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PubMed1984

Early reoperations after surgery for duodenal ulcer.

To assess the incidence of early, severe, and life-threatening complications demanding early reintervention following surgery for duodenal ulcer--initial or reoperative--2579 patients who underwent elective surgery, 2472 as an initial approach and 107 as a reintervention, are presented in this study. Twenty-three patients underwent early reoperation after initial surgery for duodenal ulcer and ten patients out of the 107 required reoperation for severe late postoperative complications. The overall incidence of early reoperation was 1 per cent (33 patients) and there was an incidence rate of .6 per cent after initial surgery versus 9.8 per cent after reoperative surgery (P less than 0.001). It is concluded that reoperative surgery for late complications following initial surgery for duodenal ulcer carries a high incidence rate for complications which warrant early reintervention. It is believed that reduction in the incidence of late complications following initial surgery for duodenal ulcer should simultaneously result in a reduction in the demand for early reoperation which is associated with a considerable mortality and morbidity rate.

Adult↗

PubMed1994

[Reoperation after corrective surgery for tetralogy of Fallot].

Thirty-two of 460 patients (6.9%) who had corrective surgery for tetralogy of Fallot in our institute between January, 1955 and March, 1994 required intracardiac reoperation. The indications for reoperation included residual lesions alone or combination of other lesions. The reoperation consisted of a new patch or direct closure of a residual ventricular septal defect in 28 (73%), reconstruction of a residual pulmonary stenosis in 18 (47%) and pulmonary regurgitation in 6 (16%), repair of tricuspid regurgitation in 11 (29%), recurrent infective endocarditis in 5 (13%), repair of a left ventricle-right atrium communication in 4 (11%). Six patients (19%) had required second reoperation of recurrent infective endocarditis in 3, other three patients required the repair of tricuspid valve disease. There were one operative death (3%) in reoperation and one death (17%) in second reoperation. Three patients (9%) died at follow-up periods of 1-21 years (mean of 9.6 years). Twenty-seven patients (84%) survived operation and 24 (89%) are now in NYHA class I and 3 patients are in class II. Reoperation after correction of tetralogy of Fallot is able to perform with low mortality and with excellent long-term results.

Adolescent↗

PubMed1993

[Coronary reoperation--report of 16 cases].

Between January 1975 and July 1992, coronary artery reoperation was performed in 16 of 333 patients who had undergone primary bypass grafting. The interval between the operations ranged from 2 to 147 months. Reoperation was done within one year in two patients, within one to five years in five patients and after more than five years in nine patients. The mean number of bypass grafts was 2.31 per patient in the first operation and 1.75 in the reoperation. The main reasons for the reoperation were an occlusion of the graft in 12 cases and both graft occlusion and new coronary artery disease in 3 cases. In one other case, an emergency right coronary bypass graft done for an acute occlusion during PTCA to an area of right coronary artery stenosis 13 months after two bypass graftings to the LAD and circumflex coronary artery. Fourteen cases had vein graft disease bypassed to the LAD or new coronary artery disease in the LAD and required reoperations of the LAD. In the case with a recurrence of myocardial ischemia after coronary bypass surgery and with bypass grafts to the LAD that were patent, there were no cases requiring reoperation. These findings demonstrate that patency of the grafts to the LAD is an important factor for reoperation after myocardial revascularization surgery.

Age Factors↗

PubMed1999

Reoperation for failed prosthetic replacement used for limb salvage.

Patients with segmental bone and joint replacement prostheses because of tumors increasingly need revision surgery because of their long term survival. Between 1970 and 1990, 208 custom prosthetic replacements were performed for limb salvage in patients with tumors. Reoperations were required in 52 patients. The mean time to reoperation was 37 months. The reoperation procedures included 35 prosthetic revisions, 11 amputations, four arthrodeses, one vascularized fibular graft, and one open reduction and internal fixation of a fracture with supplemental bone graft. Functional assessment using the new Musculoskeletal Tumor Society scoring system was available for the 36 living patients, and their mean rating was 63% (18.9) at 12 years' mean followup. Of the 35 patients who received a new prosthesis, 12 (33%) patients needed a third operation at mean followup of 68 months. The probability of prosthetic survival in the group of 35 patients needing revision to the same or another prosthesis was 79% at 5 years and 65% at 10 years. The chance and frequency of needing reoperation increased as patients survived longer. Reoperations for tumor recurrence or infection usually resulted in amputation. Reoperation for failed initial segmental bone and joint prosthetic replacement is feasible and effective and can be done without jeopardizing subsequent patient and implant survival or without significantly affecting functional results compared with the values before reoperation.

Adolescent↗

PubMed1978

Supratentorial recurrences of gliomas. Results of reoperations on astrocytomas and oligodendrogliomas.

On the basis of our previous investigation regarding histological transformation of recurrent astrocytomas and oligodendrogliomas we report the clinical results of reoperations. The present observations deal with 121 cases: grade 1 astrocytomas (45), oligodendrogliomas (12), grade 2 astrocytomas (47), and oligodendrogliomas (17), respectively. In all these a second reoperation was performed in 14 cases. Operative mortality was relatively high, but without significant difference in the two groups of maligancy: 24.5% and 29.6%. Survival times in both groups showed striking individual differences. We achieved post-reoperation survivals exceeding one year in 18 and 14 cases, respectively. The results of second reoperations were generally poor. We find no remarkable differences in survival time following reoperations in primary grade 1 and grade 2 tumours. Similarly, malignant change proved to be not decisive for survival times. On the contrary, most of our patients with unchanged grade 1 astrocytomas, reoperated on after a longer interval, achieved a short second survival only. Prolongation of life expectancy by radiotherapy is doubtful. Irradiation seems to be necessary with malignantly transformed tumours if the patient did not have any treatment before reoperation.

Adolescent↗

PubMed1979

Reoperation for coronary graft failure: clinical and angiographic results in 43 patients.

Reoperation because of early or late coronary graft failure was performed in 43 patients who were part of a group of 1,985 patients operated on for coronary artery disease and followed for up to 7 years. Considerable variation in the results was noted depending on whether the patients were symptomatic or not before reoperation. Of the symptomatic patients, 85% were asymptomatic late (30 months) after reoperation whereas of those patients reoperated on despite the apparent lack of symptoms, 71.5% remained free from angina later on. Moreover, patency rate was high (94.4% or 17/18 grafts) in the first group and much lower (38.4% or 5/13 grafts) in those reoperated on solely on the basis of an early angiogram showing malfunctioning grafts. Patency rate was higher when the graft was totally replaced (92.3% or 12/13 restudied) rather than repaired simply through interposition of a segment of vein (37.5% or 3/8). It is apparent that results of reoperation in symptomatic patients are identical to those of an initial revascularization. On the other hand, patients who are asymptomatic despite early evidence of malfunctioning grafts should be reoperated on only when optimal angiographic conditions are present, that is, a coronary artery that is a good size, severely narrowed, and supplying a large myocardial area.

Angina Pectoris↗

PubMed2000

Long-term results of reoperation and localizing studies in patients with persistent or recurrent medullary thyroid cancer.

HYPOTHESIS: Reoperation benefits patients with locoregional, persistent, or recurrent medullary thyroid cancer (MTC). Currently available localizing studies have limited utility for detecting all foci of residual MTC. DESIGN: A retrospective study with a mean follow-up time of 7.5 years (median, 13 years; range, 2.2-29 years). SETTING: A tertiary referral medical center. PATIENTS: Thirty-three patients who underwent 46 reoperations for locoregional residual MTC. RESULTS: Sixty-four percent of residual MTC was located in the lateral cervical nodes, 22% in the central cervical nodes or thyroid bed, and 14% in the anterior mediastinum (197 of 1128 nodes resected were positive for MTC). After reoperation, basal calcitonin levels were undetectable in 2 patients, reduced by greater than 50% in 10 patients, and either increased or were not reduced by greater than 50% in the remaining patients. On reoperation, one patient had a thoracic duct injury that required reexploration and ligation. Patients who had a greater than 50% decrease in calcitonin levels after reoperation were less likely to develop distant metastases compared with patients who did not have a greater than 50% decrease (P<.05). The sensitivities of magnetic resonance imaging (n = 31), computed tomographic scan (n = 16), ultrasound (n = 9), and dimercaptosuccinic acid scan (n = 3) were 91%, 86%, 88%, and 100%, respectively. CONCLUSIONS: Although reoperation in patients with residual MTC rarely results in biochemical cure, cervical reexploration is safe and in selected patients may limit MTC progression. Lateral cervical node dissection could be beneficial at the time of initial surgical treatment because of the high frequency of residual MTC in the lateral cervical nodes. Noninvasive imaging studies were helpful but far from perfect for guiding the reexploration for locoregional residual MTC.

Adult↗

PubMed1996

Reoperative rates for Crohn's disease following strictureplasty. Long-term analysis.

BACKGROUND: In Crohn's disease, ten-year reoperative recurrence rates after resection range from 30 to 53 percent. To determine the effect of strictureplasty on reoperative "recurrence" rates, experience at a single tertiary care institution was reviewed. PATIENTS AND MATERIALS: Records of all patients who underwent strictureplasty for Crohn's disease from June 1984 to July 1994 at a tertiary care institution were reviewed. Data collected included duration of disease, medical and surgical history related to Crohn's disease, indications for strictureplasty, and longterm outcome. RESULTS: One hundred sixty-two patients (87 male) underwent 191 operations for a total of 698 strictureplasties (Heineke-Mikulicz, 617; Finney's, 81). Mean number of strictureplasties was three, and mean patient age was 36 years. No mortality occurred. Cumulative five-year incidence of reoperative recurrence was 28 percent (95 percent confidence interval, 18.8-37.2 percent), with a median follow-up of 42 (range, 1-120) months. Obstructive symptoms were relieved in 98 percent of patients. To determine whether any difference in reoperative rates exists between patients who have strictureplasty alone and those who have strictureplasty with bowel resection, we divided patients in two groups, those receiving strictureplasty alone and those undergoing stricutreplasty plus resection. For patients treated by strictureplasty alone (Group A, n = 52; 32 percent), cumulative reoperative rate at five years was 31 +/- 9.6 (+/-standard error) and for patients with concomitant bowel resection (Group B, n = 110; 68 percent), it was 27.2 +/- 5.4 (+/-standard error). No statistical difference was present between these two groups. Of patients undergoing strictureplasty alone (Group A), operative recurrence was managed by new stricutreplasty in seven, by restricutreplasty in two, and by bowel resection in one. Among patients in Group B (strictureplasty and concomitant bowel resection), new strictureplasty was performed in 11, restrictureplasty in 6, and bowel resection in 9. CONCLUSION: Strictureplasty is a safe and effective procedure for Crohn's disease in selected patients. Reoperative rates are comparable with resective surgery, and most recurrences occur at new sites.

Adolescent↗

PubMed2005

[Reoperation for thyroid cancer].

Reoperation for thyroid cancer needs to consider patient-, tumor- and therapy-related aspects as well as present diagnostic results. Reoperation because of thyroid remnants, persistence of the primary tumor and lymph node metastasis (completion surgery) has to be distinguished from reoperation due to locoregional recurrence (primary tumor, lymph nodes). The primary surgical strategy should avoid the need for reoperation. The extent of reoperation is related to the extent of primary surgery, stage, and distant metastasis. The timing and indication of reoperation for differentiated thyroid carcinoma in an interdisciplinary multimodal treatment setting depends on diagnostic radioiodine scans and radioiodine therapy. Long-term, recurrence-free survival is achieved by sufficiently radical surgery with acceptable morbidity, including all additive or adjuvant treatment options.

Disease Progression↗

PubMed2006

Reoperative surgery for chronic pancreatitis: is it safe?

INTRODUCTION: Eleven percent to fifty-six percent of patients do not achieve adequate pain relief with initial operative treatment for chronic pancreatitis, and reoperations for recurrent or persistent pain are common. This study evaluates the influence of prior pancreatic procedures on operative morbidity for chronic pancreatitis. METHODS: The records of 336 consecutive patients who underwent pancreaticoduodenectomy (PD, n=78), lateral pancreaticojejunostomy (LPJ, n=152), distal pancreatectomy (DP, n=83), transduodenal sphincteroplasty (SP, n=20), and total pancreatectomy (TP, n=3) for chronic pancreatitis were retrospectively reviewed and analyzed. RESULTS: Seventy-four patients underwent reoperation after failed prior pancreatic surgery. Patients with de novo pancreatic operations had a similar complication rate as those with reoperation (PD: 48% versus 65%, P>0.05; LPJ: 23% versus 23%, P>0.05; DP: 26% versus 28%, P>0.05; SP: 21% versus 100%, P>0.05). Major complications such as pancreatic leak or abdominal abscess were similar in the two groups. Minor complications such as delayed gastric emptying or wound infections were more common in the reoperation group. There was no difference in postoperative hospital length of stay. CONCLUSIONS: Patients who undergo reoperative surgery for chronic pancreatitis have an increased risk for minor perioperative complications. The overall complication rate and the incidence of major complications are similar compared to de novo procedure. Reoperative surgery therefore appears feasible and safe in experienced hands.

Adolescent↗

PubMed2001

Reoperations at the ileostomy in Crohn's disease reflect inflammatory activity rather than surgical stoma complications alone.

After ileostomy construction for Crohn's disease reoperations due to ileal recurrences are thought to be unusually rare, whereas reconstructions of the ileostomy due to stoma complications are considered to be unusually frequent. It remains unclear why the natural course of a disease as well as outstanding results of a standardized surgical procedure should be perverted. Therefore reconstructions of the ileostomy in 92 patients colectomized during a 12.5-year period and followed up for 5.4 years were analyzed concerning preoperative indication and postoperative histology. In 28 patients (30.4%) a total of 42 reoperations were necessary. The clinical indication was prestomal recurrence in 5 reoperations (11.9%) and stoma complications in 37 (88.1%). In contrast, ileal recurrence was demonstrated histologically in 28 specimens (66.7%) and healthy ileum in the rest. There was a statistically significant association between fibrotic recurrence and stoma stenosis/retraction and a trend for association between penetrating recurrence and peristomal ulceration. The cumulative risk for a first reoperation due to clinical recurrence was calculated at 3.3% and 14.0% at 5 and 10 years postoperatively, whereas the corresponding figures for stoma complications were 25.7% and 40.0%. In contrast, the cumulative risk that a recurrence was found histologically on the occasion of the reoperation was 23.0% and 35.0%, while the probability that the ileum was healthy in the case of a stoma complication remained low. In conclusion, most reoperations after ileostomy-construction in Crohn's disease are associated histologically with recurrent inflammation. The accentuation of the inflammatory recrudescence at the stoma itself or the prestomal ileum is decisive for the clinical presentation as stoma complication or intestinal complication. These findings reinforce both well known characteristics of the inflammatory disease and of established surgery.

Adult↗

PubMed1998

Anesthetic methods in reoperative carotid surgery.

It has been suggested that general anesthesia is the preferred method for reoperative carotid surgery for several reasons, including: the difficulty of the reoperative dissection; the disease may extend unusually high into the internal carotid artery; and the reconstruction required may be more complex than a typical endarterectomy. The purpose of this study is to show that reoperative carotid surgery can be performed safely under regional anesthesia. The records of 109 reoperative carotid operations performed on 96 patients over the past 25 years were reviewed. Procedures performed under regional anesthesia were compared to those performed under general anesthesia with respect to patient characteristics, intraoperative courses, and perioperative results. Regional anesthesia was utilized in 79 operations (72.5%); 30 operations were performed with general anesthesia (27.5%). The two patient groups were essentially equivalent with regard to atherosclerotic risk factors, preoperative neurologic symptoms, and the prevalence of contralateral total occlusion. The etiologies for recurrent disease included recurrent atherosclerosis (50.4%), intimal hyperplasia (30.3%), and vein patch aneurysm (9.2%). The methods of reconstruction employed included saphenous vein patch (47.7%), vein interposition graft (11.9%), prosthetic patch (20.2%), and prosthetic graft (20.2%). Perioperative strokes occurred in one case performed under regional anesthesia (1.3%), and in two cases under general anesthesia (6.6%); this difference was not statistically significant. Reoperative carotid artery surgery can be performed under regional anesthesia safely in the majority of instances. The aforementioned theoretical factors in favor of general anesthesia could also lead to technical difficulties with intraarterial shunt insertion. Having the patient awake, even if just long enough to prove that the patient will tolerate carotid artery clamping, might simplify many of these operations by avoiding shunt insertion. Regional anesthesia should therefore be considered an acceptable option in cases of reoperative carotid surgery.

Anesthesia, Conduction↗

PubMed1989

Prevalence of reoperation for pathway obstruction after Fontan operation.

Among 334 patients undergoing the Fontan operation at two institutions and followed for a long time, freedom from reoperation for Fontan pathway obstruction was 99% at 1 year after operation and 96%, 86%, and 59%, respectively, at 5, 10, and 15 years after operation. The hazard function for reoperation had an initial very rapidly declining phase and a second phase that was still rising 15 years after operation. Twelve (17%; confidence limits [CL], 13% to 23%) of 69 patients with a right atrial to right ventricular conduit (valved or nonvalved) connection underwent reoperation for pathway obstruction, whereas only 2 (4%; CL, 1% to 10%) of 45 patients with a direct connection to the right ventricle required reoperation. Five (8%; CL, 4% to 13%) of 65 patients with a right atrial to pulmonary artery conduit connection required reoperation for pathway obstruction, and only 2 (1.3%; CL, 0.4% to 3%) of 155 patients with a direct right atrial to pulmonary artery connection required reoperation. These findings have implications as to the optimal technique of the Fontan operation and also as to use of an intraatrial tunnel as part of the repair.

Adolescent↗

PubMed1993

Risk analysis of primary versus reoperative coronary artery bypass grafting.

Reoperative coronary artery bypass grafting is being performed with increasing frequency, in part as a function of the increasing pool of patients who have undergone initial coronary artery bypass grafting and in part because of the natural progression of atherosclerosis. The great majority of patients require reoperation because of graft atherosclerosis or because of a combination of graft and native-vessel disease. Significant risk factors for reoperation include the lack of an internal mammary artery graft or incomplete revascularization at the time of the primary operation, age, and New York State Heart Association classification. Despite an increasing experience with reoperations, operative mortality remains high, approximately three to five times that of initial bypass operation. Similarly, reoperations are associated with increased morbidity, including increased rates of bleeding and low output states. Specific problems encountered at reoperation include graft atherosclerosis, progression of native-vessel disease, and a significant increase in perioperative bleeding. Bypass ischemic times tend to be longer. The use of retrograde cardioplegia and blood conservation programs may prove to be effective solutions for these problems. If perioperative results can be improved, it would appear that the long-term outlook for these patients is reasonably good.

Aged↗

PubMed1994

Cardiac reoperation in patients with bilateral internal thoracic artery grafts.

The superior long-term patency of the left internal thoracic artery (ITA) graft is reflected in the enhanced survival of the patients who undergo the procedure, and its use has been shown to lead to a reduced need for reoperation. Evidence is accumulating that use of both ITAs at the primary operation further decreases the need for reoperation, and it is hoped that the use of other arterial conduits will augment this trend. Therefore, the popularity of bilateral ITAs and other arterial conduits in coronary artery operations is growing. However, many surgeons defer using both ITAs at the primary operation partly out of fear of the difficulties that may arise in conjunction with a possible future reoperation. Thirty-six patients underwent reoperation at The Cleveland Clinic Foundation 2 days to 13 years after an earlier bilateral ITA operation because of the progression of native disease, failure of the ITA or vein grafts, or the development of valve disease or end-stage ischemic heart disease. There were four early deaths (11%) and two late deaths, with an average follow-up of 4.3 years (range, 0 to 9.8 years). Forty-seven ITAs were patent preoperatively and 11 crossed the midline. Eleven were patent but stenosed and in need of revision or replacement. Two were damaged during reoperation; both were repaired, but one was ultimately replaced. Although the mortality associated with this procedure is relatively high and these operations are difficult, reoperation can be performed at an acceptable risk, and substantial surgical objectives can be achieved with good long-term results.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗

PubMed1990

Reoperation for recurrent angina after aortocoronary bypass surgery.

One hundred reoperations were performed on 93 patients of a total of 2287 patients who underwent initial coronary artery bypass surgery (CABG) between September 1972 and August 1988. The mean age of the 84 males and 9 females was 55.5 years (range 31-75 years). All patients prior to reoperation had severe angina and were judged to be in NYHA class III or class IV. Late graft failure alone or in combination with progressive atherosclerosis accounted for more than 60% of the cases requiring reoperation. The early mortality for reoperation was 1% compared with 1.4% for initial CABG. Perioperative myocardial infarction was recorded as a complication in 3.2% of cases at initial operation compared with 1% at reoperation. Symptomatic improvement occurred in 89.1% of cases after reoperation and almost 60% became entirely asymptomatic (mean follow-up interval 17 months).

Adult↗

PubMed1993

Reoperation after mitral valve reconstruction: early and late results.

Between 1968 and 1990, 68 patients (33 male, 35 female) with a mean age of 47 years were subjected to reoperation (62 valve replacements, 6 reconstructions) after primary mitral valve reconstruction (mean interval = 81 months). The indication for reoperation was residual valve insufficiency in 51, and stenosis in 17 patients. The average preoperative New York Heart Association (NYHA) class was 3.0. The average follow-up was 63 months. The operative mortality was 8.8% (8 out of 68 patients). The actuarial late survival was 90% after 5, and 73% after 8 years. After a second mitral valve reconstruction 66% (four out of six patients) died (one early, three late). The incidence of second reoperations was 4.4% (3 out of 68 patients), and of thromboembolic complications 11.8% (8 out of 68 patients). The mean NHYHA class improved significantly. The actuarial freedom from second reoperations was 98% and 90%, and from thromboembolic complications 91% and 82% after 5 and 10 years, respectively. Endocarditis did not occur, whereas two patients on Coumadin anticoagulation had non-fatal gastrointestinal bleeding. Late survival was less favorable (P < 0.05) in patients operated on before 1980, in a higher preoperative NYHA class, after a second valve reconstruction, and if pulmonary hypertension or atrial fibrillation was present. Significant independent risk factors were older age and earlier reoperation, pulmonary hypertension or higher NYHA class postoperatively. For the last to years it has been possible to perform reoperations after mitral valve reconstructions with good early and excellent late results. The mortality and complication rates were similar to those for primary mitral valve reconstructions.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed2004

Crohn's disease patients who quit smoking have a reduced risk of reoperation for recurrence.

BACKGROUND: Smoking increases the risk of recurrent Crohn's disease (CD). METHODS: We examined the impact of smoking, quitting smoking, and other factors on reoperation for recurrent CD. We distributed questionnaires to 584 patients from a surgical database whom had undergone a surgical operation for ileocecal CD to assess history of smoking, medical, behavioral, and demographic information. RESULTS: Two hundred sixty-seven patients completed the questionnaire (46% response). Smokers were more likely to have undergone 1, 2, and 3 reoperations for recurrence at any site (relative incidence rates [RIR] 1.32, 95% confidence interval [CI]: 1.10 to 1.60; RIR 1.55, 95% CI: 1.09 to 2.20; and RIR 1.77, 95% CI: 1.02 to 3.06, respectively) and were more likely to have undergone one reoperation for recurrent ileocecal CD (RIR 1.48, 95% CI: 1.18 to 1.86). Patients who quit smoking were less likely to have undergone 1, 2, and 3 reoperations for recurrence at any site (RIR 0.25, 95% CI: 0.15 to 0.41; RIR 0.30, 95% CI: 0.16 to 0.57; and RIR 0.25, 95% CI: 0.10 to 0.71, respectively) and were less likely to have undergone one reoperation for recurrent ileocecal CD (RIR 0.27, 95% CI: 0.15 to 0.47). CONCLUSIONS: This study indicates that patients with ileocecal CD who stop smoking reduce the risk of reoperation for recurrent CD.

Adolescent↗