortic clamping for distal and proximal anastomoses.

Aged↗
PubMedDate not supplied

Reoperation for recurrent peptic ulcer.

The authors consider 74 patients who have undergone reoperation for recurrent peptic ulceration in their hospital, between 1971 and 1980. Recurrences followed gastrectomy (39 cases), vagotomy (33 cases) and gastroenteroanastomosis (GEA) (2 cases). The reoperations were: vagotomy or revagotomy; gastric resection or reresection; vagotomy combined with resection. Assessment of results was based on Visick clinical grading: 24 patients remained in Visick grade III and IV. Failure was due to a second recurrence in nine patients, who therefore underwent further operations, but two patients remained in Visick grade III and there was one operative death. The authors conclude that most patients end with both a vagotomy and a gastric resection and that the final postoperative results remain fairly poor in some cases. In attempting to cure recurrent ulcers most surgeons stress that reoperation is the treatment of choice, but all the surgical procedures are potentially difficult and therefore potentially dangerous. Nowadays, the results of medical management (cimetidine) seem satisfactory, but we must still fully evaluate the side-effects of the long-term maintenance treatment.

Adult↗