Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Reoperation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources
PubMed2001

Effects of autologous fresh platelet concentrate on haemostasis in cardiac reoperations.

The aim of this study was to determine whether autologous fresh platelet concentrate (PC) significantly improves haemostasis in cardiac reoperations compared with autologous fresh whole blood (WB). Forty-eight patients who had elective cardiac reoperations with a low-dose aprotinin priming regimen were divided into two groups. The amount of allogeneic blood transfusion was less in patients who were harvested 15 units of PC (Group PC; n = 24) before cardiopulmonary bypass (CPB) than patients who were harvested 400 ml of WB (Group WB; n = 24). The amount of mediastinal drainage for 12 h in intensive care units were significantly reduced in Group PC compared with Group WB (435 +/- 273 ml in Group PC versus 909 +/- 209 ml in Group WB; P < 0.001). Platelet count and collagen-induced whole blood platelet aggregation increased significantly higher in Group PC than Group WB after reinfusion. In conclusion, autologous fresh PC improved haemostasis compared with autologous fresh whole blood in cardiac reoperations with a low-dose aprotinin priming regimen.

Aged↗
PubMed1977

Late reoperations for squint.

Ten patients in the age range 2 to 22 years are described who had operations initially for squint in childhood. Nine had had concomitant convergent strabismus and one divergent. All presented again in adult life with a cosmetic complaint, but two also had diplopia. Reoperations were done, age range 14 to 43. These ten were all the "late reoperations" for squint which were done during the four year period 1972 to 1976 by one consultant (C.I.P.). Technically these late reoperations were not difficult, through the amount of change predictable in position of the eyeball could be only approximate. Recession +/- advancement +/- resection of horizontal recti were done in all cases. In one case no medial rectus was identified attached to the eyeball; a mass of tissue behind the caruncle was mobilised and sutured to the globe with resultant good movement. To avoid tethering of the eye by scarred conjunctiva, vertical conjunctival incisions were often converted at suturing to (see article) shaped wounds. The absence of any new cases of diplopia (the two who had it preoperatively retained it without aggravation) is attributed to the fact that all cases were under-corrected, i.e., no convergent or divergent squint was converted into a divergent or convergent squint respectively, so that the non-corresponding image remained within the area of suppression, which probably extends only to the vertical meridian in a squinting eye.

Adolescent↗
PubMed1976

Myocardial revascularization. Early and late results after reoperation.

In a series of 4,522 consecutive patients who underwent aorta-coronary bypass (ACB) with the saphenous vein at the Texas Heart Institute, 32 had a second revascularization procedure. All patients were reoperated upon because of recurrence of incapacitating angina. Reappearance of angina was related to obstruction of the grafts alone in 6 patients, to the disease of other arteries alone in 16, and to both sources in the remaining 10 patients. In 9 patients progression of the native coronary disease was found, in 16 significant coronary obstructions had been left unbypassed at the time of initial operation, and in the remaining 7 patients inadequate indication and/or performance of revascularization was considered responsible for the failure. Of the 31 survivors, 61 per cent experienced complete relief of angina or were improved, whereas 39 per cent were unimproved. Reoperation was more successful in relieving angina when performed in patients with new lesions or with previously unbypassed lisions than when done in patients with graft occlusion. Incidence of myocardial infarction after the first and second procedure was similar (3 per cent). Reoperation was performed with a mortality rate of 3 per cent, comparable to that of the original procedure, but relief of angina was not achieved so consistently.

Adult↗
PubMed1982

Coronary artery revascularization: reoperations performed on 124 consecutive patients.

The results of 124 coronary reoperations performed during a 9-year period are reviewed, with the causes of failure of the initial operations and technical considerations in the reoperation procedures. The reoperative experience provided considerable insight as to why an initial revascularization might be unsuccessful. The three basic mechanisms which appeared to lead to recurrence of symptoms or late infarction following coronary bypass were (1) inadequate initial revascularization, (2) graft failure (occlusion or stenosis), and (3) progression of disease in the native circulation. Means of prevention and surgical techniques are reviewed in detail.

Journal Article↗
PubMedDate not supplied

[The failures of surgery in peptic ulcer. Report of 62 reoperations (author's transl)].

62 reoperations were performed in 54 patients for failure of surgery for chronic ulcer. In 15 cases there was a recurrence of an ulcer left in position, in 32 cases there was an anastomotic ulcer, in 4 cases, severe hemorrhage for severe inflammation of the stoma without recurrence of the ulcer and in 11 cases, there were severe functional disorders. The authors are convinced that in the treatment of recurrent ulcer, vagotomy should always complete gastrectomy and vice versa. It is because they did not follow this advice in the early stages that they had to reoperate certain patients several times for new ulcer recurrences. The results of reoperation for functional disorders when indicated in a gastrectomised patient were mediocre in the vagotomised patients.

Adult↗
PubMed1988

Reoperative parathyroid surgery.

Reoperation for persistent or recurrent primary hyperparathyroidism immediately connotes a complex clinical management problem. Successful cure of hypercalcemia is less frequent whereas complications are more common compared to initial explorations. Of 212 patients operated on at the Mayo Clinic from 1978 through 1986, 189 (89%) were cured. Sporadic disease, multiple endocrine neoplasia, and familial hyperparathyroidism were found in 183 (87%), 20 (9%), and 9 (4%) patients, respectively. Prior to the most recent reoperation, these patients had undergone from one to five operations. Preoperative localization examinations were performed in 192 patients (91%). Cervical high-resolution, real-time ultrasonography, computed tomography, and thallium-technetium scintigraphy had sensitivity rates of 87%, 56%, and 71%, respectively. When the tumor was localized preoperatively, the operative time and cost were significantly reduced compared to nonlocalized tumors. Cervical reexploration only was required in 154 (72%), combined cervical and mediastinal exploration occurred in 46 (22%), and mediastinal exploration only was performed in 12 (6%). There was no perioperative mortality; permanent hypoparathyroidism developed in 33 patients (16%), and six patients (2.9%) suffered permanent unilateral vocal cord paralysis. Anatomically, the most frequent site to find a missed parathyroid adenoma was in the normal location. The large majority of these glands were removed through a cervical incision although, on occasion, they were retracted from the anterior superior mediastinum or the low tracheoesophageal space. These data confirm that reoperative parathyroid surgery can be performed safely, with a rather high degree of success, but too-frequently results in a lifetime morbidity of hypoparathyroidism.

Adolescent↗
PubMed1979

Causes for 340 reoperations on the extrahepatic bile ducts.

Three hundred forty of 5,086 patients undergoing operations on the extrahepatic biliary trees at the Swedish and University of Washington Hospitals in Seattle between 1956 and 1970 required reoperation on this system. This figure for reoperations did not include procedures for subhepatic or subphrenic abscess and/or wound complications. The most common cause for reoperation was an attempt to retrieve a residual or recurrent common duct stone (26.8% of the cases). The second most common cause for re-exploration was a tumor obstructing the common bile duct (18.9%). Less frequent causes for secondary surgery were stenosis of the ampulla of Vater (10.3%), bile duct injury (12.1%), pancreatitis (10.3%), inflammatory stricture (1.5%), cystic duct remnant (5%), and many other less important problems. Thus 4.7% or almost one in 20 of all our biliary operations were secondary. We feel that operative cholangiograms supplemented by manometry are the useful adjunct towards finding otherwise undetectable biliary pathology, whether on the basis of stones, tumors, or structures. We also feel that placement of T-tubes with a large arm going to the surface will allow the removal of most stones left behind after common bile duct explorations with the assistance of directable stone baskets.

Adolescent↗
PubMedDate not supplied

[Emergency reoperation for breakdown of sutures of an intrathoracic oeso-digestive anastomosis (author's transl)].

UNLABELLED: The authors report five cases of emergency reoperation for breakdown of an intrathoracic oeso-digestive anastomosis. RESULTS: 1 death, 1 failure, new fistula formation but with spontaneous cure within 20 days, 3 primary cures. The success of these reoperations seems to us to depend narrowly: - on the rapidity of diagnosis, facilitated at present by early radiological examination; - on the absolute emergency of reoperation as soon as the breakdown is obvious radiologically and clinically, - on the strictness of surgical technic which should be the same as for a cold operation. Early radiological examination of the digestive anastomoses has permitted better understanding of the mechanisms of the breakdown, emphasising: - firstly, the importance of complete hemostasis; - secondly, the suppression of any dead space around the anastomosis.

Adult↗
PubMed1978

Reoperation in symptomatic patients after direct coronary artery revascularization.

Seventy-nine patients underwent 85 reoperations to revascularize the myocardium at intervals from 2 days to 5 years (mean 13 months) after primary direct revascularization procedures. A total of 122 bypass grafts including 43 individual veins, 43 double or triple sequential veins, and 17 internal mammary arteries (IMA) were utilized. Failure of previous bypass grafting was the most common reason for recurrent symptoms, partially due to the high failure rate of radial artery segments used as bypass conduits. One operative and three late deaths have occurred. Coronary arteriography, performed after reoperation (mean 14 months) in 15 patients, revealed a graft patency rate of 68 percent. Significant differences in postoperative complications between the first and subsequent operation could not be demonstrated. Combined nonfatal perioperative infarctions with the first and subsequent operations decreased ventricular function and probably contributed to the improved symptomatic state of some patients. It is concluded that good symptomatic relief and long-term survival can be achieved by reoperation in selected patients who have recurrent symptoms after primary direct myocardial revascularization.

Coronary Disease↗
PubMed1981

Reoperations for hyperparathyroidism.

During a 20 year period, 27 patients have undergone reoperations for primary hyperparathyroidism. Hypercalcemia has been successfully controlled in 21 of the 27 patients after a total of 64 operations. Reasons for failure at initial exploration included surgical error in 12, multiple gland disease in five, unusual parathyroid gland location in five, carcinoma of the parathyroid gland in two and unknown in three. A variety of techniques were used to localize missing parathyroid glands prior to reoperation. Selective venous sampling was the most helpful but gave correct localizing information in only nine of 18 patients. Postoperatively, hypoparathyroidism was temporary in two patients and permanent in four. Recurrent laryngeal nerve injury was temporary in one patient, permanent and unilateral in two and bilateral in one patient. Reoperations for hyperparathyroidism are associated with increased morbidity and decreased success. Most importantly, failure at the initial operation is preventable in most patients.

Adolescent↗
PubMed1978

[Bileduct reoperations (author's transl)].

After cholecystectomy reoperations are required in 7%. A reoperation in indicated by pathologic alterations overlooked at the first operation, not working biliodigestive anastomoses and injuries to the common bile duct. 138 reoperations of the bile duct wer performed within 4 years which were aimed at reconstructing the normal bile duct anatomy. Mortality rate 8,7%.

Ampulla of Vater↗
PubMed1980

Parathyroid autotransplantation at the time of reoperation for persistent hyperparathyroidism.

During the 3-year period from 1977 through 1979, twelve patients received fresh autografts of hyperfunctioning parathyroid tissue into their forearm musculature at the time of reoperation for persistent or recurrent hyperparathyroidism. All patients were considered to be at high risk of permanent hypoparathyroidism after completion of their reoperative surgery, and parathyroid autotransplantation was undertaken in an attempt to circumvent this serious complication. Seven patients received autografts of adenomas; five were grafted with hyperplastic glands. At follow-up 4 to 35 months postoperatively, all 12 patients had functioning grafts, as evidenced either by a higher concentration (1 1/2 times or more) of immunoreactive parathyroid hormone in the antecubital venous effluent drainage the grafted arm compared with that of the nongrafted arm or by their ability to maintain a normal serum calcium level after cessation or tapering of replacement therapy. One patient with familial hyperparathyroidism who was noted to be hypercalcemic again only 2 months after removal of a 1.1 gm intrathyroid parathyroid "adenoma" at reoperation was believed to have persistent rather than recurrent hyperparathyroidism, most likely due to hyperfunction of residual hyperplastic parathyroid tissue left in situ in the neck or mediastinum.

Adenoma↗
PubMed1999

Is laparoscopic reoperation for failed antireflux surgery feasible?

HYPOTHESIS: Laparoscopic techniques can be used to treat patients whose antireflux surgery has failed. DESIGN: Case series. SETTING: Two academic medical centers. PATIENTS: Forty-six consecutive patients, of whom 21 were male and 25 were female (mean age, 55.6 years; range, 15-80 years). Previous antireflux procedures were laparoscopic (21 patients), laparotomy (21 patients), thoracotomy (3 patients), and thoracoscopy (1 patient). MAIN OUTCOME MEASURES: The cause of failure, operative and postoperative morbidity, and the level of follow-up satisfaction were determined for all patients. RESULTS: The causes of failure were hiatal herniation (31 patients [67%]), fundoplication breakdown (20 patients [43%]), fundoplication slippage (9 patients [20%]), tight fundoplication (5 patients [11%]), misdiagnosed achalasia (2 patients [4%]), and displaced Angelchik prosthesis (2 patients [4%]). Twenty-two patients (48%) had more than 1 cause. Laparoscopic reoperative procedures were Nissen fundoplication (n = 22), Toupet fundoplication (n = 13), paraesophageal hernia repair (n = 4), Dor procedure (n = 2), Angelchik prosthesis removal (n = 2), Heller myotomy (n = 2), and the takedown of a wrap (n = 1). In addition, 18 patients required crural repair and 13 required paraesophageal hernia repair. The mean +/- SEM duration of surgery was 3.5+/-1.1 hours. Operative complications were fundus tear (n = 8), significant bleeding (n = 4), bougie perforation (n = 1), small bowel enterotomy (n = 1), and tension pneumothorax (n = 1). The conversion rate (from laparoscopic to an open procedure) was 20% overall (9 patients) but 0% in the last 10 patients. Mortality was 0%. The mean +/- SEM hospital stay was 2.3+/-0.9 days for operations completed laparoscopically. Follow-up was possible in 35 patients (76%) at 17.2+/-11.8 months. The well-being score (1 best; 10, worst) was 8.6+/-2.1 before and 2.9+/-2.4 after surgery (P<.001). Thirty-one (89%) of 35 patients were satisfied with their decision to have reoperation. CONCLUSIONS: Antireflux surgery failures are most commonly associated with hiatal herniation, followed by the breakdown of the fundoplication. The laparoscopic approach may be used successfully to treat patients with failed antireflux operations. Good results were achieved despite the technical difficulty of the procedures.

Adolescent↗
PubMed1991

Avoiding reoperation for indeterminate thyroid nodules identified as malignant after surgery.

Thyroid nodules that are indeterminate as carcinoma by needle biopsy before surgery and by study of frozen sections at the time of surgery are occasionally identified to be malignant in later studies. If only a lobectomy has been performed, the advisability of reoperation to remove the remaining thyroid tissue to facilitate radioactive iodine therapy may cause concern. To obviate this difficulty as well as to reduce the occurrence of nodules later in a preserved contralateral thyroid lobe and to provide additional thyroid tissue for study, contralateral subtotal or near total lobectomy has been performed for indeterminate thyroid nodules. The small remnant of remaining thyroid tissue can later be ablated by radioactive iodine if desired. Of 37 patients with indeterminate thyroid nodules, none required reoperation, although the diagnosis of carcinoma was established after surgery for eight patients, three of whom were treated with radioactive iodine.

Biopsy, Needle↗
PubMed1991

Reoperative surgery for periampullary adenocarcinoma.

In recent years, the morbidity, mortality, and long-term survival of patients undergoing surgery for periampullary adenocarcinoma have improved. These changes have prompted us to reoperate on patients who have previously undergone pancreatobiliary surgery, many of whom were initially considered to have unresectable lesions. From 1979 to 1990, 38 patients with pancreatic and 17 patients with nonpancreatic periampullary adenocarcinoma underwent reexploratory surgery at The Johns Hopkins Hospital, Baltimore, Md. Thirty-three (60%) of these 55 patients had resection at the time of second laparotomy. Of the 46 patients undergoing reexploratory surgery with an intent to resect, the overall resection rate was 72% (33), 64% (16/25) for pancreatic and 100% for nonpancreatic periampullary adenocarcinoma. Postoperative complications occurred in 21 patients (38%), but only one patient (2%) died following surgery. Mean survivals from reexploratory surgery were 6.9 months for the 22 patients with pancreatic cancer undergoing palliative surgery, 20.5 months for the 16 patients with resectable pancreatic cancer, and 33.0 months for the 17 patients with nonpancreatic periampullary adenocarcinoma undergoing resection. We conclude that in carefully selected patients, reoperative surgery for periampullary cancer (1) provides a significant resection rate, (2) can be performed safely, and (3) offers a chance for long-term survival.

Adenocarcinoma↗
PubMed1993

Reoperation for bleeding in trauma.

OBJECTIVE: Analysis of the causes and clinical patterns of postoperative bleeding requiring reoperation in trauma patients. DESIGN AND SETTING: A case series of 166 consecutive patients treated over 7 years at a level I trauma center. PATIENTS: 136 patients (82%) sustained penetrating trauma, primarily gunshot wounds (102 patients). On admission, 85 patients (51%) were hemodynamically unstable. INTERVENTION: 196 reoperative procedures were performed to control bleeding: 136 laparotomies, 49 thoracotomies, five neck explorations, and six peripheral vascular operations. Results of nine explorations were negative. MAIN OUTCOME MEASURE: Of 157 initial attempts to affect hemostasis, 36 (23%) failed. Twenty-seven patients died of uncontrolled bleeding and 19 died despite successful hemostasis. The overall mortality rate was 28%. RESULTS: Major causes of bleeding were incomplete hemostasis (46%), missed injuries (30%), and iatrogenic complications (17%). Diffuse oozing occurred in only seven of 43 patients with abnormal coagulation. The liver (19 patients) and retroperitoneum (13 patients) were the most common sites of incomplete hemostasis. Missed injuries occurred mainly in the chest wall arteries (seven patients) and heart (six patients). Iatrogenic injuries most commonly involved the spleen (nine patients). CONCLUSIONS: The management of postoperative hemorrhage in trauma hinges on an early decision to reexplore, preoperative correction of abnormal coagulation, and knowledge of specific bleeding patterns.

Blood Coagulation Disorders↗
PubMed1998

Reoperative parathyroidectomy in the era of localization technology.

BACKGROUND: Recurrent and/or persistent hyperparathyroidism (HPT) is an uncommon disease. Relatively few cases are seen by any one center or surgeon. Most of the prior reviews of this problem were done in the era prior to potentially accurate magnetic resonsance imaging (MRI) and sestimibi scan localization and do not reflect current preoperative localization technology. METHODS: All cases of recurrent or persistent parathyroidectomy seen in our institution between 1992 and 1996 were reviewed retrospectively to assess the predictive value of preoperative MRI, selective venous sampling, sestimibi scanning, ultrasound examination, and computerized tomography (CT) scanning. The preoperative localization studies were compared with the findings at operation, the pathology report, and the patient's long-term calcium status. RESULTS: Twenty-eight patients were operated upon at our institution for recurrent or persistent HPT during this time interval. The final pathology turned out to be: adenoma, 24; hyperplasia, 2; carcinoma, 2. The site at which the reoperative pathology was found was in the neck in 22 patients and intrathoracic requiring sternotomy in 6. The long-term outcome, i.e., serum calcium level at > 6 months postoperatively, was normocalcemia in 22 of 28 (85%), persistent hypocalcemia in 2 of 28, and persistent hypercalcemia in 2 of 28. Some combination of MRI, sestimibi, selective venous sampling, ultrasound, and CT scan was performed on all patients preoperatively. Preoperative MRI scans were performed on 26 of 28 patients. They correctly localized the side and site of the pathology in only 12, yielding a sensitivity of 66%. There were, however, no false positives; therefore, the positive predictive value of this test was 100%. Selective venous sampling was carried out on 26 of 28 patients and correctly localized in only 8 (sensitivity, 50%). Again, there were no false positives, yielding a positive predictive value of 100%. Sestimibi scanning was performed in 16 of 28, localizing in 8 (sensitivity, 50%). The positive predictive value of this test was 80%. Ultrasound was performed in 26 of 28 patients and localized in only 3, yielding a sensitivity of 17%, with a positive predictive value of 75%. Computerized tomographic scan was performed preoperatively only when all other investigations turned out to have been nonlocalizing and was therefore done in only four patients, one of whom had a positive CT scan showing an intrathoracic, intrapericardial adenoma. CONCLUSIONS: These data demonstrate that despite the availability of what are putatively accurate preoperative localizing tests for previously unoperated cases, no one localizing test is particularly sensitive in reoperative parathyroid surgery. Magnetic resonance imaging and selective venous sampling, however, are complementary and when positive do accurately predict the site of the persistent/recurrent parathyroid pathology. Use of these preoperative localizing studies resulted in a successful outcome, i.e., normocalcemia or hypocalcemia in 93% of patients operated on.

Adult↗
PubMed1988

Multiple reoperations in recurrent colorectal carcinoma. An analysis of morbidity, mortality, and survival.

Fifty-eight patients in an existing prospective study were evaluated to determine if multiple reoperations for recurrent colorectal carcinoma extended survival. All patients had at least three major operative procedures. The median survival from first, second, third, fourth, and fifth recurrence was 29.9, 17.3, 16, 12.3, and 7.2 months, respectively. The median postoperative hospital stay was 11 days, with a range of 1 to 96 days. The major complication rate was 17%. Twenty-one patients are still alive 19 to 140 months from diagnosis (mean, 50.3 months), 9 to 125 months from the first recurrence (mean, 31.1 months), and 5 to 109 months (mean, 22 months) from the second recurrence. Eleven patients have no evidence of disease. Reoperation for recurrent colorectal carcinoma can be done with acceptable morbidity and mortality and an increase in survival.

Adult↗