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At least 811 records · Page 45Linked to original sources
PubMed2004

Preoperative ultrasound is worthwhile for reoperative parathyroid surgery.

OBJECTIVES/HYPOTHESIS: High-resolution ultrasound and sestamibi scanning are regarded as the first-line methods for preoperative localization of parathyroid adenomas. The utility of ultrasound in reoperative cases has been questioned because of concern that scarring will obscure normal tissue planes and vascularity that are critical to identification of an adenoma using this imaging modality. The purposes of the study were to evaluate the ability of high-resolution ultrasound to accurately localize parathyroid adenomas in the reoperative exploration and to identify any factors that influence its accuracy STUDY DESIGN: Retrospective chart review at a tertiary care academic medical center. METHODS: All patients seen in referral for parathyroid surgery between May 1994 and September 2002 underwent high-resolution ultrasound as their initial diagnostic test. Patients who subsequently underwent exploration were included in the study. Intraoperative and ultrasound findings were compared. RESULTS: One hundred forty-two patients were included, 116 without and 26 with prior exploration. The sensitivity and positive predictive value of ultrasound were 86.9% and 89.1%, respectively. These data were not significantly different in patients without (88.2% and 90%) and in patients with (80% and 84.2%) prior thyroid or parathyroid surgery. The overall accuracy was 79% with a false-negative rate of 11.3%. Thyroid nodularity was significantly more common (81.8%) in patients who had a false-positive or false-negative finding on ultrasound than in the total population (61.3%). CONCLUSION: High-resolution ultrasound is an accurate method for localizing parathyroid adenomas even in patients who have previously undergone parathyroid exploration. However, the presence of thyroid nodules can interfere with its accuracy.

Adult↗
PubMedDate not supplied

Analysis of the components of residual deformity in clubfeet presenting for reoperation.

We reviewed the records and radiographs of 125 children with 159 clubfeet reoperated for residual deformity after operative repair (210 reoperations). We concluded that residual forefoot adduction and supination were the most common persistent deformities (present in 95% of the feet) and that these deformities resulted from undercorrection at the time of primary operation. Although not then apparent, the persistent deformities became more evident with growth, and additional treatment became necessary. Undercorrection resulted from not releasing the calcaneocuboid joint and plantar fascia and failure to recognize residual forefoot adduction on the interoperative radiographs at primary operation.

Adolescent↗
PubMed1990

Reoperation for failed antireflux surgery.

The management of patients with an unsatisfactory result following antireflux surgery is often problematical. Ten such patients with failed antireflux surgery, for whom medical management had also subsequently failed, underwent reoperation via a thoraco-abdominal approach. The anatomical cause of the surgical failure was determined pre-operatively in most cases by endoscopy, radiology, manometry and 24-hour pH monitoring. The most common reason for failure was a slipped Nissen fundoplication. A tight wrap, a disrupted wrap and a fundoplication hernia were less common causes. At follow-up, only one patient had a poor result. Reoperation for failed antireflux surgery can yield good results and is facilitated by pre-operative definition of the cause of failure and wide operative exposure.

Adult↗
PubMed1998

Reoperation for recurrent coronary artery disease: results of 200 consecutive cases.

BACKGROUND: It is well known that reoperation for recurrent coronary artery disease is more difficult than primary coronary artery bypass grafting. However, it is possible to reduce the morbidity and mortality of reoperation to the same level as the initial procedure with careful surgical technique. METHODS: A retrospective study of the first 200 patients who underwent redo coronary bypass grafting was undertaken. RESULTS: In the first 200 cases of redo coronary bypass grafting at St George Hospital, Sydney (August 1986-January 1995), there were five in-hospital deaths (2.5%). There was one case of sternal infection (0.5%), which required surgical debridement, three cases of stroke (1.5%), one case of postoperative bleeding (0.5%), which required a return to theatre and six cases (3%) required mechanical ventilation for more than 24 h. The need for major postoperative support (such as intra-aortic balloon pumping/adrenaline infusion) was significantly affected by the degree of urgency and the degree of pre-operative ventricular impairment. CONCLUSIONS: The mortality rate of redo coronary artery bypass grafting in this series is similar to that of primary surgery described in other reports.

Adult↗
PubMed1996

An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations.

OBJECTIVE: To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short-term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair. DESIGN: Cohort study based on Medicare claims. SETTING: Hospital care. SUBJECTS: All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spinal stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort). MAIN OUTCOME MEASURES: Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complications (cardiopulmonary, vascular, or infectious), postoperative mortality, and time between first operation and any subsequent reoperation. RESULTS: Rates of surgery for spinal stenosis increased eightfold from 1979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for individuals receiving spinal fusions. The 1989 cohort experienced a slightly higher probability of reoperation than the 1985 cohort for the first 3 years of follow-up. CONCLUSIONS: A rapid increase in surgery rates for spinal stenosis was identified over a 14-year period. The wide geographic variations and substantial complication rate from this elective surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurgical treatments for this condition. The risks and benefits of particular surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks and possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US population.

Aged↗
PubMed1987

Reoperation in patients with patent coronary bypass grafts.

As the population of patients having undergone myocardial revascularization increases, the number of reoperations will escalate and reoperations of patients with patent grafts will become increasingly frequent. Successful management of this new surgical entity requires a clear understanding of the probability of atherosclerotic involvement of patent vein grafts and careful attention to technical detail. Patent vein grafts more than five years old should be replaced to avoid the potential for embolization of atheromatous material and late vein graft closure.

Arteriosclerosis↗
PubMed1987

Left thoracotomy and femoro-femoral bypass for reoperative revascularization of the posterior coronary circulation.

Left thoracotomy and femoro-femoral cardiopulmonary bypass has been used for reoperation in five patients requiring coronary bypass graft into the inferolateral surface of the heart. Five patients had refractory angina pectoris and angiographic occlusion of lateral wall native vessels or previous occluded vein grafts and all had positive exercise test. Four of the five had patent internal mammary to the LAD. Following supine positioning and removal of the saphenous vein and isolation of the femoral artery and femoral vein, a left fifth interspace thoracotomy was made, the patient heparinized and cannulated for cardiopulmonary bypass, the pericardium opened, the heart dissected free, and either the internal mammary artery dissected off the left chest wall or saphenous vein grafts used to bypass the appropriate lesions. The proximal inflow was the descending thoracic aorta making tunnels for the vein grafts through the posterior pericardium. All of the patients did well in the postoperative period. This technique is recommended for reoperations in patients with documented inferolateral ischemia as the primary cause of symptomatology with mitigating circumstances against an anterior approach.

Adult↗
PubMed1990

Left thoracotomy reoperation for coronary artery disease.

Twenty patients underwent reoperative coronary artery bypass grafting (CABG) through a left thoracotomy since 1971. This was their second CABG in 16 patients, third in three patients and fourth in one patient. Surgery was performed from 1 to 16 years following the initial procedure. Demographic data showed no significant variation from patients undergoing standard reoperative CAGB in this institution. Ejection fraction varied between 30% and 73%. Cardiopulmonary bypass technic has gradually developed since 1971, using the left femoral artery and vein. For venous cannulation a 50-cm long catheter was positioned in the right atrium. Monitoring included pulmonary artery catheter with oximetry. Fibrillatory arrest of the heart was utilized with 18-33 degrees C core cooling cardioplegia. The left internal mammary artery (6) and reverse saphenous veins (44) were used for an average of 2.5 grafts per patient. The proximal anastomosis was placed on the descending thoracic aorta or the left subclavian artery. There were two early and no late deaths. Sixteen patients were restudied before discharge from the hospital with an early graft patency rate of 98% (41/42). The left thoracotomy approach may be preferable in selected cases of redo CABG. The danger of damage to the heart and patent grafts is greatly reduced.

Aged↗
PubMed1991

Technical considerations for myocardial protection during the course of coronary artery bypass reoperation: the impact of functioning saphenous vein and internal mammary artery grafts.

New technical challenges involving the delivery of cardioplegia during the course of coronary artery bypass operation continue to be presented to the surgeon. Functioning saphenous grafts at reoperation that are at risk for distal embolization, are managed by altering the standard cardioplegia delivery techniques. Management of patent internal mammary artery (IMA) grafts depends upon the status of the native circulation and coronary collateral. The reoperation may be performed with a fibrillating heart, standard cardioplegia with a clamped mammary graft, or cardioplegia delivered during simultaneous circulatory arrest. Myocardial temperature measurements, during the course of more complex operations, are useful in choosing the appropriate technique for myocardial protection.

Collateral Circulation↗
PubMedDate not supplied

Reoperations with the right gastroepiploic artery without cardiopulmonary bypass.

The right gastroepiploic artery (RGEA) has been utilized as the bypass conduit on the inferior surface of the heart with a minimally invasive approach. Fourteen patients had reoperative coronary bypass surgery for severely symptomatic single-vessel disease of the right coronary artery. All surgeries were performed since May 1996. A small mid-line incision including splitting of the lower sternum gave excellent exposure. The inferior surface of the heart was dissected to expose and stabilize the target vessel. The heart rate was controlled with a diltiazem drip. Cardiopulmonary bypass was not necessary in any case. The right coronary artery was bypassed in three patients, the posterior descending artery branch in ten patients, and the terminal circumflex of the left coronary artery in one. After grafting, patency of the anastomosis was demonstrated by Doppler echocardiogram. Two patients had left anterior descending artery (LAD) grafts with LIMA (left mammary artery) and RGEA grafts performed simultaneously with two port access incisions. No patient had perioperative mortality or complications. No patient had recurrent angina. Doppler color echocardiographic imaging studies before discharge confirmed patency of the graft in 13 of 14 cases. In one case, the gastroepiploic artery could not be visualized. Angiographic visualization was positive in seven cases; seven patients were not studied yet. The gastroepiploic artery is an excellent conduit for vascularization of the inferior aspect of the heart. The operation can be done with a minimally invasive technique and without the use of cardiopulmonary bypass. This approach seems especially applicable in selective reoperative cases.

Aged↗
PubMedDate not supplied

Role of coronary graft flow measurement during reoperations for early graft failure after off-pump coronary revascularization.

Doppler-based techniques of coronary graft flow measurement are frequently used, especially during coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), to exclude graft dysfunction resulting from technical errors. Nevertheless, early graft failure in the immediate postoperative period continues to affect a small percentage of patients who may require emergent reoperation as a result of severe hemodynamic deterioration. In this setting, in which coronary angiography is infrequently an option, expeditious intraoperative assessment of previously constructed coronary grafts may be performed by using the Doppler-based technique Transit Time Flow Measurement (TTFM). As a result, the hemodynamic values obtained during reoperations may guide the operative strategy. In this study we report on eight patients who underwent "off-pump" CABG and necessitated early reintervention as a result of presumed graft dysfunction. In these patients, graft dysfunction was confirmed or excluded by using intraoperatively the TTFM technique, comparing newly obtained flow hemodynamic variables with those recorded as a baseline during primary operations.

Blood Flow Velocity↗
PubMedDate not supplied

Reoperative coronary surgery with and without cardiopulmonary bypass.

BACKGROUND: Reoperative coronary surgery without cardiopulmonary bypass (CPB) was analyzed to evaluate the technical profile of the patients studied and the benefit from this technique. MATERIAL AND METHODS: From November 21, 1994 to May 20, 1999, 166 patients had reoperative coronary surgery, 112 patients (Group A) with and 54 patients (Group B) without CPB. Median sternotomy was used in all the patients in Group A and in 13 patients in Group B. The remaining had a LAST (37 patients) or a posterolateral thoracotomy (4 patients). RESULTS: Anastomoses per patient were 2.4 +/- 0.8 in Group A and 1.1 +/- 0.4 in Group B (p < 0.001). When a single graft was needed, CPB was not used in 82.8% of the cases. However, when more than one graft was required, CPB was not used in only 5.6% of the cases. When a single territory had to be grafted, CPB was not used in 76.6% of the patients. If two territories were grafted, only 6.8% of the patients were in Group B, whereas no patient who needed a graft in all the three territories was in Group B. Overall mortality was 3.6% cerebrovascular accident (CVA) and acute myocardial infarction (AMI) incidence were 0.6% and 1.8%, respectively, and were similar in both groups. Incidence of early major events (overall 8.4%) was not different between groups. CONCLUSIONS: The primary endpoints (mortality, CVA rate, and AMI) were similar in both groups, but patients in Group B were less complicated. However, patients in the two groups were not the same, as the technical profile was quite different. As our results were similar to those obtained in the first operation, we think that consideration of different surgical possibilities, depending on territory to be grafted, will improve the results of redo coronary surgery, making them similar to those obtained in the first operation.

Cardiopulmonary Bypass↗
PubMed2003

Multisection CT evaluation of the reoperative cardiac surgery patient.

Development of electrocardiographically (ECG) gated multisection computed tomography (CT) has had a significant, immediate impact in cardiovascular imaging. The capabilities of this new technique have become particularly important in the preoperative assessment of the cardiac surgery patient. Cardiac surgery in the 21st century has become increasingly complex because of an aging population needing multiple procedures. As patients live longer, reoperative surgery is often needed, requiring further complicated intervention. Recent research in cardiac surgery patients has linked atherosclerotic disease of the aorta to the risk of perioperative stroke. Multisection CT has been effective in evaluations of the atherosclerotic aorta, minimizing perioperative stroke risk in these often elderly patients. By using the capabilities of ECG gating, improved CT imaging of the aortic valve has helped guide the surgeon in decisions of aortic valve replacement. Injury to preexisting coronary artery grafts is associated with significant perioperative morbidity and mortality. The superior imaging features of ECG-gated CT have enabled preoperative identification of coronary grafts, preventing injury to these important structures during reoperative surgery. Assessment of normal anatomic structures is also important in preoperative planning. Proximity of the aorta, pulmonary artery, and native coronary arteries to the sternum is an important potential cause of morbidity and mortality, and it can be preoperatively assessed with multisection CT. The advancement of ECG gating has enabled accurate assessment of the coronary arteries, which is particularly important in the preoperative identification of congenital and acquired abnormalities. With continued advances, ECG-gated multisection CT will play an increasingly important role in the evaluation of patients with cardiovascular disease.

Aged↗
PubMed1991

Reoperation after cholecystectomy. The role of the cystic duct stump.

The so-called "Postcholecystectomy Syndrome" may be due to various pathological biliary causes. The aim of this study was to evaluate the significance of the cystic duct stump syndrome and if so, how often a long (greater than 1.5 cm) cystic duct stump was an indication for reoperation on the bile ducts after cholecystectomy in our patients. Three hundred and twenty two patients underwent a second operation on the bile ducts after cholecystectomy in the last ten years. In 35 patients (10.8%) a striking findings was a long cystic duct stump (greater than 1.5 cm). In 24 of these patients, a pathological finding, in addition to the long cystic duct stump, was found on exploration. Out of these 24 patients there were 14 with common bile duct stones; 6 with stenosis of the sphincter of Oddi; 3 with chronic pancreatitis and in one patient hepatitis was the cause of the symptoms. From the remaining 11 patients 8 had a stone in a partial gall bladder or cystic duct stump. One patient had a fistula between the cystic duct stump and duodenum and one a suture granuloma. There was only one patient where a 1.5 cm long cystic duct stump remnant was the only pathological finding. Four years after reoperation this patient is still suffering from the same intermittent gastrointestinal symptoms. We conclude that the cystic duct stump is hardly ever a cause for recurrent symptoms in itself. Total excision of the cystic duct does not eliminate the existence of postcholecystectomy symptoms.

Cholecystostomy↗
PubMed1999

Reoperations for bleeding portal hypertension. Surgical rescue of surgical failures.

BACKGROUND: Surgery for portal hypertension has a low rebleeding rate. Patients that rebleed can be grossly divided into those who die as a consequence of the episode, those who don't die but develop liver failure (remaining as Child-Pugh C) and those who, in spite of the bleeding episode, retain good liver function (Child-Pugh A or B). At our hospital, the latter group is considered for further surgical treatment. We report here the results of surgical rescue of surgical failures. METHODS: In a twenty year period, 36 patients (30 Child-Pugh A, 6 Child-Pugh B) were reoperated. The files of these patients were reviewed. RESULTS: Average age was 33 years. Cirrhosis was present in 31 cases. All patients were electively reoperated with portal blood flow preserving procedures. Operative mortality for the whole group was 12% and for the Child-Pugh A group 6.6%. Rebleeding was observed in 5.5%. Postoperative incapacitating encephalopathy was recorded in one case (2.7%). Good quality of life was recorded in 84% of the cases. Survival (Kaplan-Meier) was 78% at 6 months and 69% at 5 years. CONCLUSIONS: Surgical failures in low risk patients (Child-Pugh A or B) can be treated by means of surgery, and a low mortality, re-bleeding and encephalopathy rate can be expected. The performance of a portal blood flow preserving procedure is recommended.

Adolescent↗
PubMed1997

Reoperation rates for recurrent ovarian endometriomas after surgical excision.

This was a retrospective study analyzing the need for reoperation for recurrent endometriomas after surgical therapy. There were 104 women who were followed after surgical excision of endometriomas, with a cross section of 46 gynecologic surgeons. When using a life-table for follow-up analysis, only 2.9% of all patients had reoperation for recurrence, with a maximum recurrence probability of 7% at 32 months of follow-up.

Adult↗
PubMed2001

Human tissue valves in aortic position: determinants of reoperation and valve regurgitation.

BACKGROUND: Human tissue valves for aortic valve replacement have a limited durability that is influenced by interrelated determinants. Hierarchical linear modeling was used to analyze the relation between these determinants of durability and valve regurgitation measured by serial echocardiography. METHODS AND RESULTS: In adult patients, 218 cryopreserved aortic allografts were implanted with the subcoronary (85) or the root replacement technique (133), and 81 patients had root replacement with a pulmonary autograft. Mean follow-up was 4.2 years (SD 2.7; range, 0 to 10.5). Patient age, operator experience with subcoronary implantation, and allograft diameter were independent predictors for reoperation. With repeated color Doppler echocardiography, the severity of aortic regurgitation was assessed by the jet length method and the jet diameter ratio. Multilevel hierarchical linear modeling was used to estimate initial aortic regurgitation (intercept), its change over time (slope), and the effect of 11 potential determinants of durability on aortic regurgitation. With the jet length method, the intercept was 0.94 grade and the slope was 0.11 grade per year. With the jet diameter ratio, the intercept was 0.34 and the annual increase was 0.01. Subcoronary implanted valves had more initial aortic regurgitation, but progression of aortic valve regurgitation did not differ from root replacement. At midterm follow-up, recipient age <40 years was the only independent predictor of aortic regurgitation. CONCLUSIONS: Subcoronary implantation has a learning curve, resulting in more initial aortic regurgitation and early reoperation compared with root replacement. In both techniques, progression of aortic regurgitation over time is small but accelerated in young adults.

Adolescent↗
PubMed1988

Reoperative surgery for early complications following abdominal and abdominothoracic operations.

In-hospital mortality was 9.6% in 3000 abdominal and abdominothoracic operations carried out by me or under my care. Intra-abdominal complications developing during the recovery period required reoperation in 141 patients. The decision to reoperate was a clinical one in 97.8%, although investigations were often helpful in localizing the site of the complicating lesion: the mortality in this group was 42.5%. Technical failure at the first operation could be indicated in 46%. Leaks and bleeding were most frequent and carried a high mortality. Patient selection and preparation, and selection of the simplest effective procedure, are not yet capable of being fully assessed in an individual patient.

Abdomen↗