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At least 685 records · Page 38Linked to original sources
PubMed1993

[Reoperation in patients with thymoma].

For past seven years, reoperations were carried out for six patients with thymoma and myasthenia gravis (MG). Of six patients, five patients were suspected recurrent thymoma and remaining one patient was diagnosed as the residual thymus after thymothymectomy or thymomectomy. Myasthenia gravis has been progressing in five patients after initial operation except for one patient. Two cases of pleural dissemination tumors, one case of local recurrent thymoma and one case of the residual thymus were confirmed by surgery, remaining two patients had no recurrent tumor. As surgical procedure, median sternotomy using for reoperation has a great surgical risk, because left brachiocephalic vein closely adhered to the sternum is apt to be injured. Clinical symptoms of MG were improved in all the patients after reoperation regardless of recurrent tumor.

Adult↗
PubMed1995

[Early reoperation in chylothorax after thoracic surgery].

Chylothorax is a rare complication of thoracic surgery. The chyle leak can induce serious metabolic and immunological disorders. The ideal treatment of chylothorax has not been clearly established, and opinions are still divided between medical treatment and early or late surgical reoperation after prolonged medical treatment. Out of a total of 1.750 thoracic operations performed at the Centre Chirurgical du Val d'Or over the last 10 years, six cases of chylothorax were reoperated early, an average of five days after the initial operation. The chyle leak was easy to localize in every case. The second operation was performed via the same initial incision. All six patients has an uneventful postoperative course and only one case had a persistent chyle leak which gradually resolved. The mean total hospital stay was 18 days. No systemic infections or deaths were recorded. Early reoperation avoids the complications of prolonged medical treatment, is technically easy and decreases the length of hospital stay.

Adult↗
PubMed1996

Outcome of reoperative valve surgery via right thoracotomy.

BACKGROUND: The rate of patients being referred for mitral or tricuspid valve surgery after previous cardiac surgery is expected to increase. Reoperative median sternotomy has known risks, including injury to or embolism from prior grafts, sternal dehiscence, phrenic nerve injury, excessive hemorrhage, and inadvertent cardiac injury leading to morbidity and mortality. METHODS AND RESULTS: To avoid these problems, the right thoracotomy approach for reoperative mitral or tricuspid valve surgery was used in 62 patients from January 1990 to September 1995. Average patient age was 66 +/- 12 years. Previous operations included: coronary artery bypass graft, 31; mitral valve surgery, 26 (repair, 12, replacement, 14); and aortic valve surgery, 10. Patients were cannulated via the ascending aorta or common femoral artery with bicaval venous drainage. Systemic cooling and fibrillatory arrest were used. Operations performed included mitral valve repair in 27 patients; mitral valve replacement in 18; prosthetic mitral valve replacement in 14; repair of prosthetic mitral valve leak in 2; and tricuspid valve repair in 5. There was 1 intraoperative death and 4 other hospital deaths; 30-day hospital mortality was 6.4%. Complications were uncommon; only 1 patient required reexploration for bleeding. There have been 4 late deaths, and at a mean follow-up of 27 months (range, 1 to 69 months), survivors are in New York Heart Association class I or II. CONCLUSIONS: Right thoracotomy is a safe, feasible alternative to median sternotomy for selected reoperative mitral valve patients and should be considered whenever repeat sternotomy could prove hazardous.

Adult↗
PubMed1996

[Reoperations in Crohn's disease].

In the span of 23 years (1973-1995) 242 patients with Crohn's disease were operated on at the Department of Surgery in Hradec Králové. From this total number there were 146 (60.3%) men and 96 (39.7%) women. Eight patients (3.3%) died, in 4 cases (1.6%) carcinoma in Crohn's disease was found. Reoperations for recurrences were performed in 76 patients (31.4%), in 46 (60.5%) of them only 1 operation, in 18 (23.7%) 2 reoperations and in 12 patients (15.8%) 3 or more surgical treatments were necessary. Within the time interval mentioned above 124 different operations were done. Authors point out some factors that may affect the Crohn's disease recurrences, their influence was assessed even in the clinical set. A higher risk of recurrences and reoperations were found in women, patients younger than than 20 years, people with a short history prior to primary operation, in distal parts of intestine (ileum, rectum) localizations, in multiple gut involvement, after improper surgical performance, in cases of aggressive forms of disease and from other reasons (medicamentous post-operative treatment, immunological factors etc.). (Tab. 11, Fig. 1, Ref. 22.)

Adolescent↗
PubMed1997

[Results of reoperations for goiter].

We report 47 reoperations for benign thyroid goiters between February 1994 and October 1995 out of a total of 1125 thyroidectomies. These operations concerned 42 women and 5 men with an average age of 54 years. The mean time between the 2 operations was 19 years. On 45 occasions, the reoperation included a totalisation of the previous partial thyroidectomy. In 2 cases a near total thyroidectomy was performed leaving a minimal thyroid remnent on one side. The mean weight of the resected gland was 73 grs. The morbidity included 2 temporary recurrent laryngeal nerve palsies resolving within 2 months and 7 cases of temporary hypocalcemia without permanent hypocalcemia. In the case of repeated surgery, the risks of recurrent laryngeal nerve damage and parathyroid gland resection are typically increased. The risk varies according to the initial surgical resection: unilateral lobectomy versus bilateral subtotal lobectomy. Surgical risks can be significantly decreased with a safe surgical technique. Indications for reoperations in case of benign thyroid goiter are rare and can probably still be reduced. Treatment with thyroxin is sometimes ineffective and is questionable after sub total thyroidectomy for nodular goiter. A primary total thyroidectomy can be indicated in such selected cases.

Female↗
PubMed1994

[Reoperation after surgical repair of atrioventricular canal defect].

Among 114 survivors who underwent total repair of atrioventricular canal defect between 1981 and 1993, 19 patients underwent reoperation for the occurrence and progression of mitral valve insufficiency (18 patients), thrombosed prosthetic valve (1 patient), and subaortic stenosis (4 patients) on one or two occasions after operation. There were 7 males and 12 females with ages at reoperation ranging from 3 months to 13.8 years (mean, 3.8 years), and was no operative but one late death. At reoperation, reparative procedures involving the readjustment of previously repaired mitral cleft and annuloplasty were successfully achieved in 6 patients who had no additional abnormalities of subvalvar apparatus. Twelve patients, who were associated with additional valvar and subvalvar lesions, needed a prosthetic valve replacement. We emphasized that surgical technique based on precise knowledge of each individual mitral and submitral anatomy is indispensable to achieve good surgical results. When the anatomy involves submitral abnormalities, careful postoperative follow-up should be recommended to take measures of the progression of mitral valve regurgitation.

Adolescent↗
PubMed1994

[Reoperations on valvular disease: an analysis of outcome].

To evaluate risks and complications of reoperation on valvular disease, we reviewed data on 186 patients who underwent reoperations because of prosthetic valve malfunctions, pregression of valvular disease after open mitral commissulotomy and previous valvular replacement. Overall hospital mortality was 4.8% (9/186 patients). The common causes of death was low cardiac output syndrome (3 pts.) and respiratory failure (3 pts.) and others (3 pts). Hospital mortality was different according to the risk factors. There was no significant difference between the operative procedures; AVR (6.2%), MVR (3.2%), DVR (8%), TVR (0%) and MVR + TVR (9%). Furthermore, advanced age, valve position, renal failure, preoperative %FS, LVDd and diagnosis of prosthetic valve malfunction did not appear to be significant risk factor. However, preoperative respiratory failure and emergency operation showed significant increase of hospital mortality in comparison with other factors. On the basis of this reports, hospital mortality and late survival indicated that reoperation should be performed early as the potentially safe condition.

Disease Progression↗
PubMed1998

[Reoperation after the Fontan operation in single ventricle and tricuspid atresia].

The outcome of the Fontan-type operation for complex heart disease has been significantly improved, and low morbidity and mortality rates are reported. However, some problems still occur in late follow-up, including ventricular failure, hepatic congestion, supraventricular arrhythmia, cerebrovascular events, exercise intolerance, and residual or new cardiac lesions. Reinterventions after the Fontan-type operation for complex cardiac defects in 43 patients are reviewed. In addition to catheter interventions, the main reasons for reoperation were subaortic stenosis, pulmonary artery and vein obstructions, and interatrial shunt. Early intervention, particularly for subaortic obstruction, is recommended, and the Damus-Kay--Stansel anastomosis appears to be the procedure of choice. Reoperation was required in 6 of the 43 patients, with one operative death. The total event-free survival rate after 10 years of follow-up was 53%. The need for reoperation appears to be reduced after performing the total cavopulmonary shunt procedure compared to that after atriopulmonary connection. However, late arrhythmia remains a significant problem in this group of patients, and further assessment of the results of reintervention for arrhythmia is required.

Fontan Procedure↗
PubMed1998

The fate of pelvic osteolysis after reoperation. No recurrence with lesional treatment.

Twenty-three hips (21 patients) with 30 pelvic osteolytic lesions underwent reoperation and were observed prospectively for 25 to 74 months (average, 40 months) to assess the fate of pelvic osteolysis after reoperation. The average radiographic dimensions of the lytic lesions were 2.4 x 1.9 cm with the largest lesion measuring 7 x 5 cm. The porous ingrowth acetabular component shell had been left in situ in 15 hips and had been revised in eight. There was no difference in the average lesional size for hips with revised shells compared with those with unrevised shells. In cases where the shell was left in situ, the osteolytic lesions were curetted by working around the component perimeter or through holes in the shell. In 18 hips the bone defect(s) were grafted with autograft or allograft. Regardless of the management of the acetabular shell or the absence or presence of bone graft, none of the osteolytic lesions have progressed. Twenty-six of the 30 lesions have increased radiographic density. All acetabular components remain radiographically well fixed. There were no new osteolytic lesions. All hips were functioning well, and none have required subsequent reoperation for any reason. There was a statistically significant reduction in the operative time and the amount of blood loss when the acetabular component was not revised. It does not appear necessary to remove a well fixed and well positioned cementless acetabular component for the treatment of pelvic osteolysis. Debridement of periarticular inflammatory tissue and lesional curettage, either with or without bone graft, is effective in managing this type of bone loss. Revision of the acetabular component shell was associated with a significant increase in operative time and blood loss. These results support routine radiographic evaluation after total hip arthroplasty to monitor the development of osteolysis. On the basis of this experience, the authors recommend lesional treatment of progressive pelvic osteolysis to avoid more difficult surgery and minimize patient morbidity.

Acetabulum↗
PubMed1998

[Type A acute aortic dissection: late reoperations for dilatation of the distal false lumen and aortic regurgitation].

From January 1990 to December 1996, 71 patients aged 33 to 79 years (mean 60 +/- 11) underwent an emergency operation for type A acute aortic dissection. Fifty-three (74.6%) survived, and were followed 7 to 94 months (mean follow up 2.9 +/- 1.8 years) after the first operation. Five patients underwent reoperation for dilatation of the distal false lumen 7 to 52 months (mean period, 25 months) after primary repair. One patient underwent replacement of the arch and descending aorta, three patients underwent replacement of the descending aorta, and one patient underwent the stented graft implantation, resulting in closure of the entry site. Three patients underwent reoperation for severe aortic valve regurgitation 12 to 31 months (mean period, 24 months) after primary repair. Two patients underwent aortic valve replacement, and one patient underwent aortic root replacement. The actuarial freedom from reoperations was 81 +/- 6.9% at 3 years, and 73 +/- 9.9% at 5 years.

Adult↗
PubMed1979

Aortic and mitral prosthetic valve reoperations: early and late results.

A total of 232 valvular reoperations (123 mitral valve reoperations [RMVR] and 109 aortic valve reoperations [RAVR] were performed in 194 patients with previously implanted prosthetic valves. Early mortality was 10% (12/123) for the RMVR subgroup and 14% (15/109) for the RAVR subgroup (P = NS). Late mortality was 16% (18/111) for the RMVR subgroup and 25% (23/94) for the RAVR subgroup (P = NS). Patients with prosthetic endocarditis or prosthetic stenosis constituted higher-risk subpopulations. Principal determinants of both operative mortality and late attrition were preoperative cardiac functional status and the nature of the pathology mandating valve replacement. Early prosthetic valve replacement is advocated to correct hemodynamic abnormalities before advanced ventricular decompensation ensues, especially when prosthetic valvular endocarditis or prosthetic stenosis exists.

Aortic Valve↗
PubMed1981

Reoperation for recurrent peptic ulceration.

Thirty-eight patients undergoing reoperation for recurrent peptic ulceration have been reviewed after at least 3 years. All were considered to be in Visick grade IV before reoperation. There were no operative deaths. Thirty-three of the patients ended with both a vagotomy and antral resection. After reoperation 17 patients (45 per cent) remained in Visick grades III and IV. Eight patients have had further operations and, after 47 procedures in 38 patients, 14 (37 per cent) were still in Visick grades III and IV. Vagotomy and antrectomy has a high non-ulcer mobidity rate and we conclude that other methods of treatment for recurrent ulceration require evaluation.

Aged↗
PubMed1976

[Reoperations in cancer surgery (author's transl)].

Early detection of local recurrences and metastases is the most important condition for the success of reoperation in cancer surgery. A strict long-term follow-up, with standardized documentation, of patients operated on for malignancies is therefore necessary. While reoperations in cancer of the esophagus, the stomach or the lung are not very effective, surgery for recurrent carcinoma of the female breast, the colon and the rectum is more successful. The results of reoperation improve with increasing lapse of time since initial surgery, if radical resection of the local recurrences and the solitary metastases is possible. Treatment by an interdisciplinary team is considered to be the best.

Female↗
PubMed1976

[Reoperation in carcinoma of the thyroid (author's transl)].

From 1960 to 1975 a total of 82 reoperations were performed in patients with malignant goiter in the Surgical Clinic of the University of Munich. In reoperation as in primary surgery, the criteria for operative management and prognosis are dependent on histology (differentiated-undifferentiated carcinomas), extension of tumor, and age and sex of the patient. The need for early and radical reoperation increases with declining age, and also with limitation and differentiation of the carcinoma. Early results are presented: an accurate statement about late prognosis is not yet possible.

Adenocarcinoma↗
PubMed1977

Results of reoperation for recurrent angina pectoris.

Although a coronary bypass operation improves the quality of life and possibly prolongs it, a small percentage of patients do not have satisfactory results and require reoperation. From July, 1970, to March 1975, 358 patients underwent coronary bypass for chronic disabling or preinfarction angina. Angina requiring operation recurred in 24 men and 2 women. Hyperlipoproteinemia was present in 19 of the 26 (73%), and 3 patients had early-onset diabetes mellitus. Only 2 of 14 patients with progression of arteriosclerosis were helped by a second operation. Of 7 patients with occluded grafts, local disease, and no progression, 5 were helped by reoperation. Patients with occluded coronary bypass grafts without progression of arteriosclerosis benefit substantially from a second revascularization procedure. Aguarded prognosis must be held, however, for those with progression of arteriosclerosis with hyperlipoproteinemia or juvenile-onset diabetes who undergo reoperation. Patients with initially diffuse disease and graft occlusion also seem to benefit less from a second operation.

Angina Pectoris↗
PubMed1979

Reoperations in strabismus.

Reoperations in strabismus are done for overcorrection, undercorrections, and new strabismus problems such as dissociated vertical deviation and ptosis. Each patient requiring reoperation should be thoroughly evaluated on the basis of current findings with the understanding that some alteration in anatomy will be found. Restrictions must be freed and muscle force balanced to first provide straight eyes in the primary position and secondly the best vision possible. With persistence, 80% to 90% of patients requiring reoperation can expect a satisfactory end result.

Adult↗
PubMed1998

Reoperation after repair of atrioventricular canal defects.

Late events requiring reoperation after atrioventricular canal defect are most commonly related to failure of the repair of the mitral component of the common atrioventricular valve. The need for reoperation also occurs with new developments in the left ventricular outflow tract in the form of subaortic stenosis, particularly in patients with partial atrioventricular canal. Reoperations for other reasons in the population of operated patients with atrioventricular canal defects are rare events. Copyright 1998 by W.B. Saunders Company

Journal Article↗
PubMed1980

Reoperation for massively calcified pulmonary valve heterografts. Surgical considerations.

Calcifications of pulmonary valve heterografts inserted in children are more frequently recognized with increasing follow-up periods and may lead to reoperation. This complication is common with our non-industrially prepared procine valves and may also be observed with Hancock porcine heterografts. Reoperation is rendered difficult by incrustation of the massively calcified heterograft into the posterior aspect of the sternum and because of the need of adequate exposure of the pulmonary bifurcation. Four patients were successfully reoperated on by the authors. The valves were not replaced. An improved surgical technique used in the last three cases is described.

Adolescent↗