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At least 883 records · Page 49Linked to original sources
PubMed1988

Persistent pain after excision of an interdigital neuroma. Results of reoperation.

Thirty-four patients (thirty-seven feet) had a reoperation for pain that persisted after excision of a plantar interdigital (Morton) neuroma. A longitudinal plantar incision was used in thirty-three feet and the previous dorsal web-space incision was used in four feet. Of the thirty-nine pathological specimens that were obtained intraoperatively, twenty-six (67 per cent) contained elements either of primary interdigital neuroma tissue or of an interdigital neuroma in association with an amputation-stump neuroma, indicating that the recurrent pain in these patients had probably resulted from an incomplete initial excision. All but one of the thirty-four patients were available for follow-up at an average of seventy-six months (range, ten to 124 months) postoperatively. Twenty-two patients (67 per cent) had complete relief from or marked improvement in pain, three (9 per cent) had improvement but had persistent pain, and eight (24 per cent) had no improvement or had worse pain. The longitudinal plantar incision was satisfactory in all but one patient and did not result in a painful plantar scar. The number of previously unsuccessful attempts that had been made to excise the neuroma did not adversely affect the results of reoperation in this group of patients.

Adult↗
PubMed1987

[Alkaline gastritis. Gastric reoperations].

The authors present 23 cases (1.6%) of reoperated patients with alkaline gastritis syndrome at Dr. Bonorino Udaondo National Gastroenterology Hospital. Over 1400 surgical operations performed in order to treat the gastroduodenal ulcer disease; 19 patients showed an evident syndrome of alkaline gastritis and the rest of cases had a mixed syndrome, because of another syndromes. The initial operation was a gastric resection Billroth II type in 22 cases and the rest are had a vagotomy with a gastroenterostomy. In all the cases, clinical, radiological, laboratory, endoscopy and histopathology aspects as well as Kay and Hollander test were studied. The modified surgical operations were: Soupault-Bucaille with isoperistaltic loop (7 cases), with anisoperistaltic loop Poth type (1 case), reoperations with the Y en Roux technique (14 cases), desgastroenterostomy, closing of the jejunal and gastric drainage and pyloroplasty (1 case). It was fulfilled with a vagotomy. The 50% of the cases have to 8 years after the operation; another were reexamined at 100 and 15 years being without symptoms.

Adult↗
PubMed1987

Technical complications and related reoperations after gastric banding.

Seventy-two patients who underwent gastric banding for extreme obesity were followed for a mean of 30 (range 12-54) months. The mean weight loss after 1 year was 41 kg. About two-thirds of the patients had only minor complaints postoperatively, but the others had complications, some of which were serious. Two patients died. Complications related to the banding technique necessitated 33 reoperations in 22 patients. The most common cause of reoperation/complication was functional stenosis of the upper pouch outlet, but only 3 of 22 revisional operations were successful. Reduction in band tension resulted in fewer reoperations but also less weight loss. The incidence of complications and the poor outcome of revision indicate that gastric banding should still be regarded as an experimental operation. Peroperative measurement of all technical details and careful and frequent follow-up examination are necessary in the search for an optimal technical procedure, giving good weight loss with a minimum of complications.

Adult↗
PubMed1987

[Reoperations in persistent and recurrent secondary hyperparathyroidism].

Forty-seven reoperations for persistent or recurrent secondary hyperparathyroidism (HPT) in 29 patients are reported. The patients are part of a group of 181 patients operated on for secondary HPT between 1975 to 1986. Most reoperations were performed in the neck (26 operations in 17 patients). The main cause were remaining parathyroid glands in the mediastinum (9 patients), followed by normally localized glands in the neck, which had not been discovered during previous operations. In 7 patients a hyperplasia of the autografted tissue was the reason for recurrent disease. They were treated by resection of the autograft. In 10 other patients autologous cryopreserved parathyroid tissue was reimplanted because of persistent postoperative hypoparathyroidism.

Adolescent↗
PubMed1987

[Reoperations on the lungs in children].

On the basis of an experience with 24 reoperations on the lungs in children at late terms, indications have been developed for such operations and for their volume. A rational complex of treatment in the period of preoperative management was determined. Technical and tactical errors occupied the main place in the structure of causes resulting in reoperations. Recovery was achieved in all the 24 patients.

Adolescent↗
PubMed1986

[Reoperation after treatment of a disk hernia. Comparison between radiology and surgical findings in 18 cases].

Eighteen patients with recurrent sciatica after lumbar disc surgery were investigated by both, myelography and computed tomography (CT) before reoperation. The radiological diagnosis according to the original x-ray report was correlated with the surgical findings at reoperation. Myelography reports describe morphological changes but often contain no definite diagnosis. CT reports usually contain detailed tissue diagnosis, but correlation with surgical findings is generally poor. Review of the original x-ray films leads to the following conclusions: At present, myelography is always indicated, except in suspected extreme lateral disc herniation. CT should be reserved for particular clinical or myelographic problems.

Humans↗
PubMed1986

Failures and reoperations following low-friction arthroplasty of the hip. A five- to fifteen-year follow-up study.

One thousand nine Charnley low-friction arthroplasties performed by one surgeon were investigated for occurrence of failure from five to 15 years after operation. Six hundred ninety-six of the arthroplasties, 499 operations for primary and 197 for secondary surgery, qualified for study. Eleven hips of the 499 primary arthroplasties (2.2%) and five hips of 197 secondary surgery (2.5%) required reoperation. Six hips (of five patients) in primary and four hips in secondary surgery were identified as "pending failure," for which further surgical correction may be imminent. There were six deep infections (1%), one in primary and five in secondary surgery. Five patients (0.7%) required reoperations other than revision of arthroplasty. Combining the actual and pending failures resulting from mechanical failures and deep infection, there were 31 failures in 696 arthroplasties (4.5%).

Adult↗
PubMed1987

Reoperations upon the biliary duct system for benign disorders are still indicated.

During the last 12 years, we performed 78 reoperations upon the biliary tract for benign disorders. Not included were early complications after the initial operation or endoscopic manipulation. The indications for reoperations were obstructive jaundice, recurrent colic and asymptomatic biliary fistula in 57, 18 and three patients, respectively. Endoscopic retrograde cholangiography was found to be the preoperative diagnostic method of choice. Intraoperative examination demonstrated cholangiolithiasis in 48 patients (five patients with stenosis), stenosis of the bile duct in eight, sump syndrome after choledochoduodenostomy in six and cholangitis without any further pathology in three. In three patients, the revision was negative. Several reinterventions were carried out: exploration of the bile ducts (12 per cent with papillotomy), removal of a biliodigestive anastomosis and a biliary enteric anastomosis in 52, 12 and 14 patients, respectively. The postoperative cholangiogram showed residual stones in 12 patients. Two-thirds of the stones disappeared spontaneously and one-third were removed endoscopically. There were local complications in 12 of the patients. The mortality rate was 6.4 per cent. All of these patients were more than 70 years old and were considered at high risk. In spite of endoscopic retrograde cholangiography, the number of operative reinterventions upon the biliary duct system has hardly declined over the last few years. This is partly due to new specific complications in connection with endoscopic retrograde endoscopy (perforation, hemorrhage or pancreatitis).

Bile Duct Diseases↗
PubMed1985

Computerized technetium/thallium scans and parathyroid reoperation.

Twenty-three consecutive patients who underwent reoperation for persistent primary hyperparathyroidism were studied with computerized technetium/thallium scans to evaluate it as a localization test. Prospective and blinded retrospective readings of the scans were correlated with findings at surgery. Computerized technetium/thallium scanning detected 52% of the parathyroid adenomas found at surgery. Forty-two percent of adenomas were localized exactly. There were no false positive scans. No normal parathyroid glands were imaged. No mediastinal glands were imaged. The study was not observer dependent. We conclude that computerized technetium/thallium scanning is helpful in patients undergoing parathyroid reoperation. If positive, it can accurately localize adenomas. If negative, we recommend more invasive studies.

Adenoma↗
PubMed1985

Resection and reoperation in neuro-oncology. Rationale and approach.

The author presents a discussion of the role of radical resection and reoperation in the treatment of patients with malignant brain tumors. Mechanical cytoreduction, morbidity and mortality associated with surgery, reoperation, principles of the surgical method, and the future of surgery are detailed.

Astrocytoma↗
PubMed1986

Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma.

Eleven patients who continued to have elevated calcitonin (CT) levels after thyroidectomy and central node dissection for medullary carcinoma of the thyroid gland (MCT) were subjected to additional surgery. Metastatic MCT was found in the excised tissue from each patient. Normalization of CT values was obtained in four patients who had a few microscopic, unilateral metastases. In these patients an average of 13 normal lymph nodes were excised at reoperation for each metastasis. The results of the reoperative series demonstrate that it is possible, with meticulous neck dissection, to normalize CT levels in patients with microscopic metastases from MCT. Metastases that can be seen or palpated are always associated with microscopic lymph node metastases. Removal of such microscopic metastases is probably the key to achieving normal postoperative CT levels.

Adult↗
PubMed1986

Reoperation for failed antireflux operations.

UNLABELLED: Experience with gastroesophageal reflux in patients without prior operations has yielded understanding of pathophysiology, surgical techniques, and results. Less is known about patients with failed antireflux operations. This report of 61 patients undergoing repeat antireflux procedures addresses this issues. Not included are patients with gastroesophageal reflux after ulcer operations or with inappropriate antireflux operations for motility disorders. Group A patients (n = 34) had only one previous operation, Group B (n = 19) had two, and Group C (n = 8) had three or more. Group C had significantly (p less than 0.05) more dysphagia and less heartburn than Group A. This observation correlated with findings from manometry, pH testing, and endoscopy, which showed progressively worse esophageal body function and a greater incidence of severe esophagitis and esophageal leak, but less gastroesophageal reflux, in Group C than B and in Group B compared to A. Operative mortality was 4.9%. Repeat antireflux operations in the 58 survivors were as follows: Group A included 25 standard antireflux procedures and seven bowel interpositions, and 75% were transthoracic. Group B included 16 antireflux procedures and one bowel interposition, and 82% were transthoracic. Group C included four antireflux procedures and three interpositions, and all were transthoracic. Clinical results were excellent or good in 85% in Group A, 66% in Group B, and only 42% in Group C (A versus C, p less than 0.05). Surgical complications increased from 27% in Group A to 75% in Group C (p less than 0.05). CONCLUSIONS: Patients with one prior operation and recurrent gastroesophageal reflux are similar to patients with no prior operations. Results of repeat antireflux operations deteriorate with increasing operations because of impaired esophageal function and progressive tissue destruction. Therefore, second reoperations must be definitive and resection and reconstruction with healthy tissue considered. A transthoracic approach is preferable for first reoperations and mandatory after multiple antireflux procedures.

Adolescent↗
PubMed1984

[Coronary reoperation--yes or no?].

From 1979 to April 1984, 51 patients were reoperated on for postoperative angina pectoris. Three patients died early and 4 late. The cause of death was cardiac in all cases. After the second operation the mean observation period was 24.2 months and the mean functional class 2.0. These results were somewhat worse than was to be expected after the first operation. The single significant risk factor was an ejection fraction reduced below 50%. The indication for reoperation should therefore be confined to patients with severe angina, good left-ventricular function, bypassable coronary arteries and sufficient graft material available (saphenous vein, internal mammary artery).

Adult↗
PubMed1984

Early and late prognosis after reoperation for prosthetic valve replacement.

From 1969 to 1983, 89 patients underwent replacement of a prosthetic heart valve, an average of 66 months after initial implantation, because of primary failure of the prosthesis in 39 patients (44%), endocarditis in 16 (18%), systemic valve-related complications in 16 (18%), and periprosthetic leaks in 13 (15%). In the remaining five patients (5%), a prosthesis was removed concomitantly with the replacement of another native heart valve. A mechanical valve was replaced in 64 cases (72%) and a bioprosthesis in 25 (28%). Forty-six of the prostheses (52%) were in the mitral position, 37 (42%) were in the aortic position, and six patients (6%) underwent replacement of two prostheses. Preoperatively, four patients were in Functional Class I, 21 in Class II, 37 in Class III, and 27 in Class IV. There were 19 early deaths (21.3%). Early mortality was significantly higher with aortic (35.1%) than with mitral prosthetic valve replacement (8.7%, p less than 0.01). Preoperative diagnosis had a significant correlation with mortality, which was higher with infective endocarditis (62.5%) than with all other indications for operation (12.3%, p less than 0.001). No correlation was found with the preoperative clinical class of the patients. During the time period of this study, there was a marked decline in the mortality rate, which decreased from 29.2% prior to 1979 to 7.4% during the last 2 years (p less than 0.05). Actuarial survival was 60% at 5 years and 38% at 10 years after reoperation. Among the 53 survivors followed up for an average of 39 months, 47 (88.9%) remained in Class I or II and six were in Class III (11.3%) at last follow-up. A second prosthetic valve replacement (third valve replacement) was required in eight patients, three of whom died at re-replacement. Recent improvements in myocardial protection techniques, in the treatment of prosthetic valve endocarditis, and increased surgical experience have contributed to decrease the risk of reoperation for prosthetic valve replacement. Late results are similar to those of a first valve implantation.

Actuarial Analysis↗
PubMed1984

[Reoperation following aortocoronary bypass. Indications and results].

Aorto coronary reoperation can be performed with a low morbidity and mortality rate which approaches that of initial surgical procedures. Increasing experience in setting indication and in managing surgical procedures has led to better results during the last years. There is a good prognosis in such cases having only singular new stenoses in greater coronary vessels, which still have a good run off. Also good results can be expected in patients suffering from stenotic or completely occluded grafts, without progression of disease. Only 50-60% of the reoperated patients obtain complete relief of angina, which is comparable to our results of 41 cases.

Angina Pectoris↗
PubMed1983

Reoperative abdominal arterial surgery--a ten-year experience.

The safety and durability of elective reconstructive procedures of the abdominal aorta and its major branches are universally accepted; however, late complications continue to threaten limbs and lives of a minority of patients. The strategy of managing such revascularization failures has received inadequate attention. Between February 1971 and July 1981, 76 patients underwent 83 remedial, transabdominal revascularization procedures because of failed reconstructions. Group I consisted of 34 patients with occlusive complications (0% remedial operative mortality rate); group II, 21 patients with prosthetic sepsis including graft-enteric fistula (14% operative mortality); group III, 11 patients with aneurysmal degeneration (36% operative mortality); and group IV, 10 patients with visceral ischemia (0% operative mortality). The remedial operative mortality rate for the combined groups was 7.9%. Limb preservation was the rule in group I (91%); however, 29% of limbs at risk in group II ultimately required major amputation (15% early, 14% late). All patients in group II without an established graft-enteric fistula were saved; however, three of ten with active hemorrhage died of the sequelae of hypovolemic shock. Progressive arteriosclerotic morbidity and massive intraoperative bleeding accounted for the high mortality rate in group III. Favorable results were obtained in reoperation for recurrent visceral ischemia (renal ischemia in five, mesenteric ischemia in five). On the basis of this experience, an aggressive surgical approach seems justified. First, complete bifemoral revascularization performed at the time of original operation should reduce the need for reoperation. Second, elective, transabdominal remedial arterial surgery can be done with acceptable morbidity and mortality rates. Third, graft-enteric erosions and periprosthetic sepsis must be treated aggressively to avoid life-threatening sepsis and hemorrhage. Finally, anatomic revascularization can be performed successfully after a suitable period following removal of an infected retroperitoneal prosthesis.

Adult↗
PubMed1983

[Late reoperations in cancer surgery of the lung].

In early reoperations following surgery of the lung haemorrhage comes first. In the late phase of reoperations, i.e. more than 3 months till 6.5 years after surgery, 12 secondary operations were performed for metachronic carcinomatous tumours and due to insufficient "radical" surgery. The postoperative mortality rate was 0. The results obtained are in favour of secondary operations because they are able to prolong the life expectancy of those patients.

Adult↗