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 847 records · Page 47Linked to original sources
PubMed2001

Cardiac reoperation in a patient with osteogenesis imperfecta: a case report.

A case of a 40-year-old man with dehiscence of the prosthetic aortic valve and recurrence of mycotic aneurysm of the left ventricular outflow tract with osteogenesis imperfecta is presented. He had an operation of aortic valve replacement and direct closure of the mycotic aneurysm for infective endocarditis twenty-one months ago. We performed reoperation of prosthetic aortic valve, patch closure of the mycotic aneurysm and graft replacement of the ascending aorta. He was complicated with multiple fractures of bilateral scapla and dislocation of left shoulder one postoperative day. Fortunately, cardiac reoperation was performed successfully in this patient despite anticipated difficulties with tissue friability with osteogenesis imperfecta.

Adult↗
PubMed2001

Reoperative Snodgrass procedure.

PURPOSE: We examine the results of a reoperative Snodgrass procedure for complex hypospadias. MATERIALS AND METHODS: A total of 25 patients with hypospadias in whom repair had failed underwent a reoperative Snodgrass procedure. Mean patient age and number of prior repairs were 11.4 years and 2.5, respectively. Before this treatment the meatus was at the distal shaft in 10 cases, mid shaft in 9, proximal shaft in 4 and penoscrotal junction in 2. Preoperatively the associated complications were fistulas in 13 patients, residual chordee in 12 and diverticulum in 1. In 8 cases the fistula was incorporated into the hypospadiac opening and treated as a longer defect. The urethral plates were, subjectively, surgically altered or unaltered in 7 and 18 patients, respectively. In 8 patients (group A) the previous repair(s) did not involve dissection of the urethral plate (unaltered) nor was there a fistula. The remaining 17 patients were classified as group B. The neourethra was then reconstructed as the Snodgrass technique. Followup urethral calibration was performed in 17 patients. RESULTS: Mean followup period was 13.7 months. Mean length and size of neourethra were 19.9 mm. and 14Fr, respectively. There were 7 (28%) postoperative fistulas of the neourethra. The incidences of postoperative fistula of the neourethra were 0% and 41.2% in groups A and B, respectively (p <0.01). Statistically the surgically altered urethral plate and the presence of a preoperative fistula were 2 independent factors predicting a higher postoperative fistula rate. The overall postoperative meatal stenosis rate was 13 (52%) with 3 (37.5%) in group A and 10 (58.8%) in group B, respectively (p >0.05). The meatal stenosis was treated with simple dilation in 11 cases and meatoplasty during subsequent fistula repair in 2. Stricture at the anastomostic site between the normal urethra and neourethra was noted in 2 patients. Fistula repair was successfully performed 6 months later in 4 patients. CONCLUSIONS: The Snodgrass procedure is a viable option for the treatment of previously failed hypospadias repair. It was highly effective in patients with a surgically unaltered urethral plate and no preoperative fistula.

Adolescent↗
PubMed2001

[Reoperations in thyroid gland cancer].

Results of reoperation for the thyroid gland cancer (THGC) were analyzed in 189 patients for 1981-2001 yrs period. Majority of patients were primarily operated in other hospitals of Ukraine. Thorough characteristic of the cancer forms, terms of reoperation performance, results of histological investigation of the tumor are adduced. Large frequency (41.2%) of the operation performance for THGC recurrences in term up to one years after performance of primary intervention trusts the necessity of operative intervention performance on thyroid gland (THG) in specialized centre by experienced surgeons. Absence of malignant growth in the THG stump while performance of definitive thyroidectomy in 60% of observations is not the cause to reject of doing it because the conduction of radioiodine therapy is possible after complete excision of the THG tissue. Examination and ultrasonographic investigation of the THG region and of cervical lymphatic nodes after performance of operation for THGC is recommended to conduct no less than once in 6 months.

Adolescent↗
PubMedDate not supplied

[Reoperations in lung surgery].

A second thoracotomy in patients who have undergone previous chest surgery can be performed soon or immediately after the first operation and is usually aimed at resolving severe or even life-threatening postoperative complications. Late reoperations, on the other hand, are either performed to resolve complications of previous surgery or to remove second primary lung tumors (SPLCs) or metastases. The most exacting reoperation in this context is completion pneumonectomy, which is particularly indicated in the case of failure of the residual lobe to re-expand after primary surgery; it is also used for--rarely occurring--fistulas of the lobar bronchi and for new ipsilateral primary lung tumors. This type of surgery is technically complicated and has been associated, in our experience and that of others, with a certain mortality. Technically less difficult is a second ipsilateral thoracotomy for exploratory purposes or minor parenchymal resection, and the same is true of contralateral lobar or sublobar resections. Lastly, Abruzzini's operation, for fistulas of the primary bronchus, is relatively complicated but often leads to good results; we have performed 15 such operations with only one death occurring due to acute myocardial infarction.

Adolescent↗
PubMedDate not supplied

[Reoperation on the femoral arterial bifurcation: technical notes and surgical strategy].

Femoral bifurcation reoperation is a stern test for skilfull surgeons, owing to the presence of thick scar tissue from the previous operations, especially when prosthetic grafts are used. In cases of aorto-femoral graft thrombosis, if thrombectomy of the entire graft is possible, one could isolate the anastomotic tract with all the afferent vessels and construct a new anastomosis downstream in tissue which allows a better run-off. Often in our experience we executed a by-pass, with a vein or short tract of new graft, from the previous prosthetic branch to a distal part of the deep femoral artery. In this way the reoperation is faster and safer, limiting dangerous dissection times. In infected inguinal pseudo-aneurysms we prefer an axillo-femoral by-pass, with isolation of the deep femoral artery by lateral incision, outside the infected field. In the non-infected ones, the reconstruction involves the use of a new small-sized graft between the previous structures. In cases of femoro-femoral occlusion we think it is better, first of all, to evaluate the possibility of an orthotopic graft from the aorta or iliac artery.

Aneurysm, False↗
PubMed2002

Laparoscopic reoperation following unsuccessful antireflux surgery in childhood.

We determine the feasibility of laparoscopic revision surgery in children following previous open and laparoscopic antireflux operations. To give an objective overview about this topic, we analyzed the outcome of 15 children (8 girls and 7 boys) who had undergone attempted laparoscopic revision between 4 and 72 months (median 16 months) after a previous antireflux operation. Seven patients had previously undergone an open antireflux procedure (4 Nissen fundoplication; 3 Thal procedure) and 8 a laparoscopic procedure (5 Nissen; 3 Toupet's procedure). Two of these children were mentally handicapped. The indications for revision were: recurrent reflux, 5; valve migration, 5; valve dismount, 5. Eight procedures comprised construction of a new Nissen fundoplication and in 7 cases a Toupet's procedure was performed. Revision was successfully completed laparoscopically in 10 cases, 7 of 8 patients following a previous laparoscopic procedure and in 3 of 7 following a previous open operation. Operating time ranged between 70 and 140 minutes (median 90 minutes). No perioperative complications occurred in either group. All patients were discharged within 3 to 4 days after the redo procedure. Follow-up time varied between 6 months and 7 yrs. Preoperative symptoms were relieved in all patients and all antireflux medication has been discontinued, except in two cases that still had rare symptoms. Although technically challenging, laparoscopic reoperation for recurrent gastroesophageal reflux disease can be performed safely and with good results, in the hands of experienced endoscopic surgeons. Reoperation is likely to be more difficult following failure of an open procedure than after failure of a laparoscopic one. Concerning the type of procedure, redo surgery is more difficult to perform after Nissen's than after Toupet's or Thal's procedure.

Child↗
PubMed2002

Surgical experience in fifty-five consecutive reoperative fundoplications.

Laparoscopic antireflux surgery has dramatically changed the way heartburn and regurgitation have been managed over the last 10 years. The possibility of surgical correction with limited morbidity has resulted in a substantial increase in the number of fundoplications performed. Given that the rate of operative failure can be expected to be constant the need for surgical management of recurrent symptoms will become more prevalent. Between August 1996 and December 2001 55 patients presented with recurrent symptoms after a previous antireflux surgery. The presentation, management, and operative outcomes of patients undergoing reoperative fundoplication were studied. The 55 patients (25 male and 30 female) had a mean age of 47.1 years (range 22-69 years). Mean laparoscopic operative time was 234 minutes (range 180-330 minutes), and mean open time was 261 minutes (range 150-390 minutes). A laparoscopic repair was attempted in 45 patients and was completed without conversion in 37 (82.3%); seven of the eight patients requiring conversion had at least one prior open antireflux procedure. Average length of stay was 4.6 days (range one to 46 days); laparoscopic patients were in the hospital an average of 2 days (range one to 6 days). There were eight (12.7%) perioperative complications, no esophageal leaks, and no deaths. Average follow-up was 21.3 months (range 1-65 months). In patients who had a definitive antireflux procedure (53) 49 (92.5%) reported good to excellent outcomes; four had fair outcomes. All stated they were improved. Four patients reported occasional dysphagia, three reported intermittent nausea, five have infrequent to frequent chest pain, and four have diarrhea at least weekly. Despite being technically difficult reoperative fundoplication effectively alleviates dysphagia, regurgitation, and reflux symptoms in the majority of patients with low operative morbidity. The operation can be completed laparoscopically in most of those whose original operation was performed laparoscopically.

Adult↗
PubMed2002

[Coronary bypass surgery in 1971-80 and 1995-96: increased age and comorbidity, unchanged survival rates and fewer early reoperations 1 and 5 years postoperatively].

OBJECTIVE: To describe the characteristics of patients undergoing coronary bypass surgery (CABG) over the past 30 years and the outcome after 1 and 5 years. DESIGN: Retrospective. METHOD: All 1041 patients who had undergone a first CABG in the Thorax centre of the Erasmus Medical Centre in Rotterdam during the period from 1 July 1971 through 31 May 1980 (group I) were compared with all patients who had also undergone such a first operation during the period between 1 September 1995 and 31 December 1996 (group II). Data on the patients, the operations, any reoperations and the mortality were obtained from patient records, from general practitioners and from municipal archives. Cumulative percentages of survival and of not having reCABG or percutaneous transluminal coronary angioplasty (PTCA) were analysed by using the Kaplan-Meier-method. RESULTS: The patients in group I were 11 years younger on average than those in group II and there were more men (group I: 88%, group II: 76%). The patients in group II had more comorbidity than those in group I. The actuarial perioperative mortality was 1.2% in group I and 1.6% in group II. The overall 5-year mortality was significantly lower in group I than in group II (9.1% vs. 11.0%). After adjustment for the baseline characteristics, however, the patients in group II had a lower risk of mortality. Coronary revascularisation in the first 5 years was required more often in group I than in group II (7.4% vs. 4.2%). Independent predictors of a higher 5-year mortality were: a reduced ejection fraction (both groups), more extensive vascular disease (group I), chronic pulmonary disease, renal function disorders and diabetes mellitus (all group II), while treatment for hyperlipidaemia had a favourable effect on survival. CONCLUSION: The age and comorbidity of the operated patients had increased over the years, while the chance of survival was no less than before and there was less chance of an early reoperation.

Adult↗
PubMed2002

Reoperation for a patient 25 years after a Starr-Edwards ball mitral valve was installed.

A 45-year-old female suffered from increasing dyspnea during exercise and edema of lower extremities from January 2000. She had undergone mitral valve replacement with Starr-Edwards ball prosthesis (model 6320) due to mitral valve regurgitation 25 years ago. The cardiac catheterization and echocardiography documented mitral, aortic and tricuspid valves regurgitation grade III. Left ventricular ejection fraction rate was 49% and the pressures of CVP, RA, RV and PA were also increased. Laboratory examination showed slight hemolytic anemia. Double valve replacement (ATS valve) and tricuspid annuloplasty were carried out in April 2000. Strut cloth wear was confirmed at operation. Her postoperative course was uneventful. We hereby review the published paper of all cases with an implanted Starr-Edwards ball valve who required redo valve replacement with over 15 years follow-up. We consider that cloth injury is the main cause for reoperation and it usually associated with hemolytic anemia; cloth wear not only involves the aortic position but also frequently involves the mitral position for over 15 years follow-up patients and can be corrected by reoperation. Cloth wear should be concerned for those surviving patients who have received the Starr-Edwards ball valve during long-term follow-up.

Anemia, Hemolytic↗
PubMed2002

[Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation].

OBJECTIVES: We investigated the causes of failure and ensuing problems and findings in patients with unrelieved or recurrent carpal tunnel syndrome (CTS) and evaluated the results of revision surgery. METHODS: The study included 26 patients (21 women, 5 men; mean age 52 years; range 30 to 71 years) who underwent reoperation for unrelieved or recurrent symptoms following at least a year (range 1 to 4 years) after the initial surgery. A total of 34 operations had been carried out in 31 hands. All patients were investigated clinically and electrophysiologically. The mean follow-up after reoperation was 19 months (range 12 to 38 months). RESULTS: The diagnosis was confirmed in all patients by clinical and electrophysiologic studies. The primary operations had been performed using 11 transverse incisions, three incisions confined proximally to the wrist crease, 10 incisions without insufficient distal extension, and seven appropriate incisions. The transverse carpal ligament release was inadequate in 23 hands; it had not been released in three hands at all. Excessive fibrous tissue developed in one patient, leading to complete bilateral median nerve compression. Bilateral and unilateral tenosynovitis resulting from rheumatoid arthritis and tuberculosis was detected in two patients, respectively. All patients underwent repeat open carpal tunnel release. Neurolysis and tenosynovectomy were performed in both hands of one patient and in one hand of two patients, respectively. Clinical results were excellent in 24 hands, good in six hands, and fair in one hand. CONCLUSION: Selection of appropriate incision and achievement of complete carpal tunnel release without any injury to the median nerve or its branches are of great importance with regard to postoperative results. Careful imaging studies of the carpal tunnel should be carried out especially in patients with unilateral involvement, presenting with an atypical age or occupation.

Adult↗
PubMed2003

The reoperation of failed rotator cuff repairs.

BACKGROUND: Operative management of a failed primary rotator cuff repair is very difficult, and the results are also less satisfactory. In order to identify which factors are responsible for the failure of the initial surgery and which factors are correctable with reoperation, the results of surgical treatment for failed initial rotator cuff repair were analyzed. METHODS: Twenty patients with a previous repair of the rotator cuff received a second operation for pain and functional impairment. The second repair was performed with an average interval of 11.8 months from the primary repair. The average follow-up was 60.7 months and the results were rated on the basis of pain, range of motion and function. RESULTS: Multiple factors accounted for the failure of initial surgery: large to massive tear at the time of previous repair (80%), persistent subacromial impingement (75%), poor condition of the deltoid muscle (35%), rupture of the long head of biceps tendon (25%), poor quality of cuff tissue (25%) and severe subacromial or intra-articular adhesion (20%). After reoperation, 15 patients (75%) had pain free or occasional aching soreness. Eleven patients (55%) had active forward elevation over 120 degrees, while the average preoperative motion was 80 degrees and the postoperative motion was 127 degrees. Twelve patients (60%) had no functional impairment or were left with some restriction. Over-all satisfactory results were noted in eleven patients (55%). CONCLUSIONS: The most common factors associated with the failure of the initial repair were large to massive tear and inadequate acromioplasty. Most factors could be avoided at the initial repair, while several factors such as irreparable massive tear, poor deltoid function and poor cuff tissue were very difficult to be corrected at the repeat repair. The primary goal should be relief of pain instead of functional improvement. Since the results were not consistent, careful assessment and management should be made in the initial attempt.

Adult↗
PubMed2003

[The complications of reoperation for thyroid disease after a thyroidectomy].

OBJECTIVE: To find out the morbidity of reoperation for thyroid disease, and discuss its complications and the risk factors associated with it. METHOD: Retrospective study. Incidence of recurrent laryngeal nerve palsy and hypoparathyroidism. This paper reported 43 cases underwent secondary thyroidectomy during the year from 1997 to 2001 in our hospital. Frozen sections were done in all cases during the operations. RESULT: Of the 43 cases, the initial frozen sections pathologic diagnosis were benign diseases in 30 cases, but their last pathologic diagnosis were malignant change after the first operation. Complications were 6 transient palsy of the recurrent laryngeal nerve, 2 patients developed permanent unilateral palsy and one temporary hypoparathyroidism. CONCLUSION: Frozen section helps to raise the accuracy of diagnosis. Secondary thyroidectomy can be avoided by selecting suitable types of operations. Subtotal thyroidectomy of benign nodular thyroid will be good for preventing recurrence. Secondary thyroidectomy should be safe procedure. Because of the high risk of complications reoperations for thyroid gland disease should be done only if the patient cannot be treated in other ways.

Adolescent↗
PubMed1992

Techniques of valvular reoperation.

Valve replacement is simply the exchange of one disease for another. Degeneration of bioprostheses and thrombotic obstruction of mechanical valves, other forms of prosthetic dysfunction and prosthetic valve endocarditis are the main complications leading to reoperation. Repeat valve surgery is more complex than primary surgery and therefore carries a higher mortality and morbidity, even in the hands of experienced surgeons. Several technical details of valve replacement have contributed to the improved results obtained by some surgical groups. Difficulties start with the opening of the sternum, especially in cases where the pericardium was not closed during the initial operation. Cardiopulmonary bypass may be instituted in the usual fashion or may be done by cannulation of the femoral or iliac vessels. The heart need not be completely liberated from the adhesions. Access to the aortic root is usually not difficult, but the left atrium may be less accessible. Removal of the prosthesis also requires precise technique, for disruption of the annulus or damage to other valves or neighbouring structures may occur. Finally, the choice of valve substitute and technique of implantation must be tailored to the patient's characteristics and the type of pathology. One of the most important causes of morbidity and mortality after reoperation is perioperative and postoperative bleeding, resulting from the extensive dissection and from the coagulation disorders, including anticoagulation treatment. Pharmacological manipulation has recently contributed to reduce the severity of this complication. The results of repeat valve surgery have improved markedly and have now reached values which approximate those of primary valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Loss, Surgical↗
PubMed2004

Proliferation activity and apoptosis in granulation tissue and cholesteatoma in middle ear reoperations.

The aim of the study was to find out the potential prognostic value of proliferation activity and apoptosis in cholesteatoma and granulation tissue removed during middle ear reoperation in recurrent middle ear inflammation. Granulation tissues and recurrent cholesteatoma were analysed after being surgically removed from the middle ear in a group of 25 patients qualified for middle ear reoperation procedure. Paraffin sections were stained with haematoxylin and eosin according to Mallory's method. Immunohistochemical reaction Anti-PCNA was performed. Apoptosis was evaluated using the TUNEL method. The percentage of PCNA-positive cells was 42-95% in the matrix of the cholesteatoma and 29-81% in the perimatrix. In the granulation tissue it was 35-75%. The percentage of apoptotic cells was 12-73% in the matrix of the cholesteatoma, 5-72% in the perimatrix and 1-65 % in the granulation tissue. The prognostic value of the parameters studied in the recurrent middle ear inflammatory process is questionable, probably due to the small number of cases under examination.

Adult↗
PubMed2004

Reoperation for severe right ventricular dilatation after tetralogy of Fallot repair: pulmonary infundibuloplasty should be added to homograft implantation.

BACKGROUND AND AIM OF THE STUDY: Right ventricular dilatation observed after tetralogy of Fallot repair regresses after pulmonary valve implantation, unless the dilation is too severe. The presence of an akinetic patch in the right ventricular outflow tract (RVOT), a known factor promoting right ventricular dilatation, may prevent right ventricular recovery after valve implantation. The exclusion of a large akinetic RVOT area during reoperation of patients presenting with severe post-repair right ventricular dilatation was investigated. METHODS: Eight patients underwent a pulmonary infundibuloplasty between May 2000 and October 2002. Their mean preoperative cardothoracic index was 0.66 +/- 0.08, and preoperative NYHA class II (n = 4), III (n = 3) or IV (n = 1). Three patients were offered heart transplantation but refused. All had severe pulmonary regurgitation and underwent a RVOT valve implantation except one patient who had a previous homograft pulmonary valve insertion. Concomitant procedures were tricuspid ring implantation (n = 3), atrial septal defect closure (n = 2), mitral valve repair (n = 1) and modified right atrial Maze (n = 1). RESULTS: Median follow up time was 13 months (range: 6 -29 months). One patient suffered a fatal ventricular fibrillation at home. All patients but one were in NYHA class I. After a mean of 5 +/- 3 months, their mean workload capacity rose from 115 +/- 19 W to 155 +/- 62 W, and mean VO2max rose from 16.5 +/- 2 to 18.3 +/- 2 ml/min/kg. CONCLUSION: Pulmonary infundibuloplasty may be a useful adjunct in reoperation of tetralogy of Fallot patients presenting with severe right ventricular dilatation and large akinetic area of the RVOT.

Adolescent↗
PubMed2002

Symptoms and reflux competence in relation to anatomical findings at reoperation after laparoscopic total fundoplication.

OBJECTIVE: To investigate the mechanisms and anatomical failures after total laparoscopic fundoplication using the symptoms and findings at reoperation. DESIGN: Prospective open study. SETTING: University hospital, Sweden. PATIENTS: Twenty-one patients who were reoperated on a median of 33 (0.5-102) months after laparoscopic fundoplication. INTERVENTIONS: The patients were divided into three groups according to the mode of presentation. The first group presented with dysphagia and no gastro-oesophageal reflux (GOR) (n = 6). The second group (n = 11) had recurrent GOR and the third group (n = 4) complained of a sense of excessive fullness. RESULTS: In the dysphagia group the reason for it in 4 patients was severe fibrosis in the hiatal region including the right part of the fundoplication. One patient had correctly located fundoplication but it was too tight. In the last patient the part of the stomach used was too low down. All patients in the GOR group had a slippage and rupture of the fundoplication. Ten patients also had a recurrent hernia. In 6/11 patients the fundal mobilisation was incomplete. In the last group (excessive fullness) one patient had a postoperative leak from the fundal part, one patient a para-oesophageal hernia, and one patient an intact but herniated repair. One further patient had an intact abdominal oesophagus and crural repair, but a large portion of the stomach had herniated through the left part of the fundoplication and acted as a volvulus. CONCLUSIONS: Dysphagia was caused by hiatal fibrosis or other technical failures rather than a normal tight fundoplication. Using the wrong part of the stomach causes recurrent heartburn. The laparoscopic suturing technique must be improved.

Adult↗
PubMed2004

Reoperations in patients with patent left internal mammary artery.

In the past decade the rate of reoperative coronary bypass grafting has averaged 8%. In these patients adequate myocardial protection is often difficult because delivery of cardioplegia is frequently suboptimal when the internal mammary artery graft is patent. We describe a simple technique for performing cardiac reoperation in patients with a patent left internal mammary artery graft through a balloon catheter used for angioplasty and positioned in the left internal mammary artery graft. Our study included 3 patients and there were no operative deaths and complications.

Aged↗
PubMed2005

Arch-first technique via clamshell incision: successful surgical reoperation for aortic arch dissection.

We report a case of successful reoperation for aortic arch dissection with use of the "arch-first" technique in a patient who had Marfan syndrome. Extracorporeal circulation was initiated via right subclavian artery cannulation, and the chest was entered through a clamshell incision for the best exposure. When the patient was cooled to 18 degrees C, the perfusion was stopped. After the 1st aortic arch anastomosis to a 30-mm Dacron graft, cerebral perfusion was reestablished via the right subclavian artery. The aortic repair was then completed. The cerebral ischemic time was 18 minutes, the aortic cross-clamp time was 69 minutes, and the total extracorporeal circulation time was 334 minutes. The patient was discharged from the hospital on postoperative day 10 with no neurologic impairment. The arch-first technique shortens the duration of brain ischemia. When combined with a clamshell incision, the technique is particularly helpful for reoperation of the aortic arch and thoracic aorta.

Adult↗