[Valve reoperations. Apropos of 49 patients undergoing reoperation in a series of 1390 patients with 1 or more valve prostheses].
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Adolescent↗
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[Our experience with reoperations in abdominal surgery. (54 reoperations in 46 patients in the last 4 years)].
The authors analyze 54 reinterventions in abdominal surgery in 46 patients, and present the lesions found on reintervention. In one out of two cases there is an intra-peritoneal septic focus. In more than 25 p. 100 of the cases the lesions were multiple. They oppose the localized septic foci and the occlusions which are of good prognosis, with the diffuse septic foci, acute pancreatitis and fistulae whose course is more often than not fatal.
Abdomen↗
[Reoperation after valve replacement--a study of reoperated and autopsy findings of long term follow up cases (author's transl)].
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Adolescent↗
Unplanned reoperations for infection complications: a survey for quality control.
BACKGROUND: Unplanned reoperation is perceived as a quality indicator for surgical procedures. However, there is a lack of data regarding the extent to which infections add to the reoperation rate. We studied the role of infection as an indication for unplanned reoperation. METHODS: The setting was a surgical department at an academic teaching hospital performing a spectrum of general, vascular, thoracic (lung), and transplant (kidney) procedures. Between January, 2003 and September, 2004, data on operations, unplanned reoperations, and complications were documented prospectively. Unplanned reoperation was defined as unexpected reoperation within 30 days of the primary procedure. Endpoints were the number of unplanned reoperations attributable to infection, the site of the infection, the type of the primary operation, and deaths. RESULTS: A total of 6,287 operations were performed during the study period. The rate of unplanned reoperations was 1.34% (84/6287), and 15 (17.9%) of these 84 patients had to undergo reoperation because of an infection. The primary operations in these cases were general surgical procedures in 11 patients, kidney transplant in two patients, and vascular surgery and lung resection in one patient each. Leakage of a gastrointestinal anastomosis was the predominant cause in the general surgical group (8/11). The most frequent initial procedure was colon resection (n = 4) followed by ileostomy closure (n = 2) and kidney transplant (n = 2). One unplanned reoperation had to be done after esophagectomy, pancreatoduodenectomy, pneumonectomy, incisional hernia repair, appendectomy, femoro-femoral bypass, and resection of a soft tissue tumor. The mortality rate after unplanned reoperation for infection was 20% (3/15), a significantly higher rate than in patients not having reoperation (p < 0.00001). Subgroup analysis did not show any significant difference in mortality according to whether the unplanned reoperation was indicated by infection, bleeding, or other reason (p = 0.28). Patients who required operation because of an infection stayed significantly longer in the intensive care unit (p = 0.018) and underwent more reoperations (p = 0.003) than those with other indications for reoperation. CONCLUSION: Infections add considerably to the rate of unplanned reoperation. The mortality rate is high, but not significantly different from that in patients having reoperation for other indications. A longer stay in the intensive care unit and a higher number of reoperations indicate a greater use of resources by these patients.
APACHE↗
Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux.
With wide application of antireflux surgery, reoperations for failed fundoplications are increasingly seen. This study was undertaken to document outcomes after reoperative fundoplications. Sixty-four patients, 26 men and 38 women, of average age 55 years+/-15.6 (SD), underwent reoperative antireflux surgery between 1992 and 2003. Fundoplication prior to reoperation had been undertaken via celiotomy in 27 and laparoscopically in 37. Both before and after reoperative antireflux surgery, patients scored their reflux and dysphagia on a Likert Scale (0 = none, 10 = continuous). Reoperation was undertaken because of dysphagia in 16 per cent, recurrent reflux in 52 per cent (median DeMeester Score 52), or both in 27 per cent. Failure leading to reoperation was due to hiatal failure in 28 per cent, wrap failure in 19 per cent, both in 33 per cent, and slipped Nissen fundoplication in 20 per cent. Laparoscopic reoperations were completed in 49 of 54 patients (91%); 15 had reoperations undertaken via celiotomy. Eighty-eight per cent of reoperations were Nissen fundoplications. With reoperation, Dysphagia Scores improved from 9.5+/-0.7 to 2.6+/-2.8, and Reflux Scores improved from 9.1+/-1.4 to 1.8+/-2.7. Seventy-nine per cent of patients with reflux prior to reoperation, 100 per cent with dysphagia, and 74 per cent with both noted excellent or good outcomes after reoperation. We conclude that failure after fundoplication occurs. Reoperations reduce the severity of dysphagia and reflux, thus salvaging excellent and good outcomes in most. Laparoscopic reoperations are generally possible. Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux, and their application is encouraged.
Adult↗
Reoperative neurosurgery in dogs with thoracolumbar disc disease.
OBJECTIVE: To characterize the subset of dogs in our neurosurgical practice that underwent spinal surgery for thoracolumbar (TL) disc herniation and subsequently underwent additional decompressive TL surgery. STUDY DESIGN: A retrospective case series. SAMPLE POPULATION: Thirty dogs that underwent reoperation for TL disc herniation. A comparison group of Dachshunds that underwent only one decompressive TL disc surgery was also studied. METHODS: Dogs that underwent reoperation were divided into two groups based on the interval between their first and second surgery. The early reoperation group included those dogs having a second surgery less than 4 weeks after the initial operation. The late reoperation group included those dogs having a second surgery more than 4 weeks after the initial operation. For each Dachshund in the late reoperation group, two Dachshunds that underwent only one decompressive TL disc surgery were selected and formed the comparison group. Dogs in the comparison group were matched with reoperated cases based on the severity of preoperative neurologic deficit and site of disc herniation. These two groups were compared to determine: (1) if age and body weight were risk factors for reoperation, and (2) if dogs had a poorer functional outcome after their second decompressive surgery than did those in the comparison group after their first (and only) decompressive surgery. RESULTS: A total of 30 of 467 (6.4%) dogs that underwent decompressive TL disc surgery were reoperated. In the early reoperative cases (n = 5 dogs), the inciting cause in all cases was residual compression from disc material at the site of the initial surgery. In the late reoperation group, 22 of 25 (88%) cases had a second disc herniation at a site distinct from the initial lesion. Dachshunds had a significantly higher risk for late reoperation (odds ratio and 95% CI = 3.67, 1.46 to 10.03); other small and medium-sized breeds (<20 kg) were underrepresented. Age and body weight were not significant predictors for reoperation. A total of 21 of 23 (91%) dogs had functional recovery after late reoperation. Complete sensorimotor loss was a significant negative predictor of functional recovery in the late reoperative cases (P = .01). Likelihood of functional recovery in dogs after their second decompressive surgery was identical to the functional recovery of dogs in the comparison group. CONCLUSIONS AND CLINICAL RELEVANCE: Our results show that a second disc herniation occurring at a site distinct from the initial lesion is the most common cause for reoperation and that Dachshunds have a significantly greater risk than other breeds.
Animals↗
[Reoperations on heart valve prostheses. Apropos of 58 cases].
In the period from 1968 to November 1980, 1 023 patients underwent surgery for single or multiple valve replacement. Fifty three patients (6,6% of the follow-up population) had to be reoperated, including 5 patients who had to be reoperated twice, giving a total of 58 reoperations. The average interval before reoperation was 30 months. The incidence was similar in monovalvular (7,5 p. 100 mitral valves, 5 p. 100 aortic valves) and polyvalvular (7 p. 100) cases. On the other hand, the incidence of reoperation of tricuspid prostheses (17 p. 100) was significantly superior to that of mitral valve (5,3 p. 100) or aortic valve (3,8 p. 100) prostheses. In 91 p. 100 of cases, the indication for reoperation was prosthetic valve dysfunction related to endocarditis in over a third of cases (21). In 32 cases, reoperation was required in the absence of any infectious process: 13 spontaneous perivalvular leaks, 10 thromboses, and 9 stenosing prostheses. There were no reoperations for wear of the prosthetic material. Only 9 p. 100 of patients were reoperated for uncorrected valvular disease. The prognosis of these reoperations was poor; hospital mortality being 42,5 p. 100. This high mortality rate is explained by the frequency of reoperation for infective endocarditis (36 p. 100) in our series, the mortality of which was 73,6 p. 100 and even higher when reoperation was an emergency for infectious or hemodynamic reasons. There was also a high mortality rate with reoperation for thrombosis (30 p. 100) because of the severe myocardial dysfunction in thrombosis of tricuspid prostheses and the emergency situation associated with mitral prosthetic valve thrombosis. Excluding these two complications, the average mortality was 21 p. 100. Although the surgical indications are relatively easy for thrombosis, perivalvular leak and stenosing prostheses, they are particularly difficult in infectious endocarditis especially with regards to the timing of reoperation. We believe that, ideally, reoperation should be delayed as long as possible to allow the antibiotic therapy the maximum time to take effect. Surgery can then be performed after controlling the infection and before the installation of severe hemodynamic distress.
Adolescent↗
A population-based study of reoperations after back surgery.
STUDY DESIGN: Longitudinal follow-up study of back surgery reoperations using an administrative database. OBJECTIVES: To identify population-based rates and factors that determine the need for reoperation after back surgery. SUMMARY OF BACKGROUND DATA: Reoperation after lumbar surgery has poorer results than the initial surgery, yet the population-based incidence and determinants of reoperation are not known. Reported rates of reoperation are derived from retrospective case series and range from 4% to 15%. There are conflicting data on the rate of reoperation after different types of initial surgery. METHODS: All patients who had back surgery in the Province of Ontario (population 10,000,000) between April 1990 and March 1991 were identified using hospital discharge abstracts and an ICD-9 code algorithm. Patients who had undergone prior surgery were excluded. Patients were observed from the index operation to subsequent readmission and reoperation with a maximal time to follow-up examination of 4 years. Basic demographic information and information regarding diagnoses, surgery performed, complications, comorbid factors, reoperation diagnosis, and surgery type were obtained. Patients were divided into surgical treatment groups, and their subsequent reoperations were identified. Multivariate analysis using proportional hazards modeling was conducted. RESULTS: The index surgery group consisted of 4,722 patients, of whom 449 (9.5%) underwent reoperations in the follow-up period. Complications from surgery were significantly higher in the fusion and fusion with decompression groups. The reoperation rate was not significantly different among individual surgery groups. Diagnosis, operation performed, complications after the index surgery, comorbid conditions, and sex did not predict the need for spine reoperation. Younger age was predictive of the likelihood of reoperation (P = 0.04) CONCLUSION: The incidence of reoperation after back surgery is independent of diagnosis and type of surgery performed. Despite different anatomic reasons for surgical intervention, the success of different types of surgery are not influenced by the factors identified in this study. More extensive surgery does not prevent nor predispose a patient to the need for further surgery.
Adult↗
Reoperations after prophylactic mastectomy with or without implant reconstruction.
BACKGROUND: The authors characterized the unanticipated reoperations after prophylactic mastectomy, with or without implant reconstruction. METHODS: The surgical cohort was comprised of 1417 women with a family history of breast carcinoma. The women received a prophylactic mastectomy with (bilateral, n = 593; contralateral, n = 506) or without reconstruction (n = 318) at the Mayo Clinic (Rochester, MN) between 1960 and 1993. Reoperations and indications for reoperation were compiled from medical records and a patient survey. RESULTS: Three hundred eighteen women received a bilateral (n = 39) or contralateral (n = 279) prophylactic mastectomy without reconstruction. With a median follow-up of 15 years, 18 women (6%) required reoperation. Most of these reoperations occurred within the first year after prophylactic mastectomy. Five hundred ninety-three women had reconstruction with implants following bilateral prophylactic mastectomy. Approximately one-half of the women (52%) required at least 1 unanticipated reoperation during a median follow-up of 14 years. Approximately 39% of all reoperations occurred within 1 year of breast reconstruction and 69% within 5 years. Implant-related issues were the most common cause for reoperation. Some women with breast carcinoma elected to receive contralateral prophylactic mastectomy with therapeutic mastectomy for the affected breast. Five hundred six women received reconstruction with implants. During a median follow-up of 8.8 years, 189 women (37%) required unanticipated reoperation. The most common indication was implant-related issues. The time course of reoperations was similar to that for women in the bilateral group. CONCLUSIONS: Surgical reoperations were fairly common among women who received prophylactic mastectomy with implant reconstruction. Most of the reoperations were implant related. Reoperations were fairly uncommon after prophylactic mastectomy without reconstruction.
Adult↗
Is reoperation still a risk factor in coronary artery bypass surgery?
BACKGROUND: Hospital mortality for reoperative coronary artery bypass grafting (CABG) is approaching that of primary CABG. This raises two questions: (1) has experience neutralized the risk of reoperation attributable to its greater difficulty, or (2) has experience neutralized the risk attributable to the higher-risk profile of reoperative patients?. METHODS: From 1990 to 2003, 21,568 CABG procedures were performed, of which 4,518 (21%) were reoperations: 3,919 first, 552 second, 43 third, 3 fourth, and 1 fifth. Reoperative patients had a higher-risk profile than primary patients, with more vascular disease, left ventricular dysfunction, and coronary artery disease (all p < 0.0001). Logistic regression was used to identify factors associated with hospital death and to develop a propensity score for reoperation, which was used to (1) adjust multivariable analyses of death and (2) compare outcomes in matched patients. RESULTS: Hospital mortality was 4.3% (168 of 3,919) for first reoperation, 5.1% (28 of 552) for second, and 6.4% (3 of 47) for third or more, compared with 1.5% (263 of 17,050) for primary operations. Risk of both primary and reoperative CABG decreased with experience (p > 0.0002); however, reoperative risk fell markedly in the mid-1990s. In both the overall and matched-pairs analyses, reoperation was a risk factor before 1997 (p < or = 0.008), but not after (p = 0.2). Reoperation within 1 year of previous CABG increased risk (p < 0.0001). Risk attributable to left ventricular dysfunction decreased with experience (p = 0.05). CONCLUSIONS: Hospital mortality for reoperative CABG has been consistently higher than for primary operation, but this difference has narrowed considerably. Patient characteristics, not reoperation itself, now have greater influence.
Aged↗
Revision total knees done for extensor problems frequently require reoperation.
UNLABELLED: We retrospectively reviewed 361 patients who had a revision total knee arthroplasty done for an extensor mechanism problem to assess the prevalence, etiology, and risk factors for subsequent reoperation. The prevalence of reoperation was 23% because 84 patients were reoperated on one or more times. The average time to the first reoperation was 2.4 years. The total number of reoperations was 127 with 58 patients reoperated on once, 15 reoperated on twice, and 11 reoperated on three or more times. The cumulative risk of a reoperation for any reason after index revision was 7% at 1 year, 19.6% at 5 years, and 35.9% at 10 years. The most common reason for reoperation was a new or recurrent patellofemoral problem, which accounted for 33% of the first reoperations. The risk of reoperation was substantially lower for patients that had femoral or tibial component malrotation corrected at the time of revision TKA. The risk of reoperation after revision TKA for an extensor mechanism complication increased in patients operated on in the 1990s compared with patients operated on in the 1970s and 1980s. LEVEL OF EVIDENCE: Therapeutic study, Level-IV-1 (case series). See the Guidelines for authors for a complete description of levels of evidence.
Arthroplasty, Replacement, Knee↗
Risk of multiple reoperations after lumbar discectomy: a population-based study.
STUDY DESIGN: Retrospective follow-up study of patients undergoing multiple (two or more) reoperations after initial lumbar discectomy using an administrative database. OBJECTIVES: To identify the population-based risk of multiple reoperations after lumbar discectomy and to analyze factors associated with the risk. SUMMARY OF BACKGROUND DATA: Although multiple reoperations after initial lumbar discectomy are likely uncommon, research to better understand reasons for and outcomes of reoperations is needed because of the large number of discectomies performed. METHODS: Data on all lumbar spine operations during 1987-1998 were obtained from the Finnish Hospital Discharge Register. The patient's initial disc operation during the study period was linked to subsequent operations, and patients with two or more reoperations were analyzed further. The risk of multiple reoperations was determined using the methods of event history analysis. RESULTS: Among 35,309 patients undergoing an initial discectomy, 4943 (14.0%) had at least one reoperation and 803 (2.3%) had two or more reoperations. A total of 63% of the second reoperations were discectomies, 14% were fusions, and the remaining 23% were decompressions. Patients with one reoperation after lumbar discectomy had a 25.1% cumulative risk of further spinal surgery in a 10-year follow-up. Reduced risk was seen when the first reoperation took place more than 1 year after the initial discectomy (relative risk 0.83, 95% confidence interval 0.72-0.96), in patients for whom the first reoperation had been a fusion (relative risk 0.27, 95% confidence interval 0.12-0.61), and in patients 50-64 years of age (relative risk 0.62, 95% confidence interval 0.48-0.79). CONCLUSION: Patients with one reoperation after lumbar discectomy are at considerable risk of further spinal surgery.
Adult↗
[Timing of reoperation of degenerated aortic and mitral bioprostheses].
Reoperative surgery for degenerated aortic and mitral valve bioprostheses has a considerable mortality. This study compares life expectancy, mode of failure and predictors for emergency reoperation and reoperative mortality between degenerated aortic and mitral bioprostheses. A total of 265 bioprosthetic valve patients, 172 aortic and 93 mitral patients, were followed to assess the time period between first and redo valve replacement. Mean life expectancy for aortic bioprostheses was 10.4 +/- 4.3 (2 to 28.6) years, whereas it was 10.0 +/- 3.7 (0.9 to 20) years for mitral bioprostheses (group M). Emergency reoperation had to be performed in 31/172 group A (18%) and 16/93 group M (17%) patients. In group A, the reoperative mortality was 5.2%; it was 1.4% for elective and 22.6% for emergency reoperation (p < 0.0001; OR = 20.3). Reoperative mortality in group M patients was 5.4% and did not differ between elective and emergency surgery. Group A patients who died at reoperation had higher transvalvular gradients before the first operation (p = 0.007), received smaller sized bioprostheses (p = 0.03) and had a higher incidence of coronary artery disease (p = 0.001) and pulmonary artery hypertension (p = 0.009) acquired during the interval. Endocarditis being the reason for primary surgery (p = 0.004), postoperative pneumonia after the first procedure (p = 0.005), pulmonary artery hypertension (p = 0.0004), later recurrence of symptoms of valve degeneration (p = 0.04), acute onset of bioprosthetic regurgitation (p = 0.00002) and a lower left ventricular ejection fraction (p = 0.03) were risk factor for emergency surgery. There were no predictors of reoperative mortality identified in mitral valve patients. The life expectancy of aortic and mitral bioprostheses is acceptable even in a relatively young patient population (mean age 46 +/- 13 in group A and 45 +/- 12 years in group M patients). Patients with degenerated aortic bioprostheses undergoing emergency reoperation have an extraordinary high reoperative mortality. They can be identified as patients who had a history of endocarditis and higher transvalvular gradients prior to the first operation, who received smaller sized bioprostheses and acquired coronary artery disease and pulmonary artery hypertension during the interval. Thus, emergency reoperation is preventable, increasing overall life expectancy of patients with bioprostheses. There were no risk factors for reoperative mortality identified in bioprosthetic mitral valve patients.
Adolescent↗
Surgery for right ventricle to pulmonary artery conduit obstruction: risk factors for further reoperation.
OBJECTIVE: To identify the surgical approaches and risk factors which influence longevity of right ventricle to pulmonary artery (RV-PA) conduits following first reoperation for obstruction. METHODS: Between January 1993 and August 2003, 114 patients underwent 141 reoperations for RV-PA conduit obstruction. Diagnoses included 'Truncus Arteriosus' (n=52), 'Pulmonary atresia/Tetralogy of fallot' (n=39), 'Double outlet right ventricle' (n=10), 'Transposition of great arteries, VSD, and pulmonary atresia' (n=9), and the 'Ross operation' (n=4). All patients had undergone a previous biventricular repair. The first reoperation for conduit obstruction was performed in 112 hospital survivors by: total conduit replacement (Group A, n=73) with valved (homograft=10 and xenograft=54) or non-valved (n=9) conduit, and patch enlargement of the obstructed RV outflow tract with preservation of the posterior and sides of the conduit wall after removing of the fibrocalcific peel and degenerated valve (Group B, n=39). Mean age at first reoperation was 8.8+/-6.7 and 7.5+/-5.3 years in patients of groups A and B, respectively. Seven patients in Group A and 18 in Group B required a second reoperation and two patients in Group B a third reoperation. RESULTS: There were two hospital deaths and no late deaths. Mean follow-up was 5.8+/-3.2 years. Risk factors for second reoperation by univariate analysis were: homograft conduit use (P=0.004), Group B surgical approach (P=0.0001), higher RV-PA systolic pressure gradient at discharge (P=0.02), and age <5-years-old (P=0.01). Multivariate analysis showed that inclusion in Group B and younger age (<5-years-old) at repair were independent risk factors for second reoperation. Group B surgical approaches had higher RV-PA systolic pressure gradient at discharge (P=0.02) and required more PA bifurcation repair at the time of second reoperation (P=0.05). Freedom from second reoperation for conduit obstruction was significantly higher in Group A patients at 5 and 8 years (P<0.04) and those with xenografts rather than homograft (P=0.04). CONCLUSIONS: Our results support the optimal surgical approach for RV-PA conduit obstruction is total replacement with a xenograft. RV outflow reconstruction by other techniques without complete dissection of PA bifurcation does not completely relieve the stenosis and could cause early restenosis. Higher systolic gradients at discharge and younger age at first reoperation are predictors of earlier reoperation.
Adolescent↗
[Coronary reoperations: recurrence of angina and clinical outcome].
OBJECTIVE: To evaluate the features of coronary artery bypass reoperations and to reduce the influence of the factors affecting postoperative morbidity and mortality. MATERIAL AND METHODS: The records of 53 consecutive patients (88.7% of men, 11.3% of women; mean age 67.1+/-7.5 years) who underwent coronary artery bypass reoperations were reviewed retrospectively. Coronary artery bypass reoperations comprised 2.98% of all coronary artery bypass grafting operations during that period. Coronary artery bypass reoperations performed within 4-week period after the last operation and complex procedures were excluded. RESULTS: Postoperative mortality after 53 reoperations and 1775 primary coronary artery bypass grafting operations was 7.5 and 2.52%, respectively, and the results are comparable with the results from other clinics of cardiac surgery. Mean time interval between primary coronary artery bypass grafting and reoperation was 90.7+/-49.9 months. Angiography at that period showed patency of venous and arterial conduits--34.6 and 76.5%, respectively. Twenty-nine patients (54.7%) received only venous conduits during reoperation. There were 2.4+/-1.1 anastomoses constructed during reoperation comparing to 3.5+/-0.9 anastomoses per patient during primary coronary artery bypass grafting. CONCLUSIONS: According to our data mortality after coronary reoperations remains higher comparing to primary coronary artery bypass grafting, however, it does not differ significantly. We observed an increasing number of elderly patients in coronary reoperations. We think that it is related to the demographical changes within our country and increased use of arterial conduits during primary coronary artery bypass grafting operations. Arterial conduits are patent at least 10 years; it means that the time period until recurrent angina and reoperation is delayed. However, progression of arterial atherosclerosis remains the main reason for coronary artery bypass grafting reoperation.
Age Factors↗
Aortic dissection. Prevalence, cause, and results of late reoperations.
From January 1977 to September 1992, 143 patients underwent an emergency operation for type A acute aortic dissection. Because of the location of the intimal tear, the replacement of the ascending aorta was extended to the transverse arch in 42 patients (29.3%). One hundred ten patients (78%) survived the operation. During the same period, 32 patients had to be reoperated on once (n = 24) twice (n = 6), or three times (n = 2) for a total of 42 reoperations. Nineteen patients had had the initial repair in our institution, and 13 had been operated on elsewhere. Reoperation was indicated for aortic valve disease (n = 4), recurring dissection (n = 7) threatening aneurysmal evolution of a persisting dissection (n = 28), or false aneurysm (n = 3). The redo procedure involved the aortic root and/or ascending aorta in 15 cases (group I), the transverse arch alone in 7 cases (group II), the transverse arch and the descending aorta or the descending aorta alone in 10 cases (group III), or the thoracoabdominal aorta in 10 cases (group IV). The risk factors for reoperation have been analyzed in the 110 survivors initially operated on in our institution. Seven of 18 patients with Marfan's syndrome (38.8%) versus 12 of 92 without Marfan's syndrome (13%) were reoperated on (p = 0.023). None of the 30 patients surviving arch replacement at initial repair required a reoperation, versus 19 of 80 (23.7%) patients surviving a replacement limited to the ascending aorta (p = 0.013). The overall mortality rate of reoperation was 21.8% (7/32) with a risk of 16.6% (7/42) at each procedure (group I, 13.3%; group II, 0%; group III, 20%; group IV, 30%). Hospital mortality was influenced by emergency operation (5/10) (p < 0.005) and thoracoabdominal replacement (3/10) (p < 0.035). The late survivals after reoperation are 65.1% +/- 17.6% at 1 year and 55% +/- 19.63% at 5 years (Kaplan-Meier, confidence interval 95%). The late survivals, after the initial repair, of the patients undergoing reoperation are 89.6% +/- 11.0%, 79.3% +/- 14.7%, 53.9% +/- 18.1%, and 35.9% +/- 21.8% at 1, 5, 10, and 12 years, respectively. In conclusion, aortic dissection is an evolving process that may require one or several reoperations after the initial repair. At initial emergency operation, the resection of the entry site, when located on or extending to the transverse arch, has reduced the risk of reoperation, in our experience. Elective reoperation must be considered before the occurrence of complications, especially in patients with Marfan's syndrome.(ABSTRACT TRUNCATED AT 400 WORDS)
Acute Disease↗
Quality of life and patient satisfaction after reoperation for primary hyperparathyroidism: analysis of long-term results.
Morbidity after reoperation for persistent or recurrent primary hyperparathyroidism (pHPT) is higher than after primary surgery. According to our experience, there is a contrast between postoperative normalization of laboratory parameters and the quality of life/patient satisfaction after reoperation. Therefore the aim of the study was to analyze the outcomes of reoperations in comparison to primary surgery. We evaluated the patients' reported quality of life using the SF-36 (an accepted health status assessment tool) and complete prospectively documented perioperative and follow-up data including postoperative complications. Additionally, we searched for reasons why primary surgical intervention did not succeed. In a prospective cohort study the perioperative data of 653 consecutive patients with pHPT, including 75 reoperated patients (11.5%) who underwent parathyroidectomy between 1987 and 1999, were evaluated by uni- and multivariate analysis. At a median 78 months (6-156 months) postoperatively, all patients underwent a planned follow-up that included the SF-36, physical examination, and laboratory investigations. A total of 51 reoperated patients were available for follow-up. Postoperative alleviation of symptoms or being symptom-free was reported by 70.6%. Patients after reoperation had lower SF-36 scores in all health domains postoperatively than patients after a primary operation. Of the reoperated patients, 19.6% stated that after evaluating the development of their complaints they would not consent to reoperation again. Subgroup analysis showed that 80% of patients with postoperatively persistent pHPT, 60% of those who did not observe symptom alleviation, and 44% of those after sternotomy were in the group of dissatisfied patients. Surprisingly, none of the patients with more than one reoperation, only two of the five patients with permanent recurrent laryngeal nerve injury, and only one of the four patients with persistent hypoparathyroidism were dissatisfied overall. Parathyroidectomy resulted in normocalcemia in 90.2% of the reoperated patients, with an operative morbidity of 27.4% and no mortality. After an unsuccessful operation for pHPT, patients should be treated at an expert center to avoid persistent hypercalcemia. Reoperations necessitating sternotomy should be restricted to patients with severe symptoms and signs.
Aged↗
Reoperation for thymoma: report of 23 cases.
Twenty-three patients underwent reoperation for thymoma at intervals of 2 months to 17 years 10 months after the initial operation. There were no operative or hospital deaths. Myasthenia gravis occurred in 12 patients, but in only 2 was it a determinant for reoperation. The longest survival after reoperation is 12 years 9 months, and that patient is free from tumor. Four distinct surgical groups emerged, and their recognition provides an improved method of reporting and suggests a strategy for better overall management. Group 1 (n = 5) had completion of thymectomy (reoperation) after thymomectomy alone or after incomplete thymectomy. The interval was 2 months to 17 years 10 months. All 5 had myasthenia gravis. At reoperation, thymomas were found in 3 and a hyperplastic thymus in 2. Four are alive and tumor free 2 years to 8 years 2 months after reoperation. One died tumor free after 5 years. Group 2 (n = 8) had reoperation for recurrent thymoma after standard (presumably complete) resection. The interval was 2 years to 13 1/2 years. Four had myasthenia gravis. Four are alive 8 months to 5 years 8 months after reoperation, 3 without detectable tumor. Four died 3 years 3 months to 8 years 4 months after reoperation, 3 free from tumor. Group 3 (n = 8) underwent reoperation for initially unresectable thymoma after adjuvant treatment with chemotherapy, radiotherapy, or both. The interval was 3 months to 4 years 8 months. Three had myasthenia gravis. Six are alive 4 months to 4 years after reoperation, only 1 with tumor.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗