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At least 919 records · Page 51Linked to original sources
PubMed1993

Reoperation for recurrent or persistent medullary thyroid cancer.

BACKGROUND: Initial operations for medullary thyroid cancer (MTC) frequently do not eradicate all disease, as evidenced by persistently elevated levels of stimulated plasma calcitonin. METHODS: Thirty-two patients with MTC and elevated stimulated plasma calcitonin levels after thyroidectomy were studied between 1990 and 1993. Thirty-five repeat neck explorations and microdissections were performed. Four patients also underwent a median sternotomy and mediastinal dissection. RESULTS: In nine patients (group 1), stimulated plasma calcitonin levels were undetectable after reoperation, whereas in 13 cases (group 2) the calcitonin levels decreased by 40% or more. In 10 cases (group 3) the CT levels did not decrease. Primary tumors that exhibited invasive features (invasion of adjacent structures or extranodal or extracapsular spread) were found more often in patients from group 3 than in patients from groups 1 or 2 (p < 0.05, Fisher's exact test). CONCLUSIONS: Reoperation resulted in normalization of calcitonin levels in 28% of patients and a decrease in calcitonin levels by 40% or more in another 42% of patients. The data also suggest that patients whose primary MTC has invaded tissues beyond the thyroid gland or a lymph node capsule are less likely to benefit from repeat operation.

Adolescent↗
PubMed1993

Myocardial protection for reoperative cardiac surgery in acquired heart disease.

We have reviewed a variety of techniques that have recently been used to improve the results of reoperation coronary bypass valve re-replacement and redo thoracic aortic surgery. The basic tenets of management in these high-risk areas are: (1) innovative use of cardiopulmonary bypass techniques to improve patient safety, including deep hypothermic arrest, (2) use of retrograde as well as antegrade infusion of cardioplegic solutions, (3) meticulous operative technique, (4) prevention of left ventricle distension, (5) TEE monitoring of intracardiac air, and (6) careful post-bypass hemodynamic monitoring. Reoperative CABG specifically requires avoiding injury to previously placed open conduits or atherosclerotic conduits, an increasingly recognized risk factor in these patients. Though direct myocardial cardioplegic protective techniques are very important for reducing operative risk, the importance of the total operative plan is critical for maximizing patient safety and ensuring improved long-term survival.

Aortic Aneurysm, Thoracic↗
PubMed1995

Our experience with reoperations for the diagnosis of the carpal tunnel syndrome.

On the basis of the analysis of the results obtained and of the surgical findings during reoperations for the diagnosis of the Carpal Tunnel Syndrome it is recommended to perform a reoperation in cases of primary failure. Underlined is the surgical approach with the use of a prolonged incision, as well as an adequate postoperative care.

Carpal Tunnel Syndrome↗
PubMed1995

Left ventricular function and valvular reoperations.

Between 1961 and 1994, 1,120 adult and adolescent patients had reintervention on the aortic, mitral or both valves. Operative mortality was 7%; five, 10, 15 and 20 year survival rates were 81%, 65%, 54% and 52%, respectively. From the sixties to the nineties, the number of procedures (58 to 304), the age of patients (40 to 57 years), incidence of acute endocarditis (0 to 9%), concomitant coronary surgery (0 to 13%) and the number of repeated interventions (5% to 22%) gradually increased. Despite such increasingly difficult conditions the operative mortality remained low and five-year survival acceptable during the last 20 years. Operative mortality was significantly higher in patients over 65 years (11% vs. 5%), in cases with additional coronary surgery (16% vs. 5%) or interventions on the ascending aorta (17.5% vs. 5%). Left ventricular systolic function was quantitatively assessed before reoperation in 372 patients. In patients with stenotic mitral lesion or with aortic valvular lesion and additional surgical interventions reduced ejection fraction (< 50%) had no effect on late outcome. In regurgitant aortic and mitral lesions and interventions on both valves, there was a trend for less successful late outcome after reintervention, but the difference did not reach statistical significance. It is concluded that valvular reoperations can be performed nowadays with only slightly increased operative risk and an acceptable late outcome as compared to primary valvular operations. Hemodynamically significant valvular and/or prosthetic lesion should be corrected again without delay regardless of an impaired left ventricular function.

Adolescent↗
PubMed1995

[New approach for defibrillation after cardiac reoperation].

Cardiac reoperations are associated with several complications such as ventricular lacerations, major vessel trauma, and ventricular arrhythmias. As it is impossible to defibrillate before ending the pericardial dissection, this latter complication increases the mortality rate in the perioperative period. In those instances, the self-adhesive electrode pads for external defibrillation were proven effective for cardioversion and defibrillation, even in the presence of adherences. In our institution, these electrode pads are compulsory for all patients requiring cardiac reoperation. The apex pad covers the cardiac apex in the V5 and V6 electrode derivations, while the posterior pad is placed over the right infrascapular area, which reduces the risk of hazardous current concentration. In addition, it does not obstruct the operative site and the pads can be connected to a R2 cable adaptor compatible with regular leading defibrillating systems. The electrode pads were tested on 132 of the 508 patients (26%) requiring cardiac surgery during a 6-month period. Eighteen of these cases (14%) required one or more defibrillating during the operation. The benefits of using this system (R2 Corporation, Skokie, Ill) include: a smaller dissection, reduced blood loss, lower numbers of blood transfusions, and decreased operating time. When the electrode pads remain in place during the patient's transfer to the intensive care unit and the first hours thereafter, they can be used again this time to control arrhythmia complications after the surgery.

Cardiac Surgical Procedures↗
PubMed1996

Reoperative surgery for recurrent strictures of the penile and bulbous urethra.

PURPOSE: We evaluated the outcome of reoperation for anterior urethral strictures. MATERIALS AND METHODS: Strictures that recurred after urethroplasty were repaired by various procedures in 20 patients (penile urethra in 8 and bulbous urethra in 12, mean followup 57 months). RESULTS: Of the recurrent penile urethral strictures 3 showed excellent and 5 satisfactory results, compared to 9 and 3, respectively, for bulbous urethral strictures. Overall 60% of the cases had an excellent outcome and no failures were documented. CONCLUSIONS: Any type of urethroplasty may fail even after a considerable period but reoperation with proper indications can offer a lasting solution.

Adolescent↗
PubMed1996

Reoperative mitral valve surgery via right thoracotomy: decreased blood loss and improved hemodynamics.

BACKGROUND AND AIMS OF THE STUDY: Reoperative mitral surgery via sternotomy can be associated with significant complications, including excessive blood loss and injuries to the heart, great vessels and patent coronary artery grafts. The right antero-lateral thoracotomy offers excellent exposure with less risk from re-entry. MATERIALS AND METHODS: Between 1982 and 1992, 221 patients had repeat mitral valve procedures at our institution. Fifteen of these 221 underwent mitral valve replacement via right thoracotomy. Indications for surgery in each group included bioprosthetic valve failure, paravalvular leak and bacterial endocarditis. Fifteen patients having reoperative mitral valve surgery via right thoracotomy approach were compared with a control group of 33 patient who underwent surgery via repeat sternotomy. All thoracotomy patients underwent mitral replacement or repair with ventricular fibrillation without aortic cross-clamping. Operative time, cardiopulmonary bypass time, requirement for inotropic support, blood loss within the first six postoperative hours, number of blood units transfused, length of ICU stay, days to discharge, and 30-day survival were compared between the two groups. In addition, the preoperative PaO2/FiO2 (P/F) ratio was evaluated as a prognostic indicator. RESULTS: Bypass time (162 +/- 43 min thoracotomy group vs. 131 +/- 34 min sternotomy group), operative time (389 +/- 100 min thoracotomy group vs. 450 +/- 25 min sternotomy group), ICU stay (6 +/- 8 days thoracotomy group vs. 5 +/- 6 days sternotomy group), P/F ratio (352 +/- 142 thoracotomy group vs. 423 +/- 108 sternotomy group), and 30-day survival (93% thoracotomy group vs. 91% sternotomy group) were not found to be significantly different between groups. Of great significance was the reduction in blood loss (277 +/- 152 ml thoracotomy vs. 651 +/- 504 ml sternotomy, p < 0.05) and blood transfused (2.0 +/- 1.7 units thoracotomy vs. 6.5 +/- 3.3 units sternotomy, p < 0.01) with the thoracotomy approach. Also of significance was a reduction in frequency with which significant inotropic support was needed to separate from cardiopulmonary bypass (26% vs. 63%, p < 0.05). Despite decreased access to the heart for de-airing maneuvers, no cerebrovascular events whatsoever were noted with the thoracotomy approach. CONCLUSION: The right thoracotomy approach is recommended for redo mitral valve surgery. Despite these advantages, severe pulmonary dysfunction (as indicated by a P/F ratio less than 300) correlated with a prolonged hospital course in four thoracotomy patients; such patients should have repeat sternotomy.

Blood Loss, Surgical↗
PubMed1996

[Tricuspid valve replacement by right thoracotomy with minimal dissection in reoperations].

We report two cases of tricuspid valve replacement for tricuspid valve insufficiency as reoperations following mitral valve replacement through midline sternotomy. A right thoracotomy was used to approach the tricuspid valve. To avoid the risk of cardiac laceration, cardiopulmonary bypass was instituted after cannulation of the femoral artery and of superior vena cava through right atrium with balloon caval occlusion and inferior vena cava through the femoral vein with balloon caval occlusion. Without aortic cross clamping under mild hypothermia, right atriotomy was performed through adherent parietal pleura, pericardium, and right atrial wall without dissection. Tricuspid valve was replaced utilizing the bioprosthetic valve with good clinical results. These new measures were expeditiously carried out without dissection of the heart, which has been deemed to be the risk of reoperations.

Bioprosthesis↗
PubMed1996

[Reoperation for aortic valve replacement after myocardial revascularization].

A series of 13 patients (11 male, 2 female, average age 61 +/- 6 years) with previous aortocoronary bypass surgery and reoperated for aortic valve replacement (AVR) were analysed retrospectively. At coronary bypass, 8 patients (Group I) has insignificant aortic stenosis (AS) (mean transvalvular pressure gradient < 40 mmHg and/or aortic valve surface > 1 cm2). The other 5 had no aortic valvular lesion (Group II). The average time interval between the two operations was 7 +/- 3.3 years (Group I: 6.7 +/- 3.5 years; Group II: 7.4 +/- 3.2 years). In Group I, 2 patients required early AVR (2 years) whereas the time of reoperation varied from 6 to 12 years in the other 6 patients. No operative complications related to the sternotomy or dissection of adhesions were observed. In 3 cases, it was necessary to free the implanted grafts on the right coronary artery to gain access to the initial part of the aorta. A transverse low aortotomy allowed AVR in good conditions in all cases. One patient in Group II died on the 5th postoperative day of a low output syndrome complicated by pneumonia. After an average follow-up of 3 +/- 2 years, 9 patients are still alive. Three patients in Group I died, two of cardiac failure and one of unknown causes. The authors conclude that "prophylactic" AVR in cases of insignificant AS in patients referred for coronary bypass surgery is not justified. Regular echocardiographic follow-up should lead to AVR at the most appropriate moment, sometimes after an interval of several years, with a low operative risk.

Aged↗
PubMed1995

[Reoperations after surgical treatment of lumbar stenosis].

UNLABELLED: PURPOSE THE STUDY: The aim of this study was to determine the causes of failure following surgical treatment of lumbar spinal stenosis, indications for redo surgery and factors influencing the final result. MATERIAL AND METHODS: Between 1975 and 1992, 38 patients were reoperated after a surgical treatment of lumbar spinal stenosis. The mean follow-up was 34 months. All of these patients had had at least one previous lumbar spinal operation. Second operation was performed 35 months on average following the previous surgery. CLINICAL EVALUATION: The grading scale used in this review assessed walking ability, radicular pain at rest and at exersion, back pain, motor deficit and sphincter dysfunction. Patients were evaluated before and after the 2 surgeries and at last follow-up. Radiological study was done from CT-scan, MRI, myelograms, static and dynamic standard X-rays before the first surgery and following the revision surgery. RESULTS AND DISCUSSION: According to our grading scale the final result was very good for 36 per cent of the patients, good for 24 per cent, fair for 24 per cent and poor for 16 per cent. The main causes of failure were post-operative destabilization and incomplete neurological decompression. In 56 per cent of our cases initial nerve roots decompression was incomplete: disc excision without bone resection in case of lumbar stenosis associated with disc herniation, incomplete lateral release, decompression of the symptomatic nerve roots only and not of all of them that were compressed. In these cases revision surgery was comprised by a new decompression. In 25 per cent of our cases post-operative destabilization was the cause of failure. During the previous surgery bone resection had been extensive: total bilateral facetectomy without fusion, wide laminectomy extended into the pars inter-articularis, resulting in isthmic fracture. Revision surgery was a posterolateral fusion with or without instrumentation generally associated with a new decompression. Two patients were reoperated on without evidence of inadequate decompression or destabilization. Result was poor in both. Final results were statistically better when the cause of revision surgery was a post-operative destabilization and when redo surgery was performed on surgically untouched levels. CONCLUSION: Final results were disappointed since only 60 per cent were good or very good results. Revision surgery should be avoided, by using pre-operative planning of the neural decompression, and by adding a fusion if a wide bone resection is necessary.

Adult↗
PubMed1996

[Reoperation after gastroesophageal reflux surgery].

In a group of 19 patients reoperated after a primary operation on account of gastrooesophageal reflux the authors demonstrate that the reason for reoperation can be either a relapse of the reflux or also other complaints (most frequently dysphagia). The selection of a suitable operation is strictly individual. Cases of a short oesophagus are most difficult to resolve. The decisive factor is a correct surgical approach-laparotomy or thoracotomy.

Adult↗
PubMed1996

[Congenital heart defects in adolescence and adulthood: fatalities and morbidity in primary and reoperation].

Adolescents and adults with congenital heart disease have become a new, continuously growing group of patients, because currently improved diagnostics and therapy allow the majority of newborns with congenital heart disease to survive to adulthood. The objective of this retrospective study was to investigate lethality and morbidity after surgery for congenital heart disease in adolescents and adults. Between 1989 and 1994, we operated 137 patients (age between 15 and 75 years; mean 33.8 +/- 15.1) because of congenital heart disease. This was equivalent to 2.7% of all patients, who were operated during this period of time. 101 cases were primary operations, in 36 cases (26.3%) a reoperation was performed. The most frequent diagnoses were ostium-secundum-defect (37.9%), anomalies of the aortic valve including sub- and supravalvular stenoses (9.5%), anomalies of the mitral valve (8%), ventricular septal defect (7.3%) and aortic coarctation (7.3%). Overall lethality was 5.8%, including emergency cases and all late deaths, which have been reported so far. Evaluation of morbidity showed an intraoperative cardiac low-output-syndrome in 3.7%, pulmonary failure in 5.8%, postoperative renal failure in 4.4% and postoperative bleeding complications in 7.3% of cases. Mean duration of postoperative ventilation and intensive care treatment were 2.3 +/- 5.3 and 3.6 +/- 7.3 d, respectively. In comparison to their preoperative status, 71% of patients had improved by one or two NYHA classes. We found that the higher perioperative risk related to reoperation had no impact on the operation's functional result, as evaluation of postoperative functional class showed no difference between primary and re-do cases. The general term congenital heart disease describes a very inhomogeneous group of patients with a broad spectrum of different diagnoses. The variable morphology and pathophysiology of the different congenital heart defects require an individual surgical strategy for each patient, in rare cases even the decision for a heart- or heart-lung-transplantation. Furthermore, adequate follow-up and competent ambulatory treatment of these patients require the cooperation of pediatric and adult cardiologists and cardiac surgeons in interdisciplinary outpatient clinics.

Adolescent↗
PubMed1997

[A successful emergency reoperation of thrombosed CarboMedics valve in the mitral position].

We report a successful emergency reoperation of a thrombosed CarboMedics valve five years after the original implantation of the prosthesis. A 53-year-old mentally retarded woman suffered acute heart failure due to a thrombosed CarboMedics valve, which was caused by inadequate control of anticoagulants. The patient was reoperated on immediately after thrombolytic therapy failed to show an improvement in leaflets' excursion. The excised prosthesis demonstrated that organized thrombi originating at both sides of the hinge portions extended to the atrial side of one of the leaflets. The bileaflet valve is supposed to prohibit catastrophic heart failure by preventing simultaneous malfunction of both leaflets. However, we believe that prompt surgical treatment is essential even for the thrombosed bileaflet valve, because a thrombus originating in the hinge area seems to develop into a fatal simultaneous malfunction of both leaflets.

Emergencies↗
PubMed1997

Right gastroepiploic artery for coronary bypass reoperation without cardiopulmonary bypass.

Reoperative coronary artery bypass grafting procedure presents a particularly challenging situation for cardiac surgeons. Technical obstacles and operative risks still exceed those of primary procedures. We report a case of a reoperative myocardial revascularization in a 61-year-old woman, in whom the pedicled right gastroepiploic artery was used to bypass the right coronary artery without cardiopulmonary bypass. Postoperative angiographic study before discharge of the patient and transcutaneous Doppler echocardiography controls at two and eleven months showed a good patency of the right gastroepiploic artery graft.

Arteries↗
PubMed1997

Reoperative surgery for choledochal cysts.

BACKGROUND: Complications often follow if a choledochal cyst is treated simply by drainage, either internal or external. This study reviews 17 patients who had had previous cystoenterostomy (n = 9) or external drainage (n = 8) and who required reoperation and cyst excision. METHODS: The study was a retrospective review including ten women and seven men managed over 9 years. The indications for reoperation were stone formation (10 patients), pancreatitis (three), portal hypertension (two) and hepatic abscess (one); two patients were asymptomatic. RESULTS: Definitive surgery with cyst excision was possible in all patients who had previously had external cyst drainage and in seven of nine who had had previous cystoenterostomy. There were no deaths. Two postoperative biliary leaks and two duodenal fistulas resolved spontaneously. CONCLUSION: Excision of a choledochal cyst is possible and desirable even after a previous drainage operation. In severely ill patients with a complication of choledochal cyst, external drainage may be a preferable initial manoeuvre.

Adolescent↗
PubMed1997

[Radiological evaluation of integration of bone grafts and bone substitutes after implantation to replace acetabular substance losses in reoperation of total hip prosthesis].

Plain radiograms are insufficient to evaluate the integrity of a graft used to replace acetabular tissue loss in reoperations for total hip replacement. The aim of this work was to compare radiographic, computed tomographic and magnetic resonance imaging findings. Two groups of patients including 12 hip joints in each were evaluated 5 years after undergoing reoperation for annular support. Allografts (5 cases) or xenografts (7 cases) were used in one group. Plain radiograms. CT-scan and MRI were performed in each patient. The graft-receiver bone borders were visible on the CT-scans but were not distinguishable on the radiograms. Bone and graft density and structure in contact with the implant could be determined on the CT-scan. MRI was difficult to interpret in most cases due to implant-induced artefacts and is not recommended in this type of reconstruction.

Adult↗
PubMed1997

[Causes for reoperations after osteosyntheses of finger and mid-hand fractures].

31 patients reoperated after osteosynthesis of a metacarpal or a phalangeal fracture were reviewed over a period of three years. The cause of injury was in 18 cases a crush, in six cases a fall, in five cases a saw injury, and in two cases axial trauma. A postoperative plaster splint immobilisation over a period of at least three weeks was carried out in 29 cases. Reoperation was necessary in most of the cases because of a loss of range of motion and a nonunion. The complication rate was independent of the method of fixation, but did depend on the type of injury. Fractures associated with soft tissue injury were more likely to develop complications.

Finger Injuries↗
PubMed1997

Reoperation for missed parathyroid adenoma.

These results in difficult patients with previously missed parathyroid adenomas demonstrate that a prospective strategy to treat these patients surgically can be used with a high degree of success. This strategy required collaboration among endocrinologists, radiologists, and surgeons. Prospectively, only patients with symptomatic persistent or recurrent primary hyperparathyroidism were included. Operative reports and pathology results from the initial operation and all previous operations were reviewed in detail. Patients with FHH or hypercalcemia from other causes were excluded. State-of-the-art radiologic localization procedures were used to localize the abnormal parathyroid gland. Most patients had only noninvasive procedures, such as the sestamibi scan, but some whose results were equivocal underwent invasive localization, including selective angiography and venous sampling. All patients underwent surgery even if the localization procedures were negative. The operative approach and strategy were dependent on the previous operative result and results of the imaging studies. Operative techniques like IOUS and urinary cAMP determination helped facilitate a more rapid successful outcome. However, in some patients, operative success was only achieved by complete dissection and removal of all tissue that might harbor the adenoma such as a lobe of the thyroid or the thymus. Abnormal parathyroid tissue was cryopreserved for possible subsequent autotransplantation in the event of hypoparathyroidism. The reoperative success rate for missed adenoma was 97%, the highest ever reported with a very acceptable complication rate and no deaths. Postoperative hypoparathyroidism, which was really a complication of the initial previous operations during which normal parathyroid tissue was removed, was treated by autotransplantation of cryopreserved tissue in 12 patients, and 8 functioned perfectly. With attention to details and possible pitfalls, reoperations for missed parathyroid adenomas can be performed safely and effectively.

Adenoma↗