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PubMed2003

Reduction of hemolysis without reoperation following mitral valve repair.

Hemolytic anemia following mitral valve repair and annular ring placement is uncommon compared with mitral valve replacement. A 60-year-old man, who had undergone mitral valve repair with a Duran ring, developed hemolytic anemia and needed a blood transfusion. Transesophageal echocardiography revealed a paravalvular mitral regurgitation jet colliding with the Duran ring. Most cases of severe hemolysis after mitral valve repair have undergone reoperation, but in the present case study, the hemolysis after mitral valve repair reduced without the need for reoperation, although the paravalvular mitral regurgitation jet continued to collide with the Duran ring.

Anemia, Hemolytic↗
PubMed1996

Valve detachment after aortic valve replacement--a successfully reoperated case with the Cabrol technique.

A 50-year-old Japanese male was admitted with a 1 month history of progressive shortness of breath, palpitations, and intermittent low-grade fever. On admission, a musical diastolic murmur (sea-gull murmur) was heard on the 3rd left sternal border. Blood studies showed an accelerated erythrocyte sedimentation rate, and positive C-reactive protein. Retrograde aortography revealed severe aortic regurgitation. At the operation, the aortic wall was remarkably thickened, and the aortic valve commissures between the right and left coronary cusps and between the left and non-coronary cusps had completely detached from the aortic wall. The aortic valve was replaced with a St Jude Medical valve using pledgeted sutures. Histologic studies of the aorta and aortic valve revealed no evidence of any pathologic changes. Echocardiography performed 82 days after aortic valve replacement showed severe paravalvular leakage and valve detachment. At the reoperation, the prosthetic valve was detached from the extremely edematous and fragile native aortic annulus. There was no vegetation or abscess formation. Aortic root replacement with the Cabrol technique was performed using a composite graft in which the prosthetic valve was placed 1 cm above the proximal extremity to reduce the tension on the suture line and the aortic annulus. Histologic study of the aorta after the reoperation showed non-specific inflammatory disease. The patient, who received steroid therapy, has recovered without any signs of graft detachment or pseudoaneurysm formation.

Aortic Valve↗
PubMed1995

Reoperation Due to Complications after Gastric Restriction Operation.

BACKGROUND: In the past 4 years we performed operations on 90 patients who suffered from morbid obesity. Five different operative techniques were available, vertical banded gastroplasty (VBG), silastic ring vertical gastroplasty (SRVG), gastric banding operation, adjustable silicone gastric banding (ASGB) and biliopancreatic diversion (BPD). METHODS: Two of these operations were mainly utilized. The ASGB was done routinely. The SRVG was used particularly for patients with hiatal hernia. Only one patient, who had a deformed pylorus, underwent BPD. RESULTS: Eleven patients had to be reoperated due to complications after the first operation of gastric restriction; They were divided into three groups depending on the type of complication: reoperation due to lack of compliance, due to technical failure, or due to other complications. In the last group we observed three patients with band perforation into the stomach without epigastric pain. This complication has, to our knowledge, only been described in very few cases. CONCLUSION: In some patients it remained difficult to reach adequate compliance, although we kept close contact with them after the operation. We do not yet know the reasons for the band perforation observed in three patients.

Journal Article↗
PubMed1995

Malleolar fractures in alcoholics treated with biodegradable internal fixation. 6/16 reoperations in a randomized study.

29 alcohol abusers with displaced malleolar fractures were randomized to treatment with biodegradable self-reinforced polyglycolide screws or metallic implants. During an average follow-up time of 7 (0-15) months, 8 patients out of 16 treated with biodegradable fixation had postoperative redisplacement of the fracture and 6 were reoperated. 1 fracture in 13 patients with metallic fixation had a slight displacement postoperatively which did not require reoperation.

Adult↗
PubMed2001

Patient evaluation, operative planning, and surgical techniques to increase control and reduce morbidity and reoperations in breast augmentation.

Current rates of reoperations and complications in augmentation mammaplasty are unacceptably high and can be improved. Risks, trade-offs, complications, morbidity, time to recovery, and reoperation rates in breast augmentation can be improved substantially by stringent patient selection, thorough tissue evaluation, implant selection based on tissue characteristics, and selection of pocket location and surgical techniques.

Breast Implants↗
PubMed1975

The role of non-drainage in reoperation.

In a study of 194 reoperation in which one third of the cases were managed without drainage of SRF, it was found that a number of failures occurred after non-drainage. Analysis of these failures shows that more than half could have been avoided if the choice of operation had been correct. It is felt that with careful attention to the criteria which was used to decide on the choice of surgical technique, the results obtained by the non-drainage method should be as good in the more complicated case as they have already been shown to be in the primary case. Because the drainage of SRF carries with it a high risk of surgical complications and these complications frequently result in the development of MPR, management of the reoperation should be carried out without drainage of SRF whenever possible.

Drainage↗
PubMed1975

Complications of total hip arthroplasty treated by reoperation.

In a series of 3,204 consecutive total hip arthroplasties performed on 2,684 patients at the Mayo Clinic from March 1, 1969, through February 28, 1972, reoperation for a complication was necessary in 125 hips (3.9 per cent). The complications, in order of frequency, were infection, dislocation, trochanteric problems, ectopic bone, and loosening of the femoral prosthesis. There were less frequent complications that also required further surgery. Attention to specific technical details is the most important means of avoiding a complication that requires reoperation.

Aged↗
PubMed1990

Reoperation for prosthetic heart valve dysfunction: 19 years' experience.

Between September 1968 and October 1987, 152 patients (66 males and 86 females; age range, 15 to 79 years) underwent 1 or more reoperations (total, 179) for prosthetic valve dysfunction at our hospital. In this report, we present material and statistics reflecting our experience with the last reoperation in these 152 patients. The procedures involved the mitral valve in 93 patients, the aortic valve in 38 patients, double valves (aortic and mitral) in 19, and the tricuspid valve in 2. Sixty-five patients were operated on for mechanical valve dysfunction, and 87 for tissue valve dysfunction. The modes of valve dysfunction that indicated surgery were primary valve failure (85 patients), valvular thrombosis and valve-related thromboembolic episodes (27 patients), paravalvular leak (25 patients), prosthetic valve endocarditis (14 patients), and hemolysis (1 patient). Three patients were in New York Heart Association functional Class II, 77 were in Class III, and 61 were in Class IV; the remaining 11 cases were emergencies. The 30-day operative mortality was 14.5%, the 5-year survival was 75%, and the 10-year survival was 63%. The preoperative functional class and the mode of valve dysfunction significantly influenced both early and late mortality.

Journal Article↗
PubMed1977

[Reoperation for esotropia (author's transl)].

The authors describe 89 cases of esotropia which have been reoperated upon because of failure of the first operation; 57 cases consist in residual esotropia, 32 cases in secondary exotropia. Rules for reoperation are proposed, the general and particular rules according to the type of the first surgery.

Diagnosis, Differential↗
PubMed1978

Reoperative parathyroid surgery for persistent hyperparathyroidism.

In a 2-year period 30 patients with persistent hyperparathyroidism following 59 prior unsuccessful procedures underwent reoperation. Preoperative arteriography was useful in planning the surgical approach in 56%, and retrospectively was correct in 63%. Selective venous catheterization gave localizing information in 83%, correctly predicting site or side in 60% of the total. Computerized axial tomography was helpful in identifying mediastinal glands before operation. Reoperation was successful in rendering the patient hypocalcemic or normocalcemic in 83%. Of the 11 patients (37%) who were rendered profoundly hypocalcemic, two were subsequently weaned from vitamin D and calcium support; seven have received either fresh or cryopreserved parathyroid autografts. Persistent hyperparathyroidism is a difficult surgical problem which we believe warrants aggressive localization attempts prior to operation. Autotransplantation with cryopreserved parathyroid tissue may be of value in the long-term management of the high incidence of postoperative hypocalcemia in this patient group.

Adenoma↗
PubMed1980

[Recurrent angina after coronary surgery. Results of reoperations for myocardial revascularization].

40 patients presented with invalidating angina after initial revascularisation surgery (44 operations). The relapse of angina was attributed to thrombosis or stenosis of the graft (33 p. 100), graft failure plus the presence of non-bypassed coronary lesions (progression of coronary artery disease or incomplete initial revascularisation) (52 p. 100) or to the presence alone of coronary lesions which had not been bypassed (15 p. 100). At reoperation 37 stenosed or thrombosed grafts were replaced or repaired and 36 new aortocoronary bypasses were implanted. The perioperative risk was comparable to that of the initial operation (4,5 p. 100 mortality, 13,6 p. 100 myocardial infarction). The long term clinical improvement (34 months) was however less satisfactory (30 p. 100 unimproved). Several factors may account for the relatively high failure rate: the incidence of incomplete revascularisation; perioperative myocardial infarction and, above all, rapid progression of the coronary artery disease. Reoperation for myocardial revascularisation should therefore be restricted to patients with severe angina despite medical therapy, in whom the angiographic appearances suggest that optimal revascularisation might be possible.

Adult↗
PubMed1981

Late clinical and arteriographic results in 500 coronary artery reoperations.

The incidence of coronary artery reoperations averaged 2.7% from 1967 through 1979. In a mean interval of 51 months between operations, three-vessel disease increased from 24% to 63%, and 31% of these 500 consecutive patients lost previously normal left ventricular function. Three angiographic indication groups were identified: (1) progressive coronary atherosclerosis, 247 (51%); (2) graft failure, 147 (29%); and (3) a combination of progressive coronary atherosclerosis and graft failure, 96 (19%). Angina recurred earlier in patient with graft failure, mean 17 months compared with a mean of 37 months for the other groups. Twenty (4%) operative deaths occurred. The series is divided into 387 patients operated upon under normothermic anoxic arrest and 113 with systemic hypothermia and cold cardioplegia. In the cardioplegia group, perioperative myocardial infarction was 2.7% in comparison with 7.8% for patients with anoxic arrest (p = 0.055). The number of grafts per patient increased from 1.0 to 1.9 and blood usage decreased from 11 units to 2.7 units. After a mean follow-up of 42 months, angina was relieved or improved in 86%. Recatheterization of 104 patients after a mean interval of 19 months showed a 79% vein graft patency rate and a 97% mammary artery graft patency rate. Grafting performed for graft failure (47) yielded an 85% patency rate. Actuarial 5 year survival was 87.4% for those with progressive atherosclerosis, 89.4% for patients with graft failure, and 91.5% for the combined indication group. Clinical improvement, graft patency, and long-term survival are nearly equal among the indication groups. Palliation derived from these reoperations approaches that achieved after primary revascularization.

Adult↗
PubMed1981

[Important cause for reoperations of the common bile duct: papillary stenosis].

The authors have surveyed 94 cases of stenosis of Vater's papilla diagnosed in 270 late reoperations. In their opinion in more than one third of the cases stenosis of Vater's papilla persisted even at the time of the first surgical interference, only it was not diagnosed and adequately solved. They are convinced that by the routine use of radiomanometry, in addition to intraoperative close circuit TV monitoring, by the correct interpretation of the data and adequate surgery, the number of late reoperations after surgery of the biliary tract can be considerably decreased. The procedure has been in use at the author's clinic since 1961.

Adult↗
PubMed1980

Results of dacryocystorhinostomy: analysis of the reoperations.

Of 291 dacryocystorhinostomies, 18 (6 percent) were considerd anatomical failures. At reoperation, 78 percent were found to have canalicular obstructions with a predominance of common canaliculus. A closed osteotomy was found in four (22 percent). Most of the failures had trauma as the initiating cause of nasolacrimal obstruction. It must be emphasized that our failures were demonstrated by anatomical observation of obstruction at reoperation. We recognize that postoperative tearing is a subjective variable and understand that some failures are asymptomatic.

Adolescent↗
PubMedDate not supplied

Late reoperations after aorto-iliac restaurations.

(1) Late thrombosis after aorto-iliac revascularisations are infrequent when the operation is correctly performed and controlled by intra-operative angiography. (2) Reoperation after thromboendarterectomy is a difficult procedure requiring great care in the aortic approach. (3) Reoperation after thrombosis of a prosthetic graft is much easier as far as dissection is concerned, usually the upper part of the former prosthesis may be kept, which renders the procedure very much easier. (4) The distal anastomosis should be realised distally to the sclerotic block surrounding the femoral bifurcation. (5) In case of poor risk patients, it is better to use extra-anatomical bypasses, and if necessary, one must be able to sacrifice a limb for a life. Mortality rates are high in our series. It may be due in part to a too much optimistic pre-operative evaluation and selection of our patients, in the first years of our experience.

Aorta, Abdominal↗
PubMed1992

Reoperation following diabetic vitrectomy.

A review of 484 consecutive eyes that were undergoing an initial pars plana vitrectomy for the sequelae of proliferative diabetic retinopathy disclosed that 41 eyes (8.5%) required one or more additional vitrectomy operations. The primary causes for reoperation included rhegmatogenous retinal detachment in 18 (44%) of the 41 eyes, recurrent vitreous hemorrhage in 21 eyes (51%), and glaucoma in two eyes (5%). The visual prognosis was worse in the group with rhegmatogenous retinal detachment, with 10 (56%) of 18 eyes progressing to no light perception (P = .003). Severe preretinal and subretinal fibrous proliferation, as demonstrated histopathologically, accounted in large part for the poor result. The preretinal membrane formation appeared to occur secondary to a combination of diabetic extraretinal vascular growth and proliferative vitreoretinopathy. Among the total group of 41 eyes that required subsequent surgery, the retina eventually remained detached in 18 eyes (44%), and phthisis bulbi occurred in 13 eyes (32%). Rubeosis iridis developed in 17 (94%) of 18 eyes in which the retina remained detached.

Adult↗
PubMed1999

Reoperation for severe pancreatitis: a 10-year experience in a tertiary care center.

OBJECTIVES: To analyze the specific problems encountered in treating patients previously operated on for necrotizing pancreatitis and to determine the benefit of such a complex and demanding procedure. DESIGN AND SETTING: Review of a case series in an academic tertiary care referral center. PATIENTS: Forty-four consecutive patients referred and reoperated on in 10 years. INTERVENTIONS: Reiterative laparotomy with complete debridement of all necrotic sites, followed by Mikulicz packing. Mikulicz packs were replaced by removable drains allowing both local prolonged lavage and open drainage of large solid necrotic debris. Enteral nutrition was performed through a feeding jejunostomy. Associated gastrointestinal tract lesions were simultaneously treated. MAIN OUTCOME MEASURES: Operative findings, bacteriological status of necrosis, in-hospital mortality, length of hospitalization, and surgical complications and their management. RESULTS: Necrosis was infected in 36 (82%) of the 44 cases and associated gastrointestinal tract lesions were found in 20 (45%) of these patients. Mortality was 23%, and was significantly (P = .03) related to the preoperative clinical status. Surgical complications occurred in 31 (70%) of the 44 patients necessitating surgical treatment in 18 (41%) of these patients. Mean (+/- SD) stay in the intensive care unit was 66+/-8 days for survivors. CONCLUSION: This complex and demanding surgical procedure is worthwhile, yielding mortality rates comparable to those observed in de novo severe necrotizing pancreatitis.

Female↗
PubMed2000

Preoperative sestamibi scanning and surgical findings at bilateral, unilateral, or minimal reoperation for recurrent hyperparathyroidism after subtotal parathyroidectomy in patients with multiple endocrine neoplasia type 1.

HYPOTHESES: Preoperative parathyroid radioisotope scanning is of little or no value in patients with multiple endocrine neoplasia type 1 when 4 or more hypertrophied glands are present. Scanning using technetium Tc 99m sestamibi and single photon emission computed tomography will achieve a high level of sensitivity and specificity after 3 or more glands have previously been removed, justifying limited surgical reexploration. DESIGN: In a prospective study, the preoperative documented report of the predicted site of residual parathyroid was compared with the surgical findings in 13 patients having 19 scans and 17 reoperations. SETTING: All patients belonged to one family, previously described as Tasman family 1, and were confirmed by genetic testing as having multiple endocrine neoplasia type 1. In 10 of 13 patients, reexploration was being undertaken more than 10 years after the first operation. MAIN OUTCOME MEASURES: Scanning was regarded as successful when the documented preoperative report correctly predicted the side and quadrant in which a gland was found at surgery. Surgery was regarded as successful when calcium levels decreased to or below normal levels and were maintained. RESULTS: All 13 scans before first reexploration were successful in identifying the location of a residual parathyroid. From a statistical viewpoint, this equates to 100% sensitivity and 92% specificity. However, despite accurate localization of 1 residual gland in every patient, 7 supernumerary glands in 4 patients and 1 parathyroid remnant in a fifth patient were not localized so that sensitivity in locating all glands in every patient was only 61%. Scans performed for persistent hypercalcemia 48 to 72 hours after reexploration in 2 patients were unsuccessful in demonstrating any residual parathyroid. Scans performed 3 months after surgery in the same 2 patients and a third patient were successful, with sensitivity and specificity of 100%. Apart from patient 11, who awaits reexploration, normocalcemia was eventually achieved in every patient, with 11 of 12 having an initial period of hypocalcemia. CONCLUSIONS: Three months after reexploration and trimming or resection with transplant of half a gland left at first operation, sestamibi scanning achieved sensitivity and specificity of 100% in locating supernumerary parathyroids in patients with multiple endocrine neoplasia type 1 and persistent hypercalcemia. Before first reexploration, however, scans rarely provided new information, predominantly showing only the hypertrophied half-gland remnant.

Adult↗