Sample records for reoperation

  1. Reoperative midface reconstruction.

    Acero, Julio; García, Eloy


    Reoperative reconstruction of the midface is a challenging issue because of the complexity of this region and the severity of the aesthetic and functional sequela related to the absence or failure of a primary reconstruction. The different situations that can lead to the indication of a reoperative reconstructive procedure after previous oncologic ablative procedures in the midface are reviewed. Surgical techniques, anatomic problems, and limitations affecting the reoperative reconstruction in this region of the head and neck are discussed.

  2. Reoperation for urinary incontinence

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler


    on a nationwide population. STUDY DESIGN: We used the Danish National Patient Registry to identify women who had surgery for urinary incontinence from 1998 through 2007 and the outcome was a reoperation within 5 years. Kaplan-Meier curves were used to estimate the rate of reoperation for 6 types of surgery...

  3. Reoperation for bleeding in cardiac surgery

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik


    bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We...... after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher......At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative...

  4. reoperation rates following intramedullary nailing versus external ...

    Reasons for reoperation among EF patients were infection. (2 patients) ... fixation. Keywords: Orthopaedic surgery, Tanzania, Intramedullary nail, External fixation, Open tibia fracture. INTRODUCTION ..... of surgical site infection. Infect Control ...

  5. Infantile esotropia: risk factors associated with reoperation

    Magli A


    Full Text Available Adriano Magli,1 Luca Rombetto,2 Francesco Matarazzo,2 Roberta Carelli1 1Department of Ophthalmology, Orthoptics and Pediatric Ophthalmology, University of Salerno, Salerno, 2Department of Ophthalmology, Federico II University, Naples, Italy Abstract: The aim of this study was to identify clinical and demographic factors associated with misalignment after first surgery performed on children affected by infantile esotropia to evaluate the reoperation rate. A retrospective study was carried out, analyzing data from 525 children who underwent bilateral medial recti recession, bilateral lateral recti resection, and inferior oblique recession and anteroposition by the same surgeon (AM. Postoperative evaluation included assessment of motor alignment at approximately 3 months, 6 months, 1 year, and 5 years. Statistical analysis was performed with a logistical regression model in which the dependent variable was the presence/absence of reoperation. We found that late surgery (after 3 years of age and a family history of strabismus are associated with a higher risk of reoperation, while some clinical factors, including some classically associated with worst motor outcome as preoperative angle, dissociated vertical deviation, and amblyopia, did not influence the incidence of reoperation in infantile esotropia. Male patients and patients with hyperopia in preoperative examinations have a significantly decreased reoperation rate. Keywords: infantile esotropia, risk factors, reoperation

  6. The benefit patients derive from aortocoronary reoperation.

    Weinhold, C; Neumaier, P S; Klinner, W


    There is an increasing incidence of aorto coronary reoperation necessitated by intractable angina which averages 2% of 4676 initial bypass procedures. Graft obliteration, graft stenosis or progression of disease led to recurrence of symptoms in 96 patients (84 male, 12 female) who underwent a second operation. Not all occluded or stenotic bypasses were feasible for reoperation. Hospital mortality (30 days) was higher than after initial CABG, but could be reduced from 12.1% to 4.8%. Subjective and objective follow-up investigations were obtained in 77 of 84 survivors and demonstrate that successful reoperation is about 10% lower in patients with a malignant form of atherosclerosis (60%) than in patients who only suffer from occluded grafts or new proximal significant stenoses in previously unbypassed vessels (70%).

  7. Reoperation versus clinical recurrence rate after ventral hernia repair

    Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik


    OBJECTIVE:: To compare the clinical recurrence rate with reoperation rate for recurrence after ventral hernia repair. BACKGROUND:: Reoperation is often used as an outcome measure after ventral hernia repair, but it is unknown whether reoperation rate reflects the overall clinical risk for recurre...

  8. Analysis of adjacent segment reoperation after lumbar total disc replacement

    Rainey, Scott; Blumenthal, Scott L.; Zigler, Jack E.; Guyer, Richard D.; Ohnmeiss, Donna D.


    Background Fusion has long been used for treating chronic back pain unresponsive to nonoperative care. However, potential development of adjacent segment degeneration resulting in reoperation is a concern. Total disc replacement (TDR) has been proposed as a method for addressing back pain and preventing or reducing adjacent segment degeneration. The purpose of the study was to determine the reoperation rate at the segment adjacent to a level implanted with a lumbar TDR and to analyze the pre-...

  9. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty.

    Leonardsson, Olof; Kärrholm, Johan; Åkesson, Kristina; Garellick, Göran; Rogmark, Cecilia


    Hemiarthroplasty as treatment for femoral neck fractures has increased markedly in Sweden during the last decade. In this prospective observational study, we wanted to identify risk factors for reoperation in modular hemiarthroplasties and to evaluate mortality in this patient group. We assessed 23,509 procedures from the Swedish Hip Arthroplasty Register using the most common surgical approaches with modular uni- or bipolar hemiarthroplasties related to fractures in the period 2005-2010. Completeness of registration (individual procedures) was 89-96%. The median age was 85 years and the median follow-up time was 18 months. 3.8% underwent reoperation (any further hip surgery), most often because of implant dislocation or infection. The risk of reoperation (Cox regression) was higher for uncemented stems (hazard ratio (HR) = 1.5), mainly because of periprosthetic femoral fractures. Bipolar implants had a higher risk of reoperation irrespective of cause (HR = 1.3), because of dislocation (1.4), because of infection (1.3), and because of periprosthetic fracture (1.7). The risk of reoperation due to acetabular erosion was lower (0.30) than for unipolar implants, but reoperation for this complication was rare (1.7 per thousand). Procedures resulting from failed internal fixation had a more than doubled risk; the risk was also higher for males and for younger patients. The surgical approach had no influence on the risk of reoperation generally, but the anterolateral transgluteal approach was associated with a lower risk of reoperation due to dislocation (HR = 0.7). At 1 year, the mortality was 24%. Men had a higher risk of death than women (1.8). We recommend cemented hemiarthroplasties and the anterolateral transgluteal approach. We also suggest that unipolar implants should be used, at least for the oldest and frailest patients.

  10. Accidental falls involving medical implant re-operation.

    Ong, Kevin L; Lau, Edmund; Moore, Tara; Heller, Michelle F


    Implantation of medical devices is becoming more prevalent, and as a result, a greater number of patients who fall accidentally are expected to have a medical implant. The Nationwide Inpatient Sample (NIS) was used to evaluate hospital admissions following accidental falls involving re-operation of existing medical implants (hip, knee, spine, and fracture fixation) from 1990 to 2005. From 1990 to 2005, hospitalisations due to accidental falls on level surfaces increased by 306%, and hospitalisations due to falls from stairs increased by 310%. Falls involving orthopaedic revision surgery (re-operation) are relatively rare, but the incidence has increased by approximately 35%. Hospital stays after falls on level surfaces involving re-operation were 1.0 day (median) longer and cost 50% (median) more than those that did not involve re-operation in 2005. After staircase falls, hospital stays for patients undergoing re-operations were 2.0 days (median) longer and cost 108% (median) more. The greater hospital costs and hospital stay for patients needing re-operations indicate that additional medical treatment was required.

  11. Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis

    Hwang, Hee-Jong; Lee, Gwang-Soo; Heo, June-Young; Chang, Jae-Chil


    Objective The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation. Methods A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored. Results Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation. Conclusion Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS. PMID:28127375

  12. Reoperations for occluded arterial bypasses in the lower limbs


    Background We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005. Methods The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions abve the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee. Results The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively (P0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) (P0.05). The rate of limb salvage was 64.29% (18/28). Conclusions The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass.

  13. Predictors of re-operation due to post-surgical bleeding in breast cancer patients

    Lietzen, Lone Winther; Cronin-Fenton, D; Garne, J P


    To assess the risk of re-operation due to post-surgical bleeding after initial breast cancer surgery and to identify predictors of re-operation.......To assess the risk of re-operation due to post-surgical bleeding after initial breast cancer surgery and to identify predictors of re-operation....

  14. Reoperation of biliary tract by laparoscopy: experiences with 39 cases.

    Li, Li-Bo; Cai, Xiu-Jun; Mou, Yi-Ping; Wei, Qi


    To evaluate the safety and feasibility of biliary tract reoperation by laparoscopy for the patients with retained or recurrent stones who failed in endoscopic sphincterotomy. A retrospective analysis of data obtained from attempted laparoscopic reoperation for 39 patients in a single institution was performed, examining open conversion rates, operative times, complications, and hospital stay. Out of the 39 cases, 38 (97%) completed laparoscopy, 1 required conversion to open operation because of difficulty in exposing the common bile duct. The mean operative time was 135 min. The mean post-operative hospital stay was 4 d. Procedures included laparoscopic residual gallbladder resection in 3 cases, laparoscopic common bile duct exploration and primary duct closure at choledochotomy in 13 cases, and laparoscopic common bile duct exploration and choledochotomy with T tube drainage in 22 cases. Duodenal perforation occurred in 1 case during dissection and was repaired laparoscopically. Retained stones were found in 2 cases. Postoperative asymptomatic hyperamlasemia occurred in 3 cases. There were no complications due to port placement, postoperative bleeding, bile or bowel leakage and mortality. No recurrence or formation of duct stricture was observed during a mean follow-up period of 18 mo. Laparoscopic biliary tract reoperation is safe and feasible if it is performed by experienced laparoscopic surgeons, and is an alternative choice for patients with choledocholithiasis who fail in endoscopic sphincterectomy.

  15. Rotator cuff injuries and factors associated with reoperation

    Alexandre Litchina Carvalho


    Full Text Available ABSTRACT OBJECTIVE: To evaluate the prevalence of rotator cuff tears and describe the profile of reoperated patients, causes of repeated tendon tears, tear evolution and range of times between surgical procedures. METHOD: This was a cross-sectional study involving 604 surgical procedures performed at two regional referral hospitals between January 2006 and December 2012. After approval by the ethics committee, data describing the patients' epidemiological profile were gathered at a single time, using Cofield's classification to measure the extent of the tears, all of which underwent arthroscopic surgery. The data were entered into Epi Info 3.5.3 and were analyzed using SPSS version 18.0. RESULTS: Among the 604 surgical procedures, females were affected in more cases (351; 58.1%. When the dominant limb was the right limb, it was affected in 90% of the cases (p < 0.05. The supraspinatus tendon was affected in 574 cases (95% and the tears were of medium size in 300 cases (49.7%. Eighteen reoperations were performed (2.98% and the upper right limb was the most affected (66.6%. The cause was non-traumatic in 12 patients. The repeated tears were mostly smaller (44%, and the length of time between the two surgical procedures ranged from 6 to 298 weeks. CONCLUSION: Female gender, smaller extent in the second procedure and non-traumatic cause were found in most of the cases analyzed.

  16. Impact of early reoperation following living-donor liver transplantation on graft survival.

    Yoshikuni Kawaguchi

    Full Text Available BACKGROUND: The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT on graft and recipient survival. METHODS: Recipients that underwent LDLT (n = 111 at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27 and a non-reoperation group (n = 84, and case-control study was conducted. RESULTS: Early reoperation was performed in 27 recipients (24.3%. Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7-96.4, and 85.2% (95%CI, 66.5-94.3, respectively, in the reoperation group (n = 27, and 95.2% (95%CI, 88.0-98.2, and 92.9% (95%CI, 85.0-96.8, respectively, in the non-reoperation group (n = 84 (the log-rank test, p = 0.31. The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9-99.5, and 88.3% (95%CI, 69.3-96.2, respectively, in the reoperation group, and 89.3% (95%CI, 80.7-94.3 and 88.0% (95%CI, 79.2-93.4, respectively, in the non-reoperation group (the log-rank test, p = 0.59. CONCLUSIONS: Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant

  17. Reoperative coronary bypass grafting without cardiopulmonary bypass through a small thoracotomy

    Boonstra, PW; Grandjean, JG; Mariani, MA

    Background. The danger of coronary reoperations is mainly hidden in the reopening of the sternum and in the manipulation of the heart and the old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations if only the left

  18. Reoperation After Combined Injury of the Index Finger: Repair Versus Immediate Amputation.

    Wilkens, Suzanne C; Claessen, Femke M A P; Ogink, Paul T; Moradi, Ali; Ring, David


    To identify factors associated with unplanned reoperation of severely injured index fingers and to address the number of amputations after initial repair. In this retrospective study, we included all patients older than 18 years of age who had repair or immediate amputation for combined index finger injury at 2 level I trauma centers and 1 community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow-up. Bivariate and multivariable analyses sought factors associated with unplanned reoperation after repair and immediate amputation. Among 114 patients with combined injury, 75 were treated with repair and 39 with immediate amputation. A total of 41 patients had an unplanned reoperation, 33 after repair (44%) and 8 after immediate amputation (21%). In multivariable analysis, patients who had a reoperation for fingers other than the index finger were at risk for unplanned reoperation after repair. Women were more likely to have an unplanned reoperation than men, and patients who had a ray amputation were at risk for unplanned reoperation after immediate amputation. Six patients (18%) had amputation after initial repair. Surgeons may counsel patients that they are twice as likely to have an unplanned reoperation after a repair for combined injury of the index finger compared with an immediate amputation. Unplanned reoperations were more common among patients with injuries involving multiple fingers. Effective shared decision making is particularly important in this setting given that 1 in 5 repaired index fingers were eventually amputated. Therapeutic IV. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Lower reoperation rates with the use of fibrin sealant versus tacks for mesh fixation

    Helvind, Neel Maria; Andresen, Kristoffer; Rosenberg, Jacob


    BACKGROUND: Groin hernia repair may be associated with long-term complications such as chronic pain, believed to result from damage to regional nerves by tissue penetrating mesh fixation. Studies have shown that mesh fixation with fibrin sealant reduces the risk of these long-term complications......, but data on recurrence and reoperation rates after the use of fibrin sealant compared with tacks are not available. This study aimed to determine whether fibrin sealant is a safe and feasible alternative to tacks with regard to reoperation rates after laparoscopic groin hernia repair. METHODS: The current...... study compared reoperation rates after laparoscopic groin hernia repair between fibrin sealant and tacks used for mesh fixation. The study used data collected prospectively from The National Danish Hernia Database and analyzed 8,314 laparoscopic groin hernia repairs for reoperation rates. Mesh fixation...

  20. The choice of reoperation after primary surgeries for uterine prolapse: A nationwide study

    Ming-Ping Wu


    Conclusion: Our study offers a population-based nationwide observation that hysteropexy correlates with a higher reoperation rate, as compared with hysterectomy; but it is still as high as 30% in the surgical choice of the failed hysteropexy group.

  1. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig;


    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outco...

  2. A review: Reduced reoperation rate for multilevel lumbar laminectomies with noninstrumented versus instrumented fusions

    Nancy Ellen Epstein


    Conclusions: Many studies document no benefit for adding instrumentation to laminectomies performed for degenerative disease, including spondylolisthesis. Reoperation rates for laminectomy alone/laminectomy with noninstrumented fusions vary from 1.3% to 5.6% whereas reoperation rates for ASD after instrumented PLIF was 80% at 5 postoperative years. This review should prompt spinal surgeons to reexamine when, why, and whether instrumentation is really necessary, particularly for treating degenerative lumbar disease.

  3. Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction.

    Roberts, Amanda; Baxter, Nancy; Camacho, Ximena; Lau, Cindy; Zhong, Toni


    Postmastectomy breast reconstruction (PMBR) aims to surgically restore a breast mound following mastectomy. However, additional surgical procedures after PMBR can lead to increased postsurgical morbidity and healthcare utilization. The primary purpose of our study was to determine the overall population-based reoperation rates following PMBR in Ontario, Canada. We conducted a population-based retrospective cohort study that included women aged 18-65 years who underwent a prophylactic or therapeutic mastectomy with immediate or delayed PMBR between April 1, 2002 and March 31, 2008. Reoperations to the breast or donor site used for reconstruction were identified using the Ontario Health Insurance Plan billing codes submitted by general or plastic surgeons. Reoperations were categorized as anticipated, unanticipated major, unanticipated minor, or oncologic. Patients were followed from the date of their PMBR to March 31, 2013, or death. Overall, 3972 women underwent PMBR between April 1, 2002 and March 31, 2008. Among them, 3504 (88%) underwent at least one reoperation during an average follow-up of 5.1 years. The median number of procedures per patient was two (mean 2.4, range 0-26). One of ten patients had three or more unanticipated major reoperations during the follow-up period. Our results provide the first long-term population-level data on the current state of PMBR reoperation rates. The results from this study will inform patient-physician surgical decision-making and provide quantitative expectations of morbidity related to PMBR.

  4. [Abdominal unplanned reoperations in the Service of General Surgery, University Hospital of Puebla].

    León-Asdrúbal, Samuel Báez; Juárez-de la Torre, Juan Carlos; Navarro-Tovar, Fernando; Heredia-Montaño, Mónica; Quintero-Cabrera, José Eduardo


    The reoperation is considered as the access to the abdominal cavity before complete healing of the surgical wound from a previous operation within the first 60 days after the first procedure. It occurs in 0.5 to 15% of patients undergoing abdominal surgery and generates significant increase in morbidity and mortality in patients undergoing abdominal surgery. Identify the number of unplanned abdominal surgical reoperations and identify the causes of these unplanned reoperations were performed in our department. This is a retrospective study conducted at the University Hospital of Puebla in the period between April 2009 to February 2012, a total of 1,709 abdominal surgeries performed by the Service of General Surgery were included. Ninety-seven cases of reoperation of which 50 cases were not planned surgery cases were identified; 72% (36 cases) from emergency operations, and 28% of elective surgery. The incidence found in our study is low compared to similar studies. Prospective studies and focus on risk factors and causes of unplanned reoperations are required, in order to know them in detail and, consequently, reduce its incidence and morbidity and mortality they add.

  5. Causes and Timing of Nonelective Reoperations After Bariatric Surgery: A Review of 1304 Cases at a Single Institution.

    Thompson, Erin; Ferrigno, Lisa; Grotts, Jonathon; Knox, Jenna; Sobelman, Samantha; Thoman, David; Bounoua, Farida; Zerey, Marc


    As the number of patients undergoing bariatric procedures for weight loss increases, an understanding of the causes and timing of complications requiring reoperation is critical. The aim of our study was to characterize the type and timing of nonelective (NE) reoperations in these patients. Over five years, 1304 patients undergoing index procedures were identified: 769 laparoscopic Roux-en-Y gastric bypasses (LRYGB), 301 laparoscopic sleeve gastrectomies, and 234 laparoscopic adjustable gastric bands. We identified 117 NE reoperations, which were grouped by index procedure as well as whether they occurred early (≤90 days) or late (>90 days). In the laparoscopic adjustable gastric bands group, slipped gastric band was the most common indication for early (n = 2) and late (n = 2) reoperations. Biliary disease was the most common cause for early reoperations (n = 4), and the only cause for late reoperations (n = 2) after laparoscopic sleeve gastrectomies. For LRYGB, diagnoses differed between the early and late groups, with the most common early indications being bowel obstruction (n = 8) and anastomotic leak (n = 4) of the 18 early reoperations, and internal hernia (n = 36) and biliary disease (n = 17) of the 82 late reoperations. The vast majority of NE reoperations were performed laparoscopically (92%), with conversions and primarily open procedures only occurring in the LRYGB group.

  6. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael


    Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should......OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior...

  7. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael


    Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should......OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior...

  8. Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study.

    Vida, Vladimiro L; Zanotto, Lorenza; Zanotto, Lucia; Stellin, Giovanni; Padalino, Massimo; Sarris, Georges; Protopapas, Eleftherios; Prospero, Carol; Pizarro, Christian; Woodford, Edward; Tlaskal, Thomas; Berggren, Hakan; Kostolny, Martin; Omeje, Ikenna; Asfour, Boulos; Kadner, Alexander; Carrel, Thierry; Schoof, Paul H; Nosal, Matej; Fragata, Josè; Kozłowski, Michał; Maruszewski, Bohdan; Vricella, Luca A; Cameron, Duke E; Sojak, Vladimir; Hazekamp, Mark; Salminen, Jukka; Mattila, Ilkka P; Cleuziou, Julie; Myers, Patrick O; Hraska, Viktor


    We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Analysis of the components of residual deformity in clubfeet presenting for reoperation.

    Tarraf, Y N; Carroll, N C


    We reviewed the records and radiographs of 125 children with 159 clubfeet reoperated for residual deformity after operative repair (210 reoperations). We concluded that residual forefoot adduction and supination were the most common persistent deformities (present in 95% of the feet) and that these deformities resulted from undercorrection at the time of primary operation. Although not then apparent, the persistent deformities became more evident with growth, and additional treatment became necessary. Undercorrection resulted from not releasing the calcaneocuboid joint and plantar fascia and failure to recognize residual forefoot adduction on the interoperative radiographs at primary operation.

  10. Complications and re-operation rate after tension-band wiring of olecranon fractures

    Romero, J M; Miran, A; Jensen, Claus Hjorth


    Tension-band wire fixation of olecranon fractures leads to a high re-operation rate because of the need to remove the metalware. This problem has commonly been thought to be related mainly to the backing-out of the Kirschner wires. A retrospective study was carried out in 55 patients with displaced...... olecranon fractures operated on with the tension-band wiring technique, in whom there was an overall 71.7% re-operation rate. Complications were few and minor in most patients. The main reason for the removal of the metalware was a direct complaint from the patient (in 61.3% of all removals). A literature...

  11. Re-operation for parotid gland cancer following non-standard surgical treatment

    Xiangmin Zhang; Xiaolin Lan; Lianbin Liu; Rong Li; Fufu Xiao; Folin Liu


    Objective: The purpose of this study was to analyze the clinical disadvantages of non-standard surgical treatment for parotid gland cancer and probe the re-operative indication following non-standard surgical treatment.Methods: Data of 58 cases suffered parotid gland cancer who received non-standard operation at other hospital and received re-operation in tumor hospital of Ganzhou from June 1998 to October 2010 were retrospectively reviewed.Results: In all cases, parotid gland cancer were residual in 46 cases, the facial nerve remaining rate was 81.0% (47/58), facial nerve branches injury rate was 3.5% (2/58), facial nerve partial resection rate was 8.6% (5/58) and total resection rate was 6.9% (4/58).The sensitivity of residual tumor was 83.3%, scanned by contrast-enhanced CT and the CT positive predictive value was 86.9%.Conclusion: Consideration of the higher residual tumor rate in patients who received non-standard operations, the re-operations were necessary.Contrast-enhanced CT positive predictive value was high for residual tumor and it was important for re-operation.

  12. Reoperation of the biliary tract by laparoscopy: an analysis of 39 cases.

    Li, Libo; Cai, Xiujun; Mou, Yiping; Wei, Qi


    Previously, prior biliary tract surgery was considered a contraindication to laparoscopic biliary tract reoperation. In this paper, we present our experience with laparoscopic biliary tract reoperation for patients with the choledocholithiasis for whom the endoscopic sphincterotomy has failed or is contraindicated. A retrospective analysis was performed on data from the attempted laparoscopic reoperation of 39 patients, examining open conversion rates, operative times, complications, and length of hospital stay. Of 39 cases, 38 were completed laparoscopically: 1 case required a conversion to the open operation because of difficulty in exposing the common bile duct. Mean operative time was 135 minutes. Mean postoperative hospital stay was 4 days. Procedures included 3 cases of laparoscopic residual gallbladder resection, 13 cases of laparoscopic common bile duct exploration and primary duct closure of choledochotomy, and 22 cases of laparoscopic common bile duct exploration and choledochotomy with T-tube drainage. There was 1 case of duodenal perforation during dissection, which was repaired laparoscopically. There were 2 cases of retained stones. Postoperative asymptomatic hypermalasia occurred in 3 cases. There were no complications due to port placement, no postoperative bleeding, bile or bowel leakage, and no mortality. At a mean follow-up time of 18 months, there was no recurrence or formation of duct stricture. The laparoscopic biliary tract reoperation is safe and feasible for experienced laparoscopic surgeons and is an alternative choice for patients with choledocholithiasis for whom the endoscopic sphincterectomy has failed or is contraindicated.

  13. Optimal Reoperation of Multi-Reservoirs for Integrated Watershed Management with Multiple Benefits

    Xinyi Xu


    Full Text Available Constructing reservoirs can make more efficient use of water resources for human society. However, the negative impacts of these projects on the environment are often ignored. Optimal reoperation of reservoirs, which considers not only in socio-economic values but also environmental benefits, is increasingly important. A model of optimal reoperation of multi-reservoirs for integrated watershed management with multiple benefits was proposed to alleviate the conflict between water use and environmental deterioration. The social, economic, water quality and ecological benefits were respectively taken into account as the scheduling objectives and quantified according to economic models. River minimum ecological flows and reservoir water levels based on flood control were taken as key constraint conditions. Feasible search discrete differential dynamic programming (FS-DDDP was used to run the model. The proposed model was used in the upstream of the Nanpan River, to quantitatively evaluate the difference between optimal reoperation and routine operation. The results indicated that the reoperation could significantly increase the water quality benefit and have a minor effect on the benefits of power generation and irrigation under different hydrological years. The model can be readily adapted to other multi-reservoir systems for water resources management.

  14. Associations between Reoperations and Psychological Factors after Contralateral Risk-Reducing Mastectomy: A Two-Year Follow-Up Study

    Dmytro Unukovych


    Full Text Available Introduction. The aim of the study was to investigate associations between reoperations after contralateral risk-reducing mastectomies (CRRM and emotional problems, body image, sexuality, and health related quality of life (HRQoL in women with breast cancer and hereditary high risk. Patients and Methods. Patients scheduled for CRRM with breast reconstruction between 1998 and 2010 completed questionnaires, comprised of SF-36, the Hospital Anxiety and Depression Scale, the Body Image Scale, and the Sexual Activity Questionnaire, preoperatively and two years after CRRM. Data on reoperations was collected from medical charts. Results. A total of 80 women participated, with a response rate of 61 (76% preoperatively and 57 (71% at the two-year follow-up. At the two-year assessment, 44 (55% patients had undergone ≥1 reoperation (reoperation group, whereas 36 (45% had not (no reoperation group. No statistically significant differences between the groups were found for HRQoL, sexuality, anxiety, or depression. A higher proportion of patients in the “reoperation group” reported being dissatisfied with their bodies (81% versus 48%, p=0.01. Conclusion. The results suggest associations between reoperation following CRRM with breast reconstruction and body image problems. Special attention should be paid to body image problems among women who are subject to reoperations after CRRM.

  15. Surgical operation and re-operation for hepatocellular carcinoma with bile duct thrombosis

    WANG Ya-dong; XUE Huan-zhou; JIANG Qing-feng; SHEN Quan; WANG Lian-cai; ZHANG Xiao; LU Bing; YU Miao; LI Ke


    Background Few reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT).The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.Methods The clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed.The effects of BDT and re-operation on prognosis were retrospectively analyzed.Results The 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P >0.05).Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P <0.05).Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P<0.05).Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P >0.05).Conclusions Hepatectomy plus BDT removal is an effective treatment option for HCC with BDT.Obstructive jaundice is not a contraindication for surgery.Re-operation after relapse can provide good outcomes if the cases are appropriately selected.

  16. Reoperation Rates for Laparoscopic vs Open Repair of Femoral Hernias in Denmark

    Andresen, Kristoffer; Bisgaard, Thue; Kehlet, Henrik


    IMPORTANCE: In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many...... laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All...... repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed. EXPOSURE: Repair of a femoral hernia. MAIN OUTCOMES AND MEASURES: Reoperation...

  17. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig


    -six fractures of the lateral femoral wall occurred during the operative procedure itself. A fracture of the lateral femoral wall occurred in only 3% (three) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (thirty-one) of the ninety......-nine with an AO/OTA type 31-A2.2 or A2.3 fracture (p fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture......BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...

  18. Body mass index is not associated with reoperation rates in patients with a surgically treated perforated peptic ulcer

    Duch, Patricia; Møller, Morten Hylander


    INTRODUCTION: The aim of the present nationwide Danish cohort study was to examine the association between body mass index (BMI) and reoperation in patients who are sur-gically treated for perforated peptic ulcer (PPU). METHODS: This was a nationwide cohort study of all Danish patients who were...... surgically treated for benign gastric or duodenal PPU between 2011 and 2013. OUTCOME MEASURES: reoperation within 30 days of the primary surgical procedure and 90-day survival. The association between BMI and reoperation are presented as crude and adjusted odds ratios (OR) with 95% confidence intervals (CIs...

  19. Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital

    Birendra; Kumar; Sah


    AIM:To investigate the occurrence of postoperative complications of gastric cancer surgery,and analyze the potential causes of reoperation for early postoperative complications. METHODS:A total of 1639 patients who underwent radical or palliative gastrectomies for gastric cancer were included in the study.The study endpoint was the analysis of postoperative complications in inpatients. RESULTS:About 31%of patients had early postoperative complications,and complications of infection occurred most frequently....

  20. The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy.

    Schmeiser, B; Zentner, J; Steinhoff, B J; Brandt, A; Schulze-Bonhage, A; Kogias, E; Hammen, T


    After surgery for intractable mesiotemporal lobe epilepsy (mTLE) seizures recur in 30-40%. One predictor for seizure recurrence is the distribution of seizure onset and interictal epileptiform discharges (IED). Our study focused on lateralization and extent of epileptiform activity regarding postoperative seizure persistence and the effect of reoperation. This study comprises 426 consecutive patients operated for intractable mTLE. Impact of preoperative seizure onset and IED on the persistence of seizures and results of reoperation were analyzed. One year after surgery, 27% of patients with mTLE experienced persistent seizures (Engel II-IV). Preoperative bilateral seizure onset in EEG was predictive for postoperative seizure recurrence (Engel II-IV: 64%). Seizure foci and IED exceeding the temporal lobe in the ipsilateral hemisphere were not found to be associated with worse seizure outcome (Engel I: 72% and 75%) compared to patients with seizure foci confined to the ipsilateral temporal lobe (Engel I: 75% and 76%). Moreover, IED exceeding the affected temporal lobe in the ipsilateral hemisphere or even bilateral IED did not negatively affect seizure freedom if seizure onset was strictly limited to the affected temporal lobe (Engel I: 85% and 65%, respectively). 60% of patients reoperated in the ipsilateral temporal lobe for persistent seizures became seizure free. Preoperative bilateral ictal foci are a negative predictor for seizure outcome. Contrarily, IED exceeding the affected temporal lobe in the ipsilateral hemisphere or even bilateral IED had favorable seizure outcome if seizure onset is strictly limited to the affected temporal lobe. Reoperation for seizure persistence constitutes a promising therapeutic option. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  1. Surgical strategies of re-operation for non-anastomotic biliary duct stricture after liver transplantation

    Shao-ping WANG


    Full Text Available Objective To investigate the re-operation timing and surgical modality for non-anastomotic biliary stricture (NABS after orthotopic liver transplantation (OLT. Methods The clinical data of 14 NABS patients hospitalized in our center from August 2003 to April 2014 were analyzed retrospectively. The patients were treated with different modalities of re-operation according to cholangiographic results, and the outcomes of re-operation were noted by postoperative follow-up. Results Among 421 OLT patients, NABS was seen in 14 (3.3%, 14/421, and it was accompanied by stenosis of hepatic artery in 4. Their total bilirubin, ALP and r-GGT levels were significantly higher in NABS patients than in non-NABS patients (P<0.01. According to cholangiographic findings, NABS was divided into 3 types: hepatic bile duct strictures (4 patients, type Ⅰ, multiple extrahepatic and intrahepatic biliary strictures (8 patients, type Ⅱ, intrahepatic biliary stricture (2 patients, type Ⅲ. The cure rate of interventional treatment in this study was 57.1% (8/14, and 6 patients eventually required surgical treatment again. The type Ⅰ patient was treated with Roux-en-Y anastomosis, and re-transplantation for other 5 patients (type Ⅱ in 4 and type Ⅲ in 1. Among these 5 patients receiving liver re-transplantation, 1 patient died of perioperative fungal infection. The blood loss (2570±851ml and operation time (492±173min in those re-transplantation patients were almost the same as their previous-transplantation (P> 0.05. More than half of type Ⅱ and Ⅲ patients needed re-transplantation, but the probability of re-transplantation was especially higher for those with hepatic artery stenosis (75%, 3/4. Cholangitis disappeared and the total bilirubin significantly reduced from 123.4µmol/L to 31.6µmol/L after resurgery. Conclusions For those NABS patients who may fail to be improved after a minimally invasive treatment, especially when it was combined with

  2. Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas.

    Schwarz, Falko; Loos, Franz; Dünisch, Pedro; Sakr, Yasser; Safatli, Diaa Al; Kalff, Rolf; Ewald, Christian


    The optimal management of chronic subdural hematomas remains a challenge. Twist drill craniotomy or burr hole trephination are considered optimal initial treatments, but the reoperation rate for hematoma recurrence and other complications is still high. Therefore, evaluation of possible risk factors for initial treatment failure is crucial. In this context, we performed a study to define a possible subpopulation that may benefit from a more invasive initial treatment regime. We retrospectively reviewed the medical charts of 193 patients with 250 chronic subdural hematomas who had undergone burr hole trephination as first-line therapy in our institution between January 2005 and October 2012. To identify risk factors for reoperation, a multivariable logistic regression analysis was performed with reoperation as the dependent variable. Surgical complications, including acute rebleeding, infection and chronic hematoma recurrence, were analyzed separately using a logistic regression model. The mean age of the cohort was 71.4 years. The male/female ratio was 137:56. Reoperation was necessary in 56 cases (29%) for recurrent hematomas and surgical complications. Predictors for reoperation for surgical complications were midline shift (odds ratio [OR] (per mm) 1.16, 95% confidence interval [CI]: 1.05-1.29, p=0.006), arterial hypertension (OR 5.44, 95% CI: 1.45-20.41, p=0.012) and bilateral hematomas (OR 4.22, 95% CI: 1.22-14.58, p=0.023). There was a trend toward a higher risk of surgically-relevant hematoma recurrence in patients with prior treatment with vitamin K antagonists (OR 1.76, 95% CI: 0.75-4.13, p=0.191). Burr hole trephination is the therapy of choice in most chronic subdural hematomas, but the rate of recurrent hematomas is high. Every hematoma should be treated individually especially in relation to midline-shift and pre-existing conditions. Further prospective studies evaluating types of treatment and hematoma density are needed. Copyright © 2015 Elsevier B

  3. Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

    Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M;


    the Danish National Patient Registry that were cross-checked with the Danish Breast Cancer Group database and the Danish Pathology Register. Main Outcomes and Measures: Reoperation rate after wire-guided BCS in patients with IBC or DCIS. Results: Wire-guided BCS was performed in 4118 women (mean [SD] age, 60......Importance: New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs...... to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. Objectives: To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS...

  4. Comparison of the Efficacy of Reoperation, Percutaneous Radiofrequency Thermocoagulation When Microvascular Decompression of Trigeminal Neuralgia Is Invalid.

    Zhang, Xin; Zhao, Hua; Tang, Yinda; Zhu, Jin; Wang, Xuhui; Li, Shiting


    To compare the curative effect of reoperation in short-term and percutaneous radiofrequency thermocoagulation (PRT) when trigeminal neuralgia patient after microvascular decompression (MVD) is invalid. Follow-up of 54 patients (30 patients with reoperation in the short term, 24 patients with PRT of primitive trigeminal neuralgia) when MVD is invalid between January 2008 and December 2014. To evaluate the degree of pain relief and facial numbness of patients after the treatment in short-term (1 month), in long-term (1 year). One month after surgery, the authors compared the reoperation group with PRT group. The ratio of cure rate P = 0.02, the ratio of effective rate P = 0.04, the ratio of facial numbness P = 0.01; 1 year after surgery, the authors compared the reoperation group with PRT group. The ratio of cure rate P = 0.004, the ratio of effective rate P = 0.006, the ratio of facial numbness P = 0.02, the ratio of recurrence P = 0.04. The short-term and long-term clinical efficacy in reoperation group was better than PRT group (P neuralgia when first MVD is invalid, reoperation is better than PRT, and a significantly lower incidence of facial numbness and recurrence than PRT.

  5. Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer.

    Al-Saif, Osama; Farrar, William B; Bloomston, Mark; Porter, Kyle; Ringel, Matthew D; Kloos, Richard T


    The objective of the study was to determine the outcome of surgical resection of metastatic papillary thyroid cancer (PTC) in cervical lymph nodes after failure of initial surgery and I(131) therapy. This was a retrospective clinical study. The study was conducted at a university-based tertiary cancer hospital. A cohort of 95 consecutive patients with recurrent/persistent PTC in the neck underwent initial reoperation during 1999-2005. All had previous thyroidectomy (+/-nodal dissection) and I(131) therapy. Twenty-five patients with antithyroglobulin (Tg) antibodies were subsequently excluded. Biochemical complete remission (BCR) was stringently defined as undetectable TSH-stimulated serum Tg. A total of 107 lymphadenectomies were undertaken in these 70 patients through January 2010. BCR was initially achieved in 12 patients (17%). Of the 58 patients with detectable postoperative Tg, 28 had a second reoperation and BCR was achieved in five (18%), seven had a third reoperation, and none achieved BCR. No patient achieving BCR had a subsequent recurrence after a mean follow-up of 60 months (range 4-116 months). In addition, two more patients achieved BCR during long-term follow-up without further intervention. In total, 19 patients (27%) achieved BCR and 32 patients (46%) achieved a TSH-stimulated Tg less than 2.0 ng/ml. Patients who did not achieve BCR had significant reduction in Tg after the first (P operations. No patient developed detectable distant metastases or died from PTC. Surgical resection of persistent PTC in cervical lymph nodes achieves BCR, when most stringently defined, in 27% of patients, sometimes requiring several surgeries. No biochemical or clinical recurrences occurred during follow-up. In patients who do not achieve BCR, Tg levels were significantly reduced. The long-term durability and impact of this intervention will require further investigation.

  6. Thoracoscopic reoperation for recurrent pneumothorax after single-incision thoracoscopic surgery.

    Sano, Atsushi; Kawashima, Mitsuaki


    An 18-year-old male patient who had undergone single-incision thoracoscopic surgery for left spontaneous pneumothorax was diagnosed with bilateral recurrent pneumothorax. We performed thoracoscopic reoperation and observed adhesions between the previous incision and the left lung. A bulla that was thought to be the cause of the recurrent left pneumothorax was found on the mediastinal side of previously ligated lesions. Longer incisions during single-incision thoracoscopic surgery may be more likely to cause adhesions. Despite the restricted view during surgery, care must be taken to identify all bullae. Use of reinforcement techniques is also important to prevent recurrence.

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

    Johnson, J E; Johnson, K A; Unni, K K


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

  8. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up

    Kautiainen Hannu


    Full Text Available Abstract Background The overall rate of operations after recurrent lumbar disc herniation has been shown to be 3–11%. However, little is known about the rate of residives. Thus the aim of this study was to explore the cumulative rates of re-operations and especially residive disc herniations at the same side and level as the primary disc herniation after first lumbar disc herniation surgery and the factors that influence the risk of re-operations over a five year follow-up study. Methods 166 virgin lumbar disc herniation patients (mean age 42 years, 57% males were studied. Data on patients' initial disc operations and type and timing of re-operations during the follow-up were collected from patient files. Back and leg pain on visual analog scale and employment status were collected by questionnaires. Results The cumulative rate of re-operations for lumbar disc herniation was 10.2% (95% Cl 6.0 to 15.1. The rate of residives at initial site was 7.4% (95% Cl 3.7 to 11.3 and rate of lumbar disc herniations at other sites was 3.1% (95% Cl 0.6 to 6.2. The occurrence of residive lumbar disc herniations was evenly distributed across the 5 years. Neither age, gender, preoperative symptoms, physical activity nor employment had effect on the probability of re-operation. Conclusion Seven percent of the lumbar disc patients had a residive lumbar disc operation within five years of their first operation. No specific factors influencing the risk for re-operation were found.

  9. Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management

    Hajari, Javad N; Christensen, Ulrik; Kiilgaard, Jens F;


    PURPOSE: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). METHODS: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were...... identified by diagnosis and surgical codes. RESULTS: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1...... year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using...

  10. Functional results and the risk factors of reoperations after lumbar disc surgery.

    Kara, Bilge; Tulum, Zeliha; Acar, Umit


    Factors such as driving motor vehicles, sedentary occupations, vibration, smoking, previous full-term pregnancies, physical inactivity, increased body mass index (BMI), and a tall stature are associated with symptomatic disc herniations. Fitness and strength is postulated to protect an individual from disc rupture. The objective of our study was to determine the pain levels and differences of functional and economic situations of patients who had undergone one or more than one operation due to lumbar disc herniation and to put forward the effect of risk factors that may be potential, especially from the aspect of undergoing reoperation. Patients who had undergone one (n=46) or more than one operation (n=34) due to lumbar disc herniation were included in the study. It was a prospective study with evaluation on the day the patients were discharged and at second and sixth months after lumbar disc operation. The Oswestry Disability Index (ODI) was used in determining the functional disability associated with back pain; the Prolo Functional Economic Rating Scale (Prolo scale) was used in determining the effect of back pain on functional and economic situations. In the ODI measurements made in the postoperative second and sixth months, significant differences appeared in favor of patients who had undergone one operation (p<0.05). According to the Prolo scale, it was found that the economic situation was better in the sixth month and the functional situation was better in the second and sixth months in patients having undergone one operation (p<0.05). The logistic regression analysis demonstrated that the lack of regular physical exercise was a significant predictor for reoperation (OR, 4.595; CI, 1.38-15.28), whereas gender, age, BMI, occupation, or smoking did not indicate so much significance as regular exercise.

  11. Reasons for reoperation after epilepsy surgery: a review based on a complex clinical case with three operations

    José F Téllez-Zenteno


    Full Text Available José F Téllez-Zenteno1, Farzad Moien-Afshari1, Lizbeth Hernández-Ronquillo1, Robert Griebel2, Venkat Sadanand21Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Canada; 2Department of Surgery, Division of Neurosurgery, University of Saskatchewan, Saskatoon, CanadaAbstract: The results of surgical treatment of epileptic seizures have gradually improved in the past decade, approaching 60% to 90% seizure-free outcome in temporal lobe epilepsy and 45% to 66% in extratemporal lobe epilepsy. Unfortunately some patients continue with seizures after epilepsy surgery and the studies have shown that approximately the 3% to 15% of patients with a previous failed surgical procedure are reoperated. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. In patients with intractable partial epilepsy there are many possible factors, alone or in combination, that could be related to the failure of resection. Some of the factors could be genetic or acquired predisposition to epileptogenicity. In this article we report a case with intractable epilepsy that required three interventions to render seizure free. We analyzed our specific case in the light of previous reports on reoperation and enumerate the potential reasons or reoperation that could apply to all patients with failure of an initial procedure.Keywords: intractable epilepsy, reoperation, epilepsy surgery, surgical failure

  12. Clinical and Epidemiological Clinical and Epidemiological Characteristics of Colloid Goiter Patients Undergoing Reoperation for Recurrent Thyroid Disease

    Gladys Iglesias Díaz


    Full Text Available Background: thyroid disease is one of the most prevalent medical conditions and thyroid cancer is the most common endocrine neoplasm. Thyroid reoperations are more common than it might seem.Objective: to establish the clinical and epidemiological characteristics of patients operated on for colloid goiter undergoing reoperation for recurrent thyroid disease.Methods: a case-series study was conducted at the León Cuervo Rubio Clinical-Surgical Hospital in Pinar del Rio. The sample included all patients (n = 29 who underwent thyroid operation and were reoperated on for recurrent thyroid disease in 2010, 2011 and 2012. The information was obtained from medical records and the register of histopathological diagnoses.Results: most patients (27.6% were in the 40-49 age group and females (79.3% were most affected. Recurrence was observed 5 to 9 years after surgery. Mixed nodules (55.2% followed by cysts (17.2% were the most frequent ultrasound diagnoses. Recurrent thyroid disease was malignant in 9% of patients.Conclusions: patients reoperated on for thyroid disease were mostly females in the fourth and fifth decade of life. The disease recurred in a period of 10 years after the first surgery in a greater number of cases. Follicular-patterned lesions, colloid goiter and cancer were the most common histologic diagnosis.

  13. What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy?

    Beaulé, Paul E; Dowding, Chris; Parker, Gillian; Ryu, Jae-Jin


    The Bernese periacetabular osteotomy (PAO) has entered its fourth decade and is frequently used for corrective osteotomy in patients with acetabular dysplasia. Although our capacity to preserve the joint after corrective osteotomy is excellent, gaining a better understanding on how well patients function after this surgery is important as well. (1) What changes in patient-reported outcomes scores occur in patients treated with PAO for hip dysplasia in the setting of a single-surgeon practice? (2) What are the predictors of clinical function and survivorship? All 67 patients presenting to a single surgeon's clinic with hip dysplasia treated with PAO between October 2005 and January 2013 were prospectively followed. Baseline demographic data as well as pre- and postoperative radiographic and functional measurements were obtained with a minimum of 1-year followup. Radiographic criteria included Tönnis grade, Tönnis angle, minimum joint space width, center-edge angle, presence of crossover sign, medial translation of the hip center, and alpha angle. We also used validated outcome measures including the WOMAC, the UCLA Activity Scale, and the SF-12. Multiple regression analysis was used to determine predictors of functional outcome scores. There were increases in WOMAC, UCLA, and SF-12 Physical scores. Higher preoperative alpha angle was associated with a lower postoperative WOMAC score (β=-0.47; 95% confidence interval [CI], -0.92 to -0.02; R2=0.08; p=0.04). The 5-year Kaplan-Meier survivorship was 94.1% (95% CI, 90.7-97.5) with reoperation (ie, hip arthroscopy and/or total hip arthroplasty) used as the endpoint for failure. With the limited numbers available, we could not identify any demographic or radiographic factors associated with reoperation. Overall survivorship for the PAO at our center at 5 years is comparable to other clinical series with overall functional scores improving. A greater alpha angle preoperatively was associated with poorer patient

  14. Reoperation on aortic disease in patients with previous aortic valve surgery

    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian


    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  15. Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck

    Aschenbach, R., E-mail: [HELIOS Hospital Erfurt, Department of Diagnostic and Interventional Radiology and Neuroradiology, Nordhaeuser Str. 74, 99089 Erfurt (Germany); Tuda, S. [HELIOS Hospital Erfurt, Department of Diagnostic and Interventional Radiology and Neuroradiology, Nordhaeuser Str. 74, 99089 Erfurt (Germany); Lamster, E.; Meyer, A. [HELIOS Hospital Erfurt, Department of Endocrinology, Nordhaeuser Str. 74, 99089 Erfurt (Germany); Roediger, H.; Stier, A. [HELIOS Hospital Erfurt, Department of Visceral Surgery, Nordhaeuser Str. 74, 99089 Erfurt (Germany); Conrad, E. [HELIOS Hospital Erfurt, Department of Nuclear Medicine, Nordhaeuser Str. 74, 99089 Erfurt (Germany); Basche, S.; Klisch, J. [HELIOS Hospital Erfurt, Department of Diagnostic and Interventional Radiology and Neuroradiology, Nordhaeuser Str. 74, 99089 Erfurt (Germany); Vogl, T.J. [University Hospital Frankfurt/Main, Center of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt/Main (Germany)


    Objectives: To evaluate the use of dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck. Methods: We retrospectively evaluated the head-neck MRIs of 30 patients with a history of hyperparathyroidism, prior head-neck surgery, and intraoperative proven adenomas. The protocol included conventional imaging with T2-weighted STIR sequences, T1w axial and coronal prior to and after contrast media administration, and dynamic magnetic resonance angiography. We compared the results from MRI, dynamic magnetic resonance angiography with 99m-Tc-Sestamibi with intraoperative findings as the gold standard. Results: In conventional MRI 19/30 true positives were detected with a sensitivity and specificity of 63.3% and 100%, respectively. However, by adding dynamic magnetic resonance angiography the detection rate increased to 28/30 true positives. Based on intraoperative findings, the sensitivity and specificity of dynamic magnetic resonance angiography were 93.3% and 100%, respectively. 99m-Tc-Sestamibi detected 24/30 true positives, sensitivity was 80%. Conclusion: The diagnostic value of MRI including dynamic magnetic resonance angiography is superior to MRI alone and superior to that of 99m-Tc-Sestamibi in the diagnostic workup of hyperfunctioning parathyroid glands when compared against intraoperative findings.

  16. Evaluation of 118 Thyroid Cancer Patients Who Underwent a Re-operation after Local Resection

    Jianping Hang; Dong Meng; Liqi Li


    OBJECTIVE To evaluate the incidence of residual thyroid cancer and cervical lymph node metastasis following a previous local resection for thyroid cancer, and to discuss methods of a reoperation.METHODS From 1994~2005, 118 patients with thyroid cancer who had previously been treated with a nodule-resection or subtotal Iobectomy in other hospitals underwent a surgical re-operation.RESULTS The incidence of residual cancer at the primary site was 38.1%. The lymph node metastasis rate at the central area was 39.8%.The rate of lymph node metastasis in patients with enlarged lymph nodes in the ipsilateral internal jugular chain was 37.5%. The rate of laryngeal recurrent nerve injury was 15.2% in other hospitals while that of the second operation in our hospital was 1.6%.CONCLUSION Nodule-resection or subtotal Iobectomy alone is not indicated for patients with thyroid cancer because of the high rate of local residual cancer. It is important to be familiar with the anatomy of the laryngeal recurrent nerve for thyroid surgery. Exploration to the central area is necessary for differentiated thyroid cancer.

  17. Analysis of reoperations and their impact on the results of pancreas transplantation.

    Genzini, T; Crescentini, F; Carneiro, A; Rangel, E B; Antunes, I; Sakuma, H; Ferreira, F Y; Perosa de Miranda, M


    Many factors, including the advances in surgical techniques and immunosuppression, have been brought significant improvement to graft and patient survivals of patients undergoing pancreatic transplantations. However, one third of these patients require reoperations (ReOps). We sought to evaluate the distribution of ReOps in the early or late postoperative period and analyze their impact on patient and graft survivals. This unicenter, retrospective study was performed using data from 182 patient charts after pancreas transplantation from January 2000 through December 2007. We performed 88 ReOps on 73 patients; 43 early and 41 late operations. The simultaneous pancreas-kidney transplantation group showed a greater incidence of premature ReOps. The group undergoing early ReOp showed a lower survival rate (87.2%) compared with the nonoperated group, but a similar survival rate (97.5%) to the late ReOp group. In relation to the survival of pancreatic grafts after 1 year, the early ReOp group showed inferior survival to the late ReOp group, both of which were significantly worse results then those of the group without ReOp. ReOps were related to the success of the procedure. When they were performed in the first 3 months they had a negative impact on patient and graft survival. Copyright (c) 2010. Published by Elsevier Inc.

  18. Re-admissions, re-operations and length of stay in hospital after aseptic revision knee replacement in Denmark

    Lindberg-Larsen, M.; Jørgensen, C. C.; Hansen, Torben Bæk


    of hospital stay was four days (interquartile range: 3 to 5), with a 90 days re-admission rate of 9.9%, re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges of 51 to 55 years (p = 0.018), 76 to 80 years (p ...-admission. The age ranges of 76 to 80 years (p = 0.018) and the large partial revision subgroup (p = 0.073) were related to an increased risk of re-operation. The ages from 76 to 80 years (p 120 min (p hospital stay...... that a length of hospital stay ≤ four days and discharge home at that time is safe following aseptic knee revision surgery in Denmark....

  19. Primary and revision anterior supine total hip arthroplasty: an analysis of complications and reoperations.

    Berend, Keith R; Kavolus, Joseph J; Morris, Michael J; Lombardi, Adolph V


    Anterior total hip arthroplasty (THA) has been touted by some as a muscle-sparing, less invasive procedure. Reports have focused on the high intraoperative and postoperative complication rates, the increased transfusion risk, and its questionable clinical benefits. The senior author's experience regarding complications and reoperations that occurred after primary and revision THA using an anterior supine intermuscular approach has been generally favorable. An electronic database was used to identify 906 patients treated with 1,035 consecutive anterior supine intermuscular THAs performed by a single surgeon between January 2007 and December 2010, which included 986 primary THAs, 2 resurfacings, 2 conversions of failed open reduction and internal fixation for fracture, and 45 revision THAs. The surgical technique used an anterior approach with a modified Smith-Petersen interval and was performed with the patient supine on a standard operating table without traction. The transfusion rate was 5%. There were three intraoperative calcar cracks and one canal perforation, which was treated with cerclage cables. Four wound complications required débridement, four hips had substantial lateral femoral cutaneous nerve paresthesias that had not resolved by the 12-month follow-up, and one femoral nerve palsy was reported. At up to 40 month's follow-up, there have been 25 revisions (2.4%), including 9 periprosthetic femoral fractures; 1 stem subsidence; 4 hips with aseptic loosening; 5 metal-on-metal bearing complications; 1 cup malpositioning, which was corrected the same day; 4 dislocations; and 1 infection. This 4-year experience with primary and revision anterior THAs has showed acceptable rates of perioperative transfusion, complications, and revisions.

  20. Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations

    Wei-Jing Ye; Ping Ping; Yi-Dong Liu; Zheng Li; Yi-Ran Huang


    Aim: To report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases. Methods: From May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old(average 11.62 ± 7.18 years) with failed previous hypospadias surgery were included in the present study. Indica- tions included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corporacavemosa. The neourethra was tubularized, and covered with subcutaneous (dartos) tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases. Results: The buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months (mean 22.6 months), the total complication rate was 15.1%, with five cases of fistula and three cases of stricture. Conclusion: Inlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations. (Asain J Androl 2008 Jul; 10: 682- 686)

  1. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael


    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral......, and rate of reoperation within the first year. In a subgroup of 50 randomly selected patients, reliability tests for measurement of posterior tilt were performed. RESULTS: Intra- and interclass coefficients for the new measurement were > or = 0.94. 23% (26/113) of patients were reoperated and increased...... score, time from admission to operation, surgeon's expertise, postoperative reduction, and implant positioning, a preoperative posterior tilt of > or = 20 degrees was the only significant predictor of reoperation (p measurement for posterior tilt appears to be reliable...

  2. Laparoscopic Repair of Primary Inguinal Hernia Performed in Public Hospitals or Low-Volume Centers Have Increased Risk of Reoperation for Recurrence

    Andresen, Kristoffer; Friis-Andersen, Hans; Rosenberg, Jacob


    BACKGROUND: Inguinal hernia repair is traditionally carried out as either open or laparoscopic repair. Laparoscopic repair has been shown to be superior in terms of pain and discomfort, but has a higher risk of reoperation. Quality of inguinal hernia repair is related to factors such as method...... of care. METHODS: This study was based on data from the Danish Hernia Database covering the period from January 1, 1998, to December 31, 2013. Hernia repairs included in this study were laparoscopic repair of primary, inguinal hernias in the elective setting, performed on adult male patients. RESULTS...... reoperation rate compared with public centers: 5.36% versus 8.53%, P ≤ .0001. Type of center and center volume were both independent risk factors for reoperation in a Cox regression model. CONCLUSION: Hospital volume had an effect on the reoperation rate for recurrence after laparoscopic inguinal hernia...

  3. Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

    Christoffersen, Mette Willaume; Helgstrand, F; Rosenberg, J;


    Repair for a small (≤2 cm) umbilical and epigastric hernia is a minor surgical procedure. The most common surgical repair techniques are a sutured repair or a repair with mesh reinforcement. However, the optimal repair technique with regard to risk of reoperation for recurrence is not well...... documented. The aim of the present study was in a nationwide setup to investigate the reoperation rate for recurrence after small open umbilical and epigastric hernia repairs using either sutured or mesh repair....

  4. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center.

    Jorns, Julie M; Visscher, Daniel; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L; Wu, Angela J


    Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

  5. [Central hemodynamic changes in children reoperated on for congenital spinal cord hernia using balanced anesthesia based on midasolam and propofol].

    Diordiev, A V; Kontakevich, M M; Il'in, A V; Kusakin, V V; Ostreĭkov, I F


    The central hemodynamics was studied and analyzed in 51 patients reoperated on for congenital spinal cord hernia under balanced anesthesia based on midasolam and proforol. The procedure for anesthesiological provision of replastic repair of operated spinal hernia, which is based on propofol of bolus administration of midasolam with a hypnotic appliance, was found to cause no negative hemodynamic effects. When the benzodiazepine antagonist flumazenyl is used, the interval between the end of surgery and tracheal extubation is virtually identical in the propofol and midasolam groups since the intravenous injection of flumazenyl induces a drastic awakening effect.

  6. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H


    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  7. rhBMP-2 protects against reoperation for pseudoarthrosis and/or instrumentation failure: A matched case-control study of 448 patients.

    Macki, Mohamed; Syeda, Sbaa; Kerezoudis, Panagiotis; Bydon, Ali; Witham, Timothy F; Sciubba, Daniel M; Wolinsky, Jean-Paul; Bydon, Mohamad; Gokaslan, Ziya


    The objective of this independent study is to determine the impact of recombinant human bone morphogenetic protein 2 (rhBMP-2) on reoperation for pseudarthrosis and/or instrumentation failure. A nested case-control study of first-time posterolateral, instrumented fusion of the lumbar spine for degenerative spinal disease was undertaken. Cases of reoperation for pseudoarthrosis and/or instrumentation failure were assigned to controls, who did not experience the primary outcome measure at the time of reoperation. Cases and controls were matched on number of interspaces fused and inclusion of interbody. Predictors of reoperation for pseudoarthrosis and/or instrumentation failure were assessed with a conditional logistical regression controlling for rhBMP-2, age, obesity, and smoking. Of the 448 patients, 155 cases of reoperation for pseudoarthrosis and/or instrumentation were matched with 293 controls. Twenty-six percent of first-time surgeries included rhBMP-2, which was statistically more commonly used in the control cohort (33.11%) versus the case cohort (12.90%) (Unadjusted odds ratio [ORunadj]=0.28) (95% confidence interval [CI]: 0.16-0.49). Following a multivariate analysis controlling for age, obesity, and smoking, the rhBMP-2 recipients incurred a 73% lower odds of reoperation for pseudoarthrosis and/or instrumentation failure (95% CI, 0.15-0.48). Neither sarcomatous nor osseous neoplasm was detected in the study population. Mean follow up did not differ between the cases (81.57±standard deviation [SD] 4.98months) versus controls (74.75±2.49month) (ORunadj=1.01) (95% CI: 1.00-1.01). rhBMP-2 in lumbar fusion constructs protects against reoperation for pseudoarthrosis and/or instrumentation failure. However, the decision to include fusion supplements should be weighted between surgical determinants and clinical outcomes.

  8. Successful Localization of Abnormal Parathyroid Gland Using Ultrasound-Guided Methylene Blue Dye Injection in the Reoperative Neck.

    Haciyanli, Mehmet; Koruyucu, Melike Bedel; Erdoğan, Nezahat Karaca; Dere, Ozcan; Sarı, Erdem; Kumkumoğlu, Yusuf; Tavusbay, Cengiz; Kamer, Erdinc


    Persistent or recurrent hyperparathyroidism is a challenging problem for endocrine surgeons. The aim of this study was to review our experience using ultrasound-guided (US-G) methylene blue dye injection for the localization and removal of abnormal parathyroid glands in patients having primary hyperparathyroidism and previous neck surgery. Between January 2012 and May 2013, six consecutive patients with primary hyperparathyroidism (PHPT) and previous neck surgery underwent focused parathyroidectomy with the use of US-G methylene blue dye injections to localize the presumed parathyroid adenoma were included in the study. We analyzed the data of six patients who underwent reoperative parathyroid surgery using US-G methylene blue dye injection retrospectively. The dye injection was performed just prior to surgery. All patients were successfully treated for their hyperparathyroidism which was confirmed by at least 50 % drop in intraoperative parathormone level 10 min after resection. There were no complications related with US-G dye injection or with surgery. US-G methylene blue dye injection is a cheap, safe, and effective method for localization of diseased parathyroid glands and guiding surgery in the reoperative neck.

  9. Outcomes and Prognostic Factors for Adult Patients With Congenital Heart Disease Undergoing Primary or Reoperative Systemic Atrioventricular Valve Surgery.

    Stephens, Elizabeth H; Han, Jiho; Ginns, Jonathan; Rosenbaum, Marlon; Chai, Paul; Bacha, Emile; Kalfa, David


    Adults with congenital heart disease (ACHD) undergoing systemic atrioventricular valve (SAVV) surgery are a complex, understudied population. We assessed midterm outcomes and prognostic factors in ACHD undergoing SAVV surgery. We performed retrospective evaluation of ACHD undergoing SAVV surgery from January 2005 to February 2016: 14 (33%) patients with congenital mitral valve stenosis/regurgitation, 15 (35%) with atrioventricular septal defect (AVSD), and 14 (33%) with congenitally corrected transposition of the great arteries (ccTGA) with systemic tricuspid valve regurgitation. Adverse events were defined as mortality, reoperation on SAVV, and late more-than-moderate (> moderate) SAVV regurgitation. Statistical analysis was performed using Fisher's exact test and one-way analysis of variance as well as univariate and multivariate risk factor analysis. Fifteen (35%) patients had preoperative systemic ventricular dysfunction, including 13 patients with ccTGA (93%, P moderate SAVV regurgitation, and SAVV reoperation rates were 5% (n = 2), 2% (n = 1), 9% (n = 3), and 7% (n = 3), respectively. On multivariate analysis, predischarge SAVV regurgitation grade was the only significant predictor of adverse events (odds ratio = 8.2, 95% confidence interval: 1.1-63.8, P = .045). Overall outcomes in this challenging population are good. The single factor associated with adverse events was predischarge SAVV regurgitation grade.

  10. Seasonal Variations in the Risk of Reoperation for Surgical Site Infection Following Elective Spinal Fusion Surgery: A Retrospective Study Using the Japanese Diagnosis Procedure Combination Database.

    Ohya, Junichi; Chikuda, Hirotaka; Oichi, Takeshi; Kato, So; Matsui, Hiroki; Horiguchi, Hiromasa; Tanaka, Sakae; Yasunaga, Hideo


    A retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database, a national representative database in Japan. The aim of this study was to examine seasonal variations in the risk of reoperation for surgical site infection (SSI) following spinal fusion surgery. Although higher rates of infection in the summer than in other seasons were thought to be caused by increasing inexperience of new staff, high temperature, and high humidity, no studies have examined seasonal variations in the risk of SSI following spinal fusion surgery in the country where medical staff rotation timing is not in summer season. In Japan, medical staff rotation starts in April. We retrospectively extracted the data of patients who were admitted between July 2010 and March 2013 from the DPC database. Patients were included if they were aged 20 years or older and underwent elective spinal fusion surgery. The primary outcome was reoperation for SSI during hospitalization. We performed multivariate analysis to clarify the risk factors of primary outcome with adjustment for patient background characteristics. We identified 47,252 eligible patients (23,659 male, 23,593 female). The mean age of the patients was 65.4 years (range, 20-101 yrs). Overall, reoperation for SSI occurred in 0.93% of the patients during hospitalization. The risk of reoperation for SSI was significantly higher in April (vs. February; odds ratio, 1.93; 95% confidence interval, 1.09-3.43, P = 0.03) as well as other known risk factors. In subgroup analysis with stratification for type of hospital, month of surgery was identified as an independent risk factor of reoperation for SSI among cases in an academic hospital, although there was no seasonal variation among those in a nonacademic hospital. This study showed that month of surgery is a risk factor of reoperation for SSI following elective spinal fusion surgery, nevertheless, in the country where medical staff rotation timing is not in

  11. Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis.

    Karhade, Aditya V; Vasudeva, Viren S; Dasenbrock, Hormuzdiyar H; Lu, Yi; Gormley, William B; Groff, Michael W; Chi, John H; Smith, Timothy R


    OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011-2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12-23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8-20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4-5 designation. Major complications occurred in 14.4% of patients: the

  12. Predictors and causes of unplanned re-operations in outpatient plastic surgery: a multi-institutional analysis of 6749 patients using the 2011 NSQIP database.

    Lim, Seokchun; Jordan, Sumanas W; Jain, Umang; Kim, John Y S


    Studies that evaluate the predictors and causes of unplanned re-operation in outpatient plastic surgery. This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all plastic surgery outpatient cases performed in 2011. Multiple logistic regression analysis was utilised to identify independent risk factors and causes of unplanned reoperations. Of the 6749 outpatient plastic surgery cases identified, there were 125 (1.9%) unplanned re-operations (UR). Regression analysis demonstrated that body mass index (BMI, OR = 1.041, 95% CI = 1.019-1.065), preoperative open wound/wound infection (OR = 3.498, 95% CI = 1.593-7.678), American Society of Anesthesiologists (ASA) class 3 (OR = 2.235, 95% CI = 1.048-4.765), and total work relative value units (RVU, OR = 1.014, 95% CI = 1.005-1.024) were significantly predictive of UR. Additionally, the presence of any complication was significantly associated with UR (OR = 15.065, 95% CI = 5.705-39.781). In an era of outcomes-driven medicine, unplanned re-operation is a critical quality indicator for ambulatory plastic surgery facilities. The identified risk factors will aid in surgical planning and risk adjustment.

  13. Preoperative breast MRI can reduce the rate of tumor-positive resection margins and reoperations in patients undergoing breast-conserving surgery

    A.I.M. Obdeijn (Inge-Marie); M.M.A. Tilanus-Linthorst (Madeleine); S. Spronk (Sandra); C.H.M. van Deurzen (Carolien); C. de Monyé (Cécile); M.G.M. Hunink (Myriam); M.B. Menke (Marian )


    textabstractOBJECTIVE. In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations. SUBJECTS AND METHODS. The study group consisted of 1

  14. 原发性腹膜后脂肪肉瘤再手术36例临床分析%Primary retroperitoneal liposarcoma reoperation of 36 cases

    游建; 金鑫; 何鑫; 肖飞; 李鸣


    Objective To investigate the primary retroperitoneal liposarcoma reasons for re-operation, strategy and operation points. Methods From June 2000 to June 2010 36 re-operation cases of retroperitoneal liposarcoma were retrospectively analyzed Results The main reasons of primary retro-peritoneal liposarcoma reoperation are incomplete surgical resection and tumor biological characteristics. The 5-year survival rate for complete resection and incomplete resection was 79. 3% and 34. 5% respectively. Bleeding and intestinal fistula were the major complications after reoperation. Conclusion The reasons of reoperation of primary retroperitoneal liposarcoma are variable. Reoperation is the effective strategy for recurrent cases. Intraoperative complete resection is the key of reoperation success.%目的 探讨原发性腹膜后脂肪肉瘤再手术的原因、处理策略及手术要点.方法 对2000年6月至2010年6月间36例腹膜后脂肪肉瘤再手术的临床资料进行回顾性分析.结果 原发性腹膜后脂肪肉瘤再手术的主要原因是手术切除不彻底和肿瘤的生物学特性.完全切除与不完全切除5年生存率分别为79.3%和34.5%.再手术后并发症以出血及肠瘘为主.结论 原发性腹膜后脂肪肉瘤再手术既有肿瘤本身原因,也与手术相关.再次手术治疗是治疗该病术后复发病例的积极手段.把握好手术时机、术中彻底切除是再手术成功的关键.

  15. Complications of rhBMP-2 utilization for posterolateral lumbar fusions requiring reoperation: a single practice, retrospective case series report.

    Hoffmann, Martin F; Jones, Clifford B; Sietsema, Debra L


    Recombinant human bone morphogenetic protein-2 (rhBMP-2) (INFUSE, Medtronic, Memphis, TN, USA) has been used off-label for posterolateral lumbar fusions for many years. The goal of this study was to evaluate the complications requiring reoperation associated with rhBMP-2 application for posterolateral lumbar fusions. During a 7-year period of time (2002-2009), all patients undergoing lumbar posterolateral fusion using rhBMP-2 (INFUSE) were retrospectively evaluated within a large orthopedic surgery private practice. A total of 1,158 consecutive patients were evaluated with 468 (40.4%) males and 690 (59.6%) females. Complications related to rhBMP were defined as reoperation secondary to symptomatic failed fusion (nonunion), symptomatic seroma formation, symptomatic reformation of foraminal bone, and infection. Inclusion criteria were posterolateral fusion with rhBMP-2 implant and age equal to or older than 18 years. Surgical indications and treatment were performed in accordance with the surgeon's best knowledge, discretion, and experience. Patients consented to lumbar decompression and arthrodesis using rhBMP-2. All patients were educated and informed of the off-label utilization of rhBMP-2. Patient follow-up was performed at regular intervals of 2 weeks, 6 weeks, 12 weeks, 6 months, 1 year, and later if required or indicated. Average age was 59.2 years, and body mass index was 30.7 kg/m². Numbers of levels fused were 1 (414, 35.8%), 2 (469, 40.5%), 3 (162, 14.0%), 4 (70, 6.0%), 5 (19, 1.6%), 6 (11, 0.9%), 7 (7, 0.6%), 8 (4, 0.3%), and 9 (2, 0.2%). Patients having complications requiring reoperation were 117 of 1,158 (10.1%): symptomatic nonunion requiring redo fusion and instrumentation 41 (3.5%), seroma with acute neural compression 32 (2.8%), excess bone formation with delayed neural compression 4 (0.3%), and infection requiring debridement 26 (2.2%). Nonunion was related to male sex and previous BMP exposure. Seroma formation was significantly higher in

  16. Return to Function, Complication, and Reoperation Rates Following Primary Pectoralis Major Tendon Repair in Military Service Members.

    Nute, Drew W; Kusnezov, Nicholas; Dunn, John C; Waterman, Brian R


    Pectoralis major tendon ruptures have become increasingly common injuries among young, active individuals over the past 30 years; however, there is presently a paucity of reported outcome data. We investigated the ability to return to full preoperative level of function, complications, reoperation rates, and risk factors for failure following surgical repair of the pectoralis major tendon in a cohort of young, highly active individuals. All U.S. active-duty military patients undergoing pectoralis major tendon repair between 2008 and 2013 were identified from the Military Health System using the Management Analysis and Reporting Tool (M2). Demographic characteristics, injury characteristics, and trends in preoperative and postoperative self-reported pain scale (0 to 10) and strength were extracted. The ability to return to the full preoperative level of function and rates of rerupture and reoperation were the primary outcome measures. Univariate analysis followed by multivariate analysis identified significant variables. A total of 257 patients with pectoralis major tendon repair were identified with a mean follow-up (and standard deviation) of 47.8 ± 17 months (range, 24 to 90 months). At the time of the latest follow-up, 242 patients (94%) were able to return to the full preoperative level of military function. Fifteen patients (5.8%) were unable to return to duty because of persistent upper-extremity disability. A total of 15 reruptures occurred in 14 patients (5.4%). Increasing body mass index and active psychiatric conditions were significant predictors of inability to return to function (odds ratio, 1.56 [p = 0.0001] for increasing body mass index; and odds ratio, 6.59 [p = 0.00165] for active psychiatric conditions) and total failure (odds ratio, 1.26 [p = 0.0012] for increasing body mass index; and odds ratio, 2.73 [p = 0.0486] for active psychiatric conditions). We demonstrate that 94% of patients were able to return to the full preoperative level of

  17. 短肠综合征肠道再手术分析%Reoperation for short bowel syndrome with intestinal disorders

    李幼生; 李宁; 李元新; 任建安; 朱维铭; 赵允召; 王剑; 郭明晓; 黎介寿


    Objective To review the reoperation for short bowel syndrome patients with intestinal disorders. Methods From January 2001 to December 2010, a consecutive series of 198 patients with short bowel syndrome was reviewed, retrospective. Of the 198 patients, 76 patients with intestinal disorders underwent reoperation. They included 56 men and 16 women (median age, 37.98± 13.75 years; range, 5-62 years).The remaining small intestine length was 72.53±41.83(0 - 150)cm. Results Seventy-six patients underwent 124(1.63±0.46)reoperations, including takedown of enterostomy, drainage for intra-abdominal infections, intestinal resection and anastomosis including obstruction, fistula, protein-losing enteropathy, intestinal per formation and necrosis). The reoperation rate of SBS for intestinal disorders was 38.4% (76/198). Conclusion The reoperation rate of SBS for intestinal disorders was so high. Reasonable surgical procedures in the paimary operation have the potential to reduce reoperation rate for small bowel syndrome.%目的分析手术后短肠综合征(SBS)病人再手术,降低SBS再手术率.方法回顾性总结2001年1月至2010年12月南京军区南京总医院解放军普通外科研究所收治的短肠综合征病人198例,其中因肠道原因而再次手术治疗病人76例(男59例,女17例),年龄5~62(37.98±13.75)岁,残存小肠长度0~150(72.53±41.83)cm.结果 76例SBS接受再次手术124(1.63±0.4)例次,再次手术以肠造口还纳(43例次)、腹腔感染引流(28例次)及病变肠袢切除吻合(肠梗阻13例次、肠瘘12例次,蛋白质丢失病7例次、肠穿孔/肠坏死5例次)为主.SBS病人因肠道原因再手术率为38.4%.结论 SBS病人因肠道原因再手术率较高,选择合理的首次手术方式,有助于降低再手术率.

  18. Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

    Anica Eschler


    Full Text Available Introduction. Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates. Materials/Methods. 21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS, radiological, and complication analysis. Results. A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially. Conclusion. Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS under number DRKS00007537.

  19. The role of 99mTc-MIBI SPECT-CT in reoperation therapy of persistent hyperparathyroidism patients

    Yin, Lijie; Guo, Dandan; Liu, Jie; Yan, Jue


    To compare the role of 99mTc-MIBI SPECT-CT image and US in reoperation of persistent secondary hyperparathyroidism patients. A total of 8 persistent secondary hyperparathyroidism patients underwent parathyroidectomy. The sensitivity and accuracy of US and 99mTc-MIBI images before operation were determined. 9 of 14 surgical resection tissues from 8 persistent secondary hyperparathyroidism patients were confirmed to parathyroid hyperplasia. The results showed that the sensitivities were 77.8% and 100%, respectively, for US and 99mTc-MIBI SPECT-CT images. And the accuracies of US and 99mTc-MIBI dual time planar image and SPECT-CT were 50%, 78.6%, respectively. There was significantly difference between two procedures (P=0.021). The superior and inferior localization of glands were both detected by the ultrasound and scintigraphy. Two ectopic parathyroidism nodules were found by 99mTc-MIBI SPECT-CT imaging, while US provided no consistent findings. There was no significantly difference between two procedures (P=0.3). Although two cases of them were not confirmed by pathology, the iPTH of them (800 and 1429 respectively) were much higher than other four cases (<400) pg/ml. PTX is a safe and effective treatment for the patients with persistent SHPT. 99mTc-MIBI planar and SPECT-CT imaging may provide more helps for clinician’s localization the hyperparathyroidism glands accurately.

  20. Impact of reconstruction and reoperation on long-term patient-reported satisfaction after contralateral prophylactic mastectomy

    Boughey, Judy C.; Hoskin, Tanya L.; Hartmann, Lynn C.; Johnson, Joanne L.; Jacobson, Steven R.; Degnim, Amy C.; Frost, Marlene H.


    Background Contralateral prophylactic mastectomy (CPM) is increasingly chosen by breast cancer patients and may be related to increased use of immediate reconstruction. This study examines long-term patient satisfaction with CPM and reconstruction in a historical cohort. Methods 621 unilateral breast cancer patients with a family history of breast cancer who underwent CPM between 1960–1993 were surveyed regarding QOL and satisfaction with CPM at two time points - approximately 10 years and 20 years after CPM. Results 583 women responded to the first follow-up questionnaire (median 10.7 years, mean 11.9 years) after CPM. 403 (69%) underwent reconstruction and 180 (31%) did not. Women electing reconstruction were younger (mean age 47 vs 53 years, p=0.01) and more likely to be married (85% vs 78%, p=0.048). Most women reported satisfaction with CPM (83%), that they would choose CPM again (84%) and make the same choice regarding reconstruction (73%). However, reconstruction patients demonstrated significantly lower satisfaction (p=0.0001) and were less likely to choose CPM again (pwomen responded to the second questionnaire (median 18.4 years, mean 20.2 years after CPM). Satisfaction with CPM remained high, with 92% of women stating they would choose CPM again. Conclusions Most women report stable long-term satisfaction with CPM. Women who had reconstruction and required reoperations in this historical cohort reported lower satisfaction. PMID:25192678

  1. 烧伤外科病人再手术原因分析与预防%Reason Analysis and Precautions of Reoperation in Burns Surgical Patients

    倪俊; 顾海峰; 许献荣; 陈瑞彩; 张杏梅


    Objective To analyze the causes of reoperation in burns surgical patients and to explore the effective preventive measures so as to make an improvement in operation quality of burns surgery. Method 202 patients undergoing operation in burns ward from January 2006 to December 2011 were analyzed retrospectively. Results There were 91 reoperations done in 60 patients in this group, included 54 times of planned reoperation and 37 times of non-planned reoperation. The causes of non-planned reoperation were postoperative complications (21 times) and operation did not achieve the desired effects (16 times) . The highest rate of non-planned reoperation was in non-burn refractory wound patients, and the lowest was in burns deformed plastic patients. It was significantly higher of the non-planned reoperation rate in the non-burn plastic patients, comparing with the burned plastic deformity patients ( P 0. 05 ) . Conclusions Active prevention and treatment of complications, emphasis on the treatment of trauma and refractory wound, improving the level of diagnosis and treatment of surgeons and reducing surgical mistakes are effective measures to decrease the incidence of non-planned reoperations in burns surgical patients.%目的 分析烧伤外科病人再手术的原因,探讨有效预防措施,以提高烧伤外科手术治疗水平.方法 对我科2006年1月至2011年12月间收治的202例烧伤外科手术病人再手术情况进行回顾性分析.结果 60例行再手术91次,包括计划再手术54次和非计划再手术37次.非计划再手术中,术后出现并发症21次,手术未达到预期疗效16次.非计划再手术率在非烧伤难愈性创面病人中最高,达22.73%,在烧伤后畸形整形病人中最低,为0.非烧伤整形病人的非计划再手术率为20.90%,明显高于烧伤整形病人的10.18% (P <0.05),难愈性创面病人的非计划再手术率为18.52%,虽高于非难愈性创面病人的10.38%,但无统计学差异(P>0.05).

  2. Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77

    Radmehr H


    Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

  3. Clinical effect of laparoscopic reoperation combined with choledochoscope in treatment of intra- and extrahepatic bile duct stones: analysis of 35 cases

    WU Liming


    Full Text Available ObjectiveTo investigate the feasibility and safety of laparoscopic reoperation combined with choledochoscope in the treatment of intra- and extrahepatic bile duct stones. MethodsThe 35 patients with intra- and extrahepatic bile duct stones who underwent laparoscopic bile duct reoperation from January 2008 to May 2012 were selected as a laparoscopic treatment group; 50 patients with recurrent intra- and extrahepatic bile duct stones who underwent open surgery in the same period were selected as an open surgery group. The t-test was used to compare the two groups in terms of off-bed activity early after operation, recovery of intestinal function, and length of hospital stay; the chi-square test was used to compare the incision infection rate between the two groups. ResultsAmong the 35 cases of intra- and extrahepatic bile duct stones, 32 completed laparoscopic surgery, 2 had the procedure converted to open surgery due to severe adhesion, and 1 had the procedure converted to open surgery due to subcutaneous emphysema. In the laparoscopic treatment group, the mean operative time of laparoscopic bile duct reoperation was 148 min (range, 105-200 min; there were no bleeding and bile leak in the perioperative period. All patients underwent T-tube drainage; postoperative peritoneal drainage was performed for 2-5 d; the mean length of hospital stay after operation was 5-8 d. No case of incision infection occurred in the laparoscopic treatment group. The laparoscopic treatment group had a significantly better outcome than the open surgery group in terms of time to off-bed activity early after operation, time to recovery of intestinal function, length of hospital stay after operation, and incision infection rate (P<0.05. In the laparoscopic treatment group, 3 cases had retained bile duct stones, and the stones were taken out through the sinus tract using a fiber choledochoscope at 2 months after operation. All cases were followed up for 6-24 months after

  4. 质量管理工具在非计划再手术监管中的应用%Application of quality management tool in the non plan reoperation supervision

    杨培鲜; 于剑波; 陈伟


    It should fundamentally intensify the supervision of non plan reoperation to reduce the incidence rate of non plan reoperation.This paper analyzed the main reasons of non plan reoperation,and makes the discussion of the application of quality management tool PDCA recyclable model in the non plan reoperation supervision.%降低非计划再手术的发生率,就要从根本上加大对非计划再手术的监管力度。本文主要分析了非计划再手术的主要原因,从质量管理工具PDCA循环模型在非计划再手术监管中的应用做出探讨。

  5. The Reasons of Reoperation and Prevention in Congenital Choledochal Cyst%先天性胆总管囊肿再手术原因及预防

    吴学东; 胡廷泽; 林春榕


    目的:分析先天性胆总管囊肿术后再手术原因及其预防措施。方法:对我院 1981年到 1999年收治的 112例先天性胆总管囊肿中再手术病例进行回顾性分析。结果: 112例中再手术 11例。早期再手术 4例,为胆总管囊肿切除、胆道重建术后 2~ 4d发生切口裂开、吻合口瘘、辅助外引流不畅等。远期因吻合口狭窄和盲袢综合征再手术各 1例,单纯囊肿引流术后返流性胆道感染再手术 5例 (其中 4例行胆总管囊肿切除、胆肠 Roux- Y吻合术,另 1例因胆总管穿孔引流术后腹腔广泛粘连作了囊肿空肠 Roux- Y式吻合术 ), 5例均于术中胆管空肠袢加做套叠瓣,全部获得治愈。结论:胆肠对等吻合、缝合严密和通畅引流可减少早期再手术;胆道返流、吻合口狭窄和盲袢存在是远期再手术的主要原因。囊肿切除、胆肠 Roux- Y吻合套叠瓣成形术可有效预防术后逆行性胆道感染。%Objective:Analyzed the reasons of reoperation in congenital choledochal cyst(CCC)and the ways of preventing.Method:11 reoperation cases were retrospective reviewed in 112 CCC patients in WCUMS from 1981 to 1999.Results:11 cases in 112 CCC patients underwent reoperation early and later after the first surgical procedure.4 children received reoperation 2- 4 days after cyst resection with a Roux- Y hepato je junostomy caused by the open of incition,anastomotic leakage and accessory drainage obstruction.7 cases underwent reoperation later after initiated operation (2 cases received anastomotic reconstruction and blindloop resection respectively after the cyst resection with a Roux- Y hepato je junostomy and 4 cases of another 5 underwent cyst resection with Roux- Y hepato je junostomy after cystoenterostomy;1 with Roux- Y cysto je junostomy after choledochostomy caused by choledoch perforation because of general adhering in abdomen)because of ascending cholangitis、 stoma

  6. Factors affecting reoperations after anterior cervical discectomy and fusion within and outside of a Federal Drug Administration investigational device exemption cervical disc replacement trial.

    Singh, Kern; Phillips, Frank M; Park, Dan K; Pelton, Miguel A; An, Howard S; Goldberg, Edward J


    The excellent clinical results of five US Federal Drug Administration (FDA) trials approved for cervical total disc replacement (TDR) (Prestige [Medtronic Sofamor Danek, Memphis, TN, USA], Bryan [Medtronic Sofamor Danek], ProDisc-C [Synthes, West Chester, PA, USA], Kineflex|C [SpinalMotion, Mountain View, CA, USA], and Mobi-C [LDR Spine, Austin, TX, USA]) have recently been published. In these prospective randomized studies, superiority or equivalency of TDR was claimed, citing an 8.7% (23/265), 9.5% (21/221), 8.5% (9/106), 12.2% (14/115), and 6.2% (5/81) (mean = 9.02%) rate of additional related cervical surgical procedures within 2 years in control anterior cervical discectomy and fusion (ACDF) patients, respectively, compared with 1.8% (5/276), 5.8% (14/242), 1.9% (2/103), 11% (15/136), and 1.2% (2/164) (mean = 4.34%) in patients receiving the cervical TDR. The rate of reoperation within 2 years after ACDF seems unusually high. To assess the rate of and specific indications for early reoperation after ACDF in a cohort of patients receiving the ACDF as part of their customary care. These results are contrasted with similar patients receiving ACDF as the control arm of five FDA investigational device exemption (IDE) studies. Multisurgeon retrospective clinical series from a single institution. One hundred seventy-six patients with spondylotic radiculopathy or myelopathy underwent ACDF by three surgeons between 2001 and 2005 as part of their clinical practices. All patients had at least 2 years of follow-up with final follow-up within 6 months of completion of this study. Cervical reoperation rates at 2-year follow-up and at 3.5-year follow-up. Review of medical records and telephone conversations were completed to determine the number of patients who had undergone a revision cervical procedure. At final follow-up, complete data were available for 159 ACDF patients. Of the 48 patients who underwent single-level ACDF and met criteria for inclusion in the IDE studies

  7. Evaluation Of Factors Influencing On Causes Of Prosthetic Valve Re-operation And Early Postoperative Survival Tehran Emam hospital (1991-2001

    Rahmani Reaza


    Full Text Available Prosthetic valve re-operation has greater mortality and morbidity than primary valve replacement. By recognition of factors influencing on causes of redo operation and preoperative survival, one can select appropriate prosthesis at primary valve replacement and when operation performed at appropriate time, surgical risk can be reduced."nMethods and Materials: Two hundred patients that underwent prosthetic valve re-operation from October 1991 through November 2001 were included in this study. There were 68 men and 132 women with the mean age of 42:tl 1.8 years. Structural failure was the commonest cause of bio-prosthesis replacement (93%. Valve thrombosis was the common cause of mechanical valve replacement (32%. Age younger Than 50 (P= 0.01 and interval after the first implantation more than 10 years (P= 0.01 affected bio-prosthesis degeneration."nResults: Atrial fibrillation (P<0.01, Older age especially more than 40 (P<0.05 and mitral position (P<0.01 affected mechanical valve thrombosis. Cross clamp time (P= 0.005, Tricuspid insufficiency (P = 0.001, NYHA IV (P = 0.005 and emergent operation (P= 0.001 were independent determinants of hospital mortality."nConclusion: In conclusion, in patients with more than 10-years life expectancy and age younger than 50, mechanical valve can be selected for primary valve replacement. If operation performed before patients reach deteriorated condition, preoperative survival would be excellent.

  8. Therapeutic effect analysis of reoperation in the treatment of upper gastrointestinal bleeding after gastrectomy%胃切除术后上消化道大出血的再手术治疗效果分析



    Objective:To analyze the clinical therapeutic effect of reoperation in the treatment of upper gastrointestinal bleeding after gastrectomy.Methods:46 cases of patients with upper gastrointestinal bleeding after gastrectomy were treated with reoperation.The curative effect of reoperation was observed.Results:After reoperation,31 cases were cured,13 cases were effective and the total effective rate was 95.65%.The incidence rate of postoperative complication was 4.35%.Conclusion:Reoperation was the effective method in the treatment of upper gastrointestinal bleeding after gastrectomy.%目的:分析再手术治疗胃切除术后上消化道大出血的临床疗效。方法:收治胃切除术后上消化道大出血患者46例,均行再次手术治疗。观察再次手术治疗效果。结果:再次手术后,痊愈31例,有效13例,总有效率95.65%。术后并发症发生率4.35%。结论:再手术是治疗胃切除术后上消化道大出血的有效方法。

  9. Causes and strategies of reoperation in cervico-occipital diseases%枕颈部疾患再手术原因分析与对策

    贺宝荣; 杨小彬; 闫亮; 郝定均; 郭华; 王晓东; 郑博隆


    目的 分析枕颈部疾患再手术的原因,探讨翻修手术的对策及其疗效,以期减少再次手术的发生率.方法 回顾性分析2000年1月至2012年1月对23例枕颈部疾患手术治疗失败患者再次手术的资料.男14例,女9例,初次手术时年龄18~52岁,平均38.6岁,2例进行3次手术.再次手术距前次手术的时间为3 h~11年.15例初次手术后假关节形成,3例初次手术后神经症状加重,2例内固定失败,1例初次手术后出现脑脊液漏及颅内感染,2例肿瘤复发.所有患者表现为不同程度的枕颈部疼痛、肢体麻木或椎体束征阳性,其中11例伴有脊髓神经功能障碍,JOA评分7.8分.翻修手术采用枕颈部寰椎后弓切除或枕骨大孔扩大减压、取髂骨块行枕颈植骨或寰枢椎植骨、枕颈部内固定或寰枢椎椎间固定.术后定期随访患者临床疗效并进行影像学评估(内固定位置、复位和植骨融合情况).结果 所有患者手术过程顺利,手术时间130~310 min,平均160 min;术中失血量300~2000 ml,平均800 ml.术中未发生血管、神经和脊髓等损伤.术后均无神经症状恶化的表现,均未发生咽壁和椎管内感染.2例患者术后切口感染,经过换药及延长抗生素使用后痊愈.23例患者随访时间6个月~3年,平均21个月.末次随访时,患者临床症状均得到明显改善,11例伴有脊髓神经功能障碍患者JOA评分改善到13.2分.按Macnab疗效评估标准评定:优11例,良8例,可4例.所有患者随访期间未见内固定松动表现,末次随访时均达到骨性融合.结论 枕颈部翻修的主要原因为假关节及残留症状,有效融合及减压是枕颈部手术最应重视的问题,可减少翻修率.%Objective To summarize the causes and strategies of reoperation in cervico-occipital diseases,so as to minimize the incidence of reoperation.Methods Between January 2000 and January 2012,23 patients who underwent reoperation in our hospital because

  10. Re-operation of residual ventricular septal defect in 12 cases%残余室间隔缺损的再手术治疗12例

    胡晓峰; 周运乾; 曹庆亨; 邱兆崑


    Objective To analyze the causation, surgical indications and pivotal points in reoperation of residual ventricular septal defect (VSD). Methods Collecting the clinical data of 12 cases of reoperated residual VSD in this hospital from 1988 to 1998 and investigating into insight of their causation, surgical indications and keys elements of reoperation in residual VSD. Results This group consisted of 12 patients of whom 8 were operated in this hospital from 1977 to 1997, and 4 were operated in other hospital. The re-operative rate of VSD in our hospital was 0.18 %.The defects in the first operation were 8 cases of simple VSD and 3 tetralogy of Fallot. The mean interval between the two operations was 4.1 years (5 months-12 years). Residual shunting in 10 patients were adjacent to the base of anterior and septal leaflets of tricuspid valve. The mean longitudinal diameter of residual VSD was 1.2 cm(0.3~2.5 cm).Three patients died after reoperation. Causes of death included low cardiac output syndrome, cardiac arrhythmia and cardiac tamponade. Conclusion 1. The common location of residual VSD is around the base of anterior and septal leaflets of tricuspid valve, this area involves some important structures like aortic valve and AV bundle which are not easily exposed. 2. Adequate exposure of entire VSD margin is the key element to avoid leakage by laceration. 3. Early re-operation is required for all residual VSD with diameter above 0.5 cm. 4. The key points of reoperation are timely operation, atrial incisional approach, patch repairment and careful hemostasis.%目的分析残余室间隔缺损(VSD)的发生原因、防治措施、手术指征和手术要点。方法对12例施行残余VSD再手术治疗患者的发生原因、预防措施、手术指征和手术要点进行分析。结果 12例中8例首次手术于1977年至1997年在我院施行,4例在外院施行,我院VSD再手术率为0.18%。首次手术时单纯VSD 9例,法洛四联症(TOF)3

  11. 食管癌二次手术19例原因分析%Analysis of 19 cases undergoing reoperation for complications following esophagectomy

    杨永波; 闫万璞; 熊宏超; 梁震; 戴亮; 康晓征; 杨合利; 陈克能


    Objective To investigate the cause and the management of treatment and prevention of reoperation following esophagectomy. Methods Clinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them , 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized. Results The indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis(n=1). All the 19 patients were successfully cured without perioperative deaths and further complications. Conclusions The indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.%目的:探讨食管癌行二次手术的原因及防治措施。方法回顾性分析2000年1月至2012年12月间北京大学肿瘤医院单一手术组施行的946例食管癌手术患者的临床资料,其中19例因术后严重并发症需行二次手术,总结该19例患者的临床特点及治疗经过。结果19例二次手术的患者中因术后胸腔内出血行开胸止血术4例,因膈疝行膈疝还纳、膈肌修补术4例,因乳糜胸行胸导管结扎术4例,因腹部切口裂开行切口缝合术4例,因创伤性胰腺炎行胸腹腔探查、腹腔置管引流术1例,因肠梗阻行回盲部切除、回肠造瘘术1例,因双侧喉返神经麻痹行气管切开术1例。19例二次手术患者全部治愈,无围手术期死亡和再次并发症发生。结论

  12. Economic Effects of Reservoir Re-operation Policy in the Rio Grande/Bravo for Sustainable Human and Environmental Water Management

    Ortiz Partida, J. P.; Sandoval Solis, S.; Lane, B.


    A central challenge of integrated water management is the design and implementation of policies to allocate water to both humans and the environment in a sustainable manner. This study uses the results from a reach-scale water-planning model to quantify and compare the economic benefits of two water management policies: (1) a business as usual (Baseline) policy and (2) a proposed reservoir re-operation policy to provide environmental flows (EFs). Results show that the EF policy would increase water supply profit, slightly decrease recreational activities profit, and reduce costs from flood damage and environmental restoration compared to the Baseline policy. In addition to supporting ecological objectives, the proposed EF policy would increase the economic benefits of water management objectives.

  13. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola


    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  14. Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations.

    Wassenaar, E B; Schoenmaeckers, E J P; Raymakers, J T F J; Rakic, S


    Laparoscopic ventral and incisional hernia repair (LVIHR) carries a risk of adhesion formation and can influence subsequent abdominal operations (SAOs). We performed a retrospective study of findings during reoperations of patients who had previously had an LVIHR by using an expanded polytetrafluoroethylene mesh (DualMesh; WL Gore, Flagstaff, AZ, USA). The medical records of all 695 patients who had LVIHR at our hospital were reviewed. Patients who underwent SAO for various indications were identified (n = 72) and analyzed. Seven LVIHR patients (1%) had early SAO (within a few days). In six patients (86%), removal of the mesh was required. Intra-operatively, in all six of these patients with peritonitis, there were no adhesions against the implant identified. Late SAOs (after more than 1 month) were performed in 65 patients (9.4%). Only one patient required acute surgical intervention due to an LVIHR-related adhesion (0.15%). Laparoscopy was performed in 83% and laparotomy in 17% of patients. Adhesions against the implant were present in 83% of patients; in 65%, the adhesions involved omentum only, and in 18%, they involved the bowel. Adhesiolysis was always easy and caused no inadvertent enterotomies. SAOs were devoid of postoperative complications. In this largest series of reoperations after LVIHR, the majority of patients had mild or moderate adhesions against the implant. The specific observations that: (1) no relaparoscopies had to be converted, (2) no inadvertent enterotomies were made during adhesiolysis, and (3) SAOs have practically been devoid of peri- and postoperative complications indicate that SAOs can be safely performed after previous LVIHR with DualMesh.

  15. Risk Factors for Reoperation and Performance-Based Outcomes After Operative Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis.

    Singh, Sameer; Larkin, Kevin; Kadakia, Anish; Hsu, Wellington


    Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity. These players are concerned with efficiently returning to play at a high level. Return-to-play rates after operative treatment have been previously reported, yet performance outcomes after such treatment are generally unknown in this population. Overall, professional athletes sustaining a foot fracture would return to play at high rates with little impact on post-operative performance or league participation. However, National Football League (NFL) athletes would have a significantly greater decline in performance, due to the high impact nature of the sport. Case series. Level 4. Athletes in the National Basketball League (NBA), NFL, Major League Baseball (MLB), and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance data were collected before and after surgery. Statistical analysis was performed, with significance accepted as P ≤ 0.05. A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% (76/77) of players were able to return to play, with a median time to return across all sports of 137 days. Players returned to preoperative performance levels within 1 season of surgery. Six players (7.8%) sustained refracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary operative treatment was a predictive factor for reinjury (99% vs 40%, P = 0.001). Athletes returned to play at a high rate after foot fracture fixation, with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at greater risk of reinjury compared with

  16. Clinical analysis of 13 cases of unplanned reoperation in obstetrics and gynecology department%妇产科非计划再次手术13例临床分析

    王相岩; 干宁


    目的 分析妇产科非计划再次手术的原因,为提高医疗质量、降低非计划再次手术的发生率提供依据.方法 对安徽医科大学附属巢湖医院妇产科13例非计划再次手术患者的临床资料进行回顾分析.结果 2012年1月至2013年12月安徽医科大学附属巢湖医院妇产科住院手术共4193例,非计划再次手术13例(0.31%).13例全部治愈出院,术后切口愈合不良,泌尿系损伤、肠管损伤、肠梗阻、出血、感染是发生非计划再次手术的主要原因.结论 加强围手术期的管理,充分医患沟通,加强专业学习,提高临床技能,规范手术操作,提高快速病理诊断准确率可减少非计划再次手术的发生.%Objective To analyze the causes of non-planned reoperation in Obstetrics and Gynecology Department ,in order to pro-vide evidence for improving the quality of medical care and reducing the incidence of unplanned reoperation .Methods The clinical data of 13 cases unplanned reoperation in our department were retrospectively analyzed .Results There were 4193 cases of hospitalization from Jan-uary 2012 to December 2013,and the rate of non-planned reoperation was 0.31%.Thirteen cases of patients were cured and discharged .The postoperative poor wound healing ,urinary system injury ,intestinal injury ,intestinal obstruction ,bleeding and infection were the reasons for the occurrence of non-planned reoperation .Conclusion We should strengthen the preoperative management ,strengthen the communication be-tween doctors and patients ,strengthen professional learning ,improve clinical skills,standardize operation,and improve the accuracy of rapid pathological diagnosis so as to decrease the incidence of non-planed reoperation .

  17. Reoperation to the ossification of the posterior longitudinal ligament%颈椎后纵韧带骨化症再手术原因分析

    潘胜发; 刘忠军; 孙宇; 张凤山; 王少波; 李迈; 张立


    Objective To discuss surgical approaches of ossification of the posterior longitudinal ligament(OPLL) of cervical spine.Methods Between June 2005 to July 2010,36 patients with OPLL of cervical spine were reoperated.There were 23 male,13 female,age from 39 to 72 years( mean 57 years).The time of the first operation to the reoperation were 4 months to 24 years,an average of 3.9 years.Among 20 patients underwent anterior corpectomy and fusion(ACD) at first operation,14 cases combined stenosis of cervical spinal canel,10 cases were insufficient decompression of OPLL,5 cases injuried of cervical spinal cord during the first operation,1 case was adjacent disc herniation.Among 14 cases underwent expensive open-door laminoplasty (ELAP)at first operation,6 cases were insufficient decompression of OPLL,4 cases were inadequate decompressed segment,2 cases were cervical segmental kyphosis,2 cases were progression of OPLL combined with disc herniation.Among 2 cases underwent combined approach at first operation,I case was insufficient decompression of OPLL,the other was adjacent disc herniation.Their pre- and post-operative X-ray,CT and MRI were analyzed.The complications of reoperation were recorded.Result There were 30 patients followed-up,with a period of 1.5-4.0 years,average 1.8 years.With 36 patients,none had deterioration,2 patients had no recovery post-reoperation,34 patients had 31.2% Japanese Orthopedic Association score improve rate.Among 22 cases underwent ELAP at second operation,3 cases had postoperative segmental palsy.Among 14 cases underwent ACD at second operation,3 cases had intraoperative dural defects.Conclusion Surgical strategy for OPLL of cervical spine should consider the type of OPLL and stenosis of cervical spinal canel.%目的 通过分析颈椎后纵韧带骨化症再手术的原因,探讨确定手术方式的影响因素.方法 对2005年6月至2010年7月收治的36例颈椎后纵韧带骨化症再手术患者资料进行回顾性分析,男性23

  18. [The longitudinal increase of the internal jugular vein and the upper v. cava as measured between the mastoid to the heart: parameter for timing the re-operation after ventriculocardiostomy (author's transl)].

    Müke, R; Glashoff, M


    Some time after ventriculo-cardiostomy in children with hydrocephalus the cardiac catheter is retracting out of the right atrium into the upper veins due to the increase of body length during growth. This might endanger proper functioning of the valve. Therefore most authors are in favour of a prophylactic elongation of the catheter by re-operation. In order to roughly predict the time for re-operation we measured course of the catheter in 4120 children. As a basis for long time supervision of children with this shunt operation we thus propose a curve of length increase of the blood vessels concerned, based on our data, in connection with the known curve of length increase of the body.

  19. Clinical analysis of reoperation for differentiated thyroid carcinoma%分化型甲状腺癌再次手术的临床分析

    郑绪才; 王圣应; 朱正志; 刘松; 陈公仆


    目的:分析行再次手术的104例分化型甲状腺癌( DTC)的手术方式、病理结果及疗效,探讨DTC再次手术策略。方法回顾性分析104例分化型甲状腺癌患者再次手术治疗的临床资料。结果经病理证实,甲状腺组织总残癌率66.35%,淋巴结残癌率77.89%。患者年龄<45岁、既往颈部淋巴结肿大、原发癌灶残留或复发、原发癌的多发与颈部淋巴结转移显著相关,差异有统计学意义(P<0.05)。术后暂时性喉返神经损伤发生率为2.88%,暂时性低钙血症发生率为5.77%,无永久性喉返神经损伤及甲状旁腺损伤。结论 DTC行再次手术时应保证肿瘤切除的彻底性,尤其对颈部淋巴结的处理;同时尽量防止喉返神经和甲状旁腺损伤等并发症的发生。%Objective To analyze the surgical methods, pathological results and therapeutic effect of 104 cases of differentiated thy-roid carcinoma ( DTC) , and to investigate the reoperation strategy. Methods The clinical data of 104 cases of differentiated thyroid carcino-ma treated by reoperation were retrospectively analyzed. Results The total residual cancer rate of thyroid tissues was 66. 35%, and the rate of lymph node residual cancer was 77. 89%. Univariate analysis showed that the patients were aged <45 years old, had a swollen past neck lymph nodes, residual or recurrence of primary cancer foci, and multiple cervical lymph node metastasis were significantly associated with the primary cancer (P<0. 05). Incidence of postoperative temporary larynx return nerve injury was 2. 88%, temporary hypocalcemia occur rate was 5. 77%, and there was no permanent laryngeal recurrent nerve injury and parathyroid injury. Conclusion DTC should guarantee the tumor resection thoroughly, especially for the treatment of cervical lymph nodes, and meanwhile complications such as recurrent laryngeal nerve and parathyroid injury should be prevented.

  20. 复发性上颌窦内翻性乳头状瘤二次手术探讨%Reoperation for recurrent inverting papilloma in maxillary sinus

    梁敏志; 杨东辉; 夏广生; 谭向杲


    目的:探讨复发性上颌窦内翻性乳头状瘤二次手术治疗策略。方法回顾性分析32例复发性上颌窦内翻性乳头状瘤的临床资料,包括复发并恶变7例。鼻内镜下手术28例,泪前隐窝入路9例,上颌窦内侧壁切除入路13例,扩大上颌窦内侧壁切除入路6例,上颌骨切除术4例。总结疗效,分析其手术治疗策略。结果术后随访13~39个月,治愈29例;复发3例,其中2例经再次手术治愈;死亡1例。结论对于本病,应根据病变侵犯范围合理选择二次手术的手术入路及手术范围,以彻底切除病灶。内镜下多种手术入路可达切除肿瘤目的,可以避免鼻外辅助切口。%Objective TTo explore the therapeutic strategy with reoperation on cases with recurrent inverting papilloma in maxillary sinus.Methods A retrospective study was carried out among 32 cases with recurrent inverting papilloma in maxillary sinus, including 7 of relapse accompanied simultaneously with the lesion malignantly transformed, with their clinical data carefully analyzed. All these cases were given surgical treatment again, with 28 cases operated on under nasal endoscope, 9 undergoing the approach via anterior lacrimal recess, 13 via the approach of paries medialis maxillaries resection, 6 via that of enlarged paries medialis maxillaries resection, and 4 via maxillectomy.Results By the end of following up period lasted for 13 to 39 months, 29 cases were cured, and 3 cases with lesion reoccurred once more, among whom 2 were cured via surgery again and 1 died.Conclusions It should be important that to carrying out reoperation for cases with recurrent inverting papilloma in maxillary sinus via a reasonable choice of surgical approach based on the invaded extension of lesion in order to achieve the aim of complete resection of involved tissues. A variety of surgical approach under nasal endoscope can achieve the purpose of tumor resection, with the advantage

  1. Significance of Size of Persistent/Recurrent Central Nodal Disease on Surgical Morbidity and Response to Therapy in Reoperative Neck Dissection for Papillary Thyroid Carcinoma.

    Lang, Brian Hung-Hin; Shek, Tony W H; Chan, Angel On-Kei; Lo, Chung-Yau; Wan, Koon Yat


    To balance the risk of disease progression, morbidity, and efficacy of reoperative central neck dissection (RCND) in papillary thyroid carcinoma, the latest clinical guidelines recommend early surgery over surveillance when the largest diseased node is >8 mm in its smallest dimension. However, the evidence remains scarce. To determine an appropriate size for first-time RCND, the relationship between size of largest diseased central node, morbidity, and response-to-therapy following RCND was examined. A total of 130 patients who underwent RCND following initial surgery for persistent/recurrent nodal disease were reviewed. Patients with largest diseased central node measured preoperatively by ultrasonography were included. Eligible patients were categorized into three groups: largest central node 15 mm (group III). Surgical morbidity and response to therapy at one year after RCND were compared between groups. To evaluate biochemical response, patients with structural incompleteness were excluded. Group III not only had significantly more high-risk tumors (by American Thyroid Association risk stratification) at initial therapy (64.5% vs. 44.4%, respectively; p = 0.038), but this group also a higher risk of extranodal extension (35.5% vs. 16.0%; p = 0.055), recurrent laryngeal nerve involvement (19.4% vs. 0.0%; p 15 mm in the largest disease central node was an independent risk factor for incomplete biochemical response, while nodal size 10-15 mm was not. These findings imply that the recommended threshold of 8 mm might be too stringent and could be raised to 15 mm without increasing the surgical morbidity from RCND.

  2. 北京市某医院79例非计划再手术原因与改进措施%Causes and improvement measures for 79 cases of unplanned reoperation in a hospital in Beijing City

    于瑾; 王东; 宋景晨; 马谢民


    目的:对北京市某三级甲等综合性医院2015年79例非计划再手术病例进行回顾性分析,探讨非计划再手术发生的原因,并提出防范措施,以指导医疗流程的改进。方法对筛选出的非计划再手术病例采用根因分析法分析手术病历信息。结果患者管理失误、患者合并症,以及手术技术错误,如手术后出血、未达预期效果手术再调整、手术损伤、吻合口瘘、切口问题是导致非计划再手术发生的根本原因。结论通过完善管理制度、加强围手术期管理、提高医务人员临床技能水平,可持续改进医疗服务质量,减少非计划再手术的发生。%Objective The paper conducts retrospective analysis on the 79 cases of unplanned reoperation in a Grade-A Class-3 hospital in Beijing during 2015, discusses the causes of unplanned reoperation, and brings forward precautionary measures in order to guide the improvement of medical process.Method For the cases of unplanned reoperation screened out, root cause analysis is adopted to analyze the medical record of operation of these cases.ResultThe root causes of unplanned reoperation include errors in perioperative management of patients, patient’s comorbidity, and errors in surgical technique, such as postoperative hemorrhage, readjustment through operation in case of the failure to reach the expected effect, operation injury, anastomotic leakage, and incision problem.Conclusion The medical service quality can be continuously improved and the occurrence of unplanned reoperation reduced by completing management system, enhancing the management during perioperative period, and improving the clinical skills of medical personnel.

  3. 腹部术后早期肠梗阻再手术治疗21例分析%Reasons for Reoperation in 21 Cases of Early Postoperative Intestinal Obstruction

    汪雷; 刘弋


    目的 探讨腹部术后早期肠梗阻的因为,总结再手术的经验.方法 回顾分析2005年1月2010年6月21例腹部术后早期肠梗阻再手术患者的临床资料.结果 21例术后早期肠梗阻出现时间为术后4~11 d,经再手术明确梗阻因为,术中证实粘连性肠梗阻12例,漏诊消化系统肿瘤3例,漏诊直肠癌1例,陈旧性粘连带致肠管卡压2例,遗漏多发肠石1例,合并急性阑尾炎、阑尾周围脓肿合并肠粘连梗阻2例,合并肠套叠1例.1例粘连性肠梗阻为术后17 d再次手术,由于无法找到明确的梗阻点,故行梗阻远近两端侧侧吻合术,术后25 d梗阻解除;其余20例经再手术后3~5d梗阻均解除,无手术死亡病例.结论 腹部术后早期肠梗阻多见为肠粘连.充分的术前准备,规范的手术操作,严密的术后观察,可减少粘连性肠梗阻的几率.选择适宜的手术方式,精确细致的手术操作是再手术成功的关键.%Objective To analyze the reasons for reoperation for early postoperative intestinal small obstruction, and summarize the experience of reoperation and treatment.Methods The reasons for reoperation in 21 patients with early postoperative intestinal small obstruction treated in our hospital from Jan 2005 to June 2010 were retrospectively analyzed.Results The 21 cases of early intestinal obstruction were occurred from 4 to 11 days after operation.By re-operating these 21 patients, the reasons for early postoperative intestinal small obstruction were clear.12 of 21 cases were adhesive intestinal obstruction,3 of 21 cases with digestive system cancer were missed diagnosed, 1 case with rectum cancer was missed diagnosed, 1 case with multiple intestinal stones was missed.And 2 cases with old intestinal adhesions and compression were diagnosed, 2 cases with acute appendicitis, the appendix abscess combined adhesive intestinal obstruction was diagnosed, and 1 case with intussusception was diagnosed.1 of 21 cases with adhesive

  4. No Difference in Reoperations at 2 Years Between Ceramic-on-metal and Metal-on-metal THA: A Randomized Trial.

    Engh, C Anderson; Sritulanondha, Supatra; Korczak, Abigail; Whalen, Terrence David; Naudie, Douglas D R; McCalden, Richard W; MacDonald, Steven J


    Hard-on-hard bearings for total hip arthroplasty continue to warrant analysis even though crosslinked polyethylene is performing very well. Ceramic-on-metal (CoM) has low in vitro wear and did well in an early clinical trial. We report on a prospective, randomized, multicenter investigational device trial comparing CoM with metal-on-metal (MoM). (1) Is there a difference in the number or type of revisions comparing CoM with MoM? (2) Are cobalt and chromium metal levels different for CoM and MoM THA? Between August 2005 and October 2006, of 1015 patients screened, 390 patients were enrolled at 11 centers and randomized to 194 CoM and 196 MoM bearings. There was no difference in the preoperative patient demographics between the study groups. Mean followup was 50 months (range, 22-75 months). Seventy-two patients from two centers had metal level analysis. With the numbers available, there was no difference in the proportion of patients undergoing revisions between the MoM and the CoM cohorts (MOM: 3% [six of 196]; COM: 1.5% [three of 194]; p = 0.50). Four MoM revisions were unrelated to the bearing surface. Two had bearing surface-related reoperations, one for an aseptic lymphocyte-dominated vasculitis-associated lesion and one for elevated metal levels with acetabular malposition. None of the CoM revisions were related to the bearing surface. The metal level analysis revealed that in contrast to the CoM, the MoM bearing group had increasing values of erythrocyte and serum cobalt from 1 to 5 years (CoM erythrocyte 0.45-0.55 ppb, p = 0.11 and CoM serum 0.88-0.85, p = 0.55, and MoM erythrocyte 0.32-0.51 ppb, p ppb, p ppb and serum IQR, 0.42-0.80 to 0.64-2.20 ppb, p group had no wear-related revisions and maintained consistently low metal levels. The MoM cobalt elevations may be important considering recent reports of taper corrosion. This CoM bearing was approved by the FDA but withdrawn from the market because of low sales. If it were available, the authors would not

  5. 二尖瓣再次手术患者临床特征分析%Clinical Analysis on the Characteristic Underwent Mitral Valve Reoperation

    周维正; 颜涛; 邹良建


    Objective:To study the risk factors and treatment methods of the re-valve surgery after mitral valve operation.Methods: From January 2006 to December 2009, a total of 28 patients underwent the second mitral valve replacement after their first mitral valve repair or replacement surgery. Among the patients who received mitral valve replacement for the first time, 7 patients had perivalvular leakage,6 patients happened the degeneration of the artificial hiovalves, 5 patients were valve stenosis.Among these patients, 4 were complicate with artificial valve endocarditis, with 3 positive of the blood culture,and 1 negative.One patient have infravalve stenosis of the artificial valve was because of thrombogenesis. Ten patients received the mitral valve replacement operation because of the degeneration of mitra valve after valve repair surgery. Results:Two patients were dead after operation, and the fatality rate was 7.14%, both were complicated with artificial valve endocarditis. The follow up was 5 months to 5 years. Two patient had severe atrioventricular block, and both received permanent pacemaker implantation in our hospital. All patients received cardioultrasonogragh, and the results showed the artificial valves worked well, and their cardiac function had been from Ⅰ to Ⅱ degree of the New York Heart Association (NYHA) functional cbassification. Conclusions:The degeneration of mitra valve after valve repair surgery has been gradually become the major cause of reoperation of the mitral valve, to restrict the indication of repair surgery can decrease the risk of reoperation. Prosthetic valve endocarditis is a severe complication with high mortality, we should discover it earlier, treat it earlier, to save enough time for the operation.%目的:探讨二尖瓣手术后再次行瓣膜手术的病因和治疗方式.方法:分析2006年1月-2009年12月28例接受再次二尖瓣置换术患者的临床资料.再次手术的病因:二尖瓣成

  6. Experience of ipsilateral laparoseopic reoperations in urology%泌尿外科同侧二次腹腔镜手术体会

    马亮; 余大敏; 张志根; 李新德; 芮雪芳; 李恭会; 丁国庆


    目的 探讨泌尿外科同侧二次腹腔镜手术可行性,总结经验和体会. 方法行同侧二次腹腔镜手术患者13例.第一次手术路径:经腹膜后4例,经腹9例.第一次手术原因:肾盂输尿管连接处梗阻3例、输尿管结石3例、肾盂结石2例、肾上腺肿瘤2例、肾囊肿2例、多囊肾1例.第二次手术原因:患侧肾脏无功能4例、结石复发3例、肾囊肿复发1例、肾盂输尿管吻合处狭窄1例、同侧肾脏发生肾癌I例、多囊肾再次进展1例、肾上腺肿瘤残留和复发各1例.2次手术间隔6~72个月,平均30个月.第二次手术均取经腹入路,直视下进腹建立气腹,松解肠道粘连后打开侧腹膜及肾周筋膜,先从解剖清晰、粘连轻处按解剖层次,逐步暴露手术部位完成手术,未切除肾脏病例术后缝合肾周筋膜及侧腹膜,恢复解剖关系. 结果 第一次手术平均手术时间93 min,平均出血量70ml,平均术后住院时问4.8 d.第二次手术均顺利完成,平均手术时间97 min,平均出血量62 ml,平均术后住院时间5.0 d.第二次手术中均发现不同程度粘连和解剖位置变化,手术难度增加.二次手术后13例随访2~24个月,未发生严重并发症. 结论 选择合适病例,在熟练掌握相关技巧后,二次腹腔镜手术可以应用于有同侧泌尿外科腹腔镜手术史患者.%Objective To evaluate the feasibility and clinical results of laparoseopic reoperation for patients with history of previous ipsilateral urology laparoscopic surgeries. Methods Thirteen patients that underwent second ipsilateral urology laparoscopic surgeries were retrospectively ana-lysed. The reasons for a second operation included nonfunctional kidney after pyeloplasty, ure-terolithotomy or pyelolithotomy in 4 cases, recurrence of urinary calculi in 3 cases, pelviureteric june-tional stenosis after pyeloplasty in 1 case, recurrence of renal cyst in 1 case, recurrence of adrenal tumor in 1 case, residual adrenal

  7. Discussion on valve re-operative cases after cardiac valve replacement%关于心脏瓣膜置换术后再次瓣膜手术的探讨

    宣海洋; 石开虎; 张飞; 徐盛松; 吴君旭; 曹炜; 龚文辉; 赵旭东


    Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.%目的 分析心脏瓣膜置换术后再次瓣膜手术的原因,探讨手术时机的选择、手术方法及对结果的影响因素.方法 对2008年10月至2010年2月心脏瓣膜置换术后再次瓣膜手术的13例患者进行回顾性分析,术前NYHA心功能Ⅲ级4例,Ⅳ级9例.单纯二尖瓣置换术7例,单纯主动脉瓣置换术3例,二尖瓣并主动脉瓣置换术3例.结果 术后早期死亡1例,病死率7.7%(1/13),死亡原因为术后低心排血量综合征.术后因出血二次开胸止血和再次气管插管各1例,经抢救治疗后均好转,12例患者均于3~6周出院.随访6~15

  8. 食管闭锁术后食管气管瘘复发再手术的临床分析%Clinical analysis of reoperation for esophageal atresia with recurrent tracheoesophageal fistulas

    朱海涛; 沈淳; 肖现民; 董岿然; 郑珊


    目的:分析食管闭锁(EA)术后食管气管瘘复发(RTEF)再手术的临床资料,总结RTEF的原因、诊断方法及再手术的经验。方法回顾性分析2005年1月至2013年12月我们收治的10例EA术后RTEF患儿的临床资料,其中男7例,女3例,再手术平均年龄为19个月,平均体重为8.3 kg,所有病例均为GrossⅢ型;10例中有9例曾接受经右胸食管气管瘘结扎+食管端端吻合术。结果在初次手术中有4例(4/10)瘘管并未切断。9例(9/10)复发瘘管的食管端开口于原食管吻合口狭窄处或近端食管。8例(8/10)术后存在不同程度吻合口狭窄,1例合并吻合口瘘。再手术前所有患儿行食管欧乃派克造影检查,确诊和疑似RTEF分别为5例(5/10,50%)、4例(4/10,40%)。所有RTEF通过胃镜及支气管镜确诊(10/10,100%)。患儿均接受再次进胸手术,平均手术时间3.2 h,平均术后住院时间为15.8 d。术后均获随访3~96个月,食管造影提示所有病例均治愈,未再发生RTEF。结论 EA术后RTEF与初次手术瘘管处理不当、食管吻合口局部炎症反应等因素有关,需再次手术治疗,再手术的疗效及患儿预后良好。%Objetive To summarize the reoperative experience for esophageal atresia (EA)with recur-rent tracheoesophageal fistulas (RTEF). Methods A retropective analysis was given to the 1 0 RTEF patients underwent reoperation in our center from Jan.2005 and Dec.2013.Male to female ratio was 4:1.The median age and average weight at reoperation were 19 months and 8.3 kilograms respectively.All cases were Gross type Ⅲ.9 cases underwent the primary repair of EA. Results During the primary repair,TEF were not cut in 4/1 0 cases.Esophageal orifices of the fistula in 9 of 1 0 cases were located around the anastomotic site or the proximal esophagus.8 cases had anastomotic stricture and 1 case had anastomotic leakage after the primary re

  9. Clinical Research of Reoperation Reasons for Hypertension Cerebral Hemorrhage%高血压性脑出血术后再手术原因的临床研究

    宋明浩; 李志祥; 马文斌


    目的 对高血压性脑出血术后再手术的原因进行临床研究,为以后的临床工作提供理论及实践依据. 方法 回顾性分析我院自2002年2月~2011年6月所有因高血压性脑出血行手术治疗213例,其中因各种原因再次手术治疗36例的临床资料. 结果 因颅内再出血再次行手术治疗29例,因大面积脑梗塞再次行手术治疗7例.再出血再手术组患者的GOS结果提示,Ⅰ~Ⅲ级者明显多于再出血未再手术组,差异有显著统计学意义(P<0.01);GOSⅣ者差异无统计学意义(P>0.05);GOSV级者明显少于未再手术组,差异有显著统计学意义(P<0.01).脑梗塞再手术组患者的GOS结果提示,Ⅰ~Ⅲ级明显多于脑梗塞未再手术组,差异有统计学意义(P<0.05);GOSⅣ级者,差异无统计学意义(P>0.05);GOSⅤ级者明显少于未再手术组,差异有显著统计学意义(P<0.05). 结论 术前认真评估患者的整体状况,手术切口的选择,手术的规范化操作,术中及术后规范化治疗以及避免医源性损伤都是防止因再出血和脑梗塞而再手术的关键.%Objective To explore the reoperation causes for hypertensive cerebral hemorrhage, so as to provide theoretical and practical basis for the future clinical work. Method The clinical data of 36 patients with reoperation out of 213 patients who received surgical operation for hypertension cerebral hemorrhage in our hospital from February 2002 to June 2011 were reviewed and analyzed. Results There were 29 cases of rebleeding and 7 cases with a large area of cerebral infarct received reoperation. In the reoperation group of rebleeding patients, the rate of I ~ III GOS stage was obviously higher than the non-reoperation group ( P 0. 05 ). And the rate of V stage was much lower ( P 0. 05). And the rate of V stage was much lower( P < 0. 05). Conclusion Careful evaluation of the overall condition, suitable surgical incision, standardized operation and

  10. 颅底肿瘤术后再手术原因的分析(附14例报告)%Analysis the reasons of emergency reoperation after skull base surgery: report of 14 cases

    郝淑煜; 薛湛; 李达; 肖新如; 汤劼; 王亮; 吴震; 张力伟; 张俊廷


    目的 探讨神经外科颅底肿瘤手术后急诊再次开颅手术病例的临床特征.方法 回顾性分析首都医科大学附属北京天坛医院神经外科2008年10月至2013年10月2 500例颅底手术病例中术后再次急诊开颅手术的14例患者,其中颅底脑膜瘤6例,神经鞘瘤3例,垂体腺瘤、颅咽管瘤、骨软骨瘤、血管平滑肌瘤、颈静脉球瘤各1例.第一次手术平均用时9.2h,术中平均出血2 750 ml.再手术的原因由术者和专家组分析得出,并由全科讨论确认.结果 再手术的14例患者中,9例表现为意识减弱,2例术后未能正常苏醒,2例术后常规CT检查发现异常,1例为突发性伤口出血.CT检查发现异常的平均时间为术后17 h,其中瘤腔内出血4例,脑内血肿伴脑挫裂伤4例,大面积脑梗死2例,脑内血肿合并硬膜下血肿l例,硬膜外血肿2例,椎动脉出血1例.再手术后恢复良好6例,中残2例,重残2例,植物生存1例,死亡3例.结论 对于行颅底肿瘤手术的患者,应加强围手术期管理,减少再次手术的发生.%Objective To report the clinical features of the patients who underwent emergent recraniotomy after skull base operation.Methods A serial of 14 cases of reoperation after elective surgery in the Department of Neurosurgery,Beijing Tiantan Hospital between October 2008 and October 2013 were reviewed.Six cases were skull basal meningioma,3 schwannoma,1 pituitary adenoma,1 craniopharyngioma,1 chondroma,1 angioleiomyoma,and 1 glomus jugular tumor.The mean length of first operation time was 9.2 h,and the mean amount of bleeding was 2 750 ml.The reason of reoperation was evaluated by the surgeons and experts,and then approved by all doctors.Results The clinical features of these reoperation patients included altered level of consciousness in 9 cases,unrecovered from anesthesia in two,abnormal CT scan in two and one sudden bleeding in wound.The mean time of abnormal CT scan was 17 h.As for the reason for

  11. Assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension%胆道多次手术合并肝硬化门静脉高压症的评估及处理

    柏立山; 柴新群; 胡志坚; 冯贤松


    Objective To probe the assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension. Methods The clinical data of 18 patients of bile duct re operation accompanied with hepatocirrhosis and portal hypertension from January 2005 to December 2008 were retro spectively analyzed. Results Of the 18 patients. 4 were grouped to Child A according to Child-Pugh classificalion. 10 were child B, another 4 were Child C. As to the causes of hepatoeirrhosis: 14 patients (77.8%)resulted from biliary cirrhosis. 2 posthepatitic cirrhosis. 2 schistosomiasis cirrhosis. Sixteen patients received simply hiliary tract re-operation. 2 received biliary tract re-operation with devascularization; the bleeding amount during operation was up to 800~1 600 mL. Three of whom had post operative complications: 1 with biliary fistula, I with intestinal fistula and 1 with upper gastrointestinal bleeding. The other patient died of multi-organ dysfunction in preoperative period. Conclusion To the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension, surgical operation will get good results if the assessment of relevant pre-operative issues are enhanced and the appropriate treatments are executed. Child-Pugh classification is not appropriate to assess the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension.%目的 探讨胆道多次手术同时合并肝硬化门静脉高压症的评估及处理.方法 回顾性分析2005年1月至2008年12月我院收治的18例胆道多次手术同时合并肝硬化门静脉高压症患者的临床资料.结果 18例胆道多次手术同时合并肝硬化门静脉高压症患者中,按照Child-Pugh分级,A级4例,B级10例,C级4例.肝硬化原因:胆汁性肝硬化14例(77.8%),肝炎后肝硬化2例,血吸虫性肝硬化2例.单独行胆道多次手术16例,联合行胆道多次手术和断流术2例;术中出血量达800

  12. Reoperation factors and treatment strategies for posterior lumbar intervertebral disc herniation%腰椎椎间盘突出症再手术因素及治疗策略

    吴伟平; 刘宝戈; 江建明


    Objective To discuss the reoperation factors, surgical treatment strategies, and the treatment outcomes of patients with posterior lumbar intervertebral disc herniation. Methods A total of 73 patients with posterior lumbar intervertebral disc herniation who underwent reoperation during January 2007 to June 2010 after primary lumbar discectomy with or without instrument fixation were retrospectively studied. Reoperation was performed by discectomy with unilateral laminactomy in 14 cases, hemilaminactomy decompression in 11 cases, discectomy with total laminactomy in 6 cases, posterior lumbar interbody fusion ( PLIF ) in 40 cases, and revision surgery with failed instrument in 2 cases. Results After a follow-up of 21 months ( ranging 6-44 months ), complications were found in 14 cases; the Oswestry disability index ( ODI )and visual analog scale ( VAS ) scores were both significantly improved after operation ( P<0.05 ). ODI was decreased from ( 63. 26 ±5. 36 )% before operation to ( 19. 68 ± 8. 42 ) % 3 months after operation. VAS score was decreased from 7. 26 ± 2.06 before operation to 3. 68 ± 1. 22 3 months after operation. Conclusion The major reoperation factors for posterior lumbar intervertebral disc surgery include intraoperative segment malpositioning, residual nucleus pulposus, sequestered intervertebral disc, adjacent segment degeneration, inadequate decompression, lumbar instability and instrumentation failure. Satisfactory effectiveness of reoperation can be obtained by proper operation time and surgery strategies.%目的 探讨腰椎椎间盘突出症再手术的因素,以及手术治疗的方法和疗效.方法 回顾分析2007年1月~2010年6月收治的腰椎椎间盘突出症再手术病例共计73例,再手术方式为单侧椎板开窗椎间盘切除术14例,半椎板切除减压椎间盘切除术11例,全椎板切除减压椎间盘切除术6例,后路腰椎椎间盘切除联合椎体间植骨融合术40例,内固定翻修2例.结果

  13. O espectro da reoperação em cirurgia de coronária The spectrum os re-operation in coronary surgery

    Jarbas J Dinkhuysen


    ção, angioplastia mal sucedida e presença de mamária prévia não causaram impacto decisivo na morbidade e na mortalidade desta série (P > 0,05.The authors present the results obtained in the first 30 day P.O. of 204 patients who underwent reoperations for coronary atherosclerosis. The interval between first and second operation varied from 1 month to 16.5 years. There was also two small groups of patients of third intervention and with associated cardiac lesions. The basic strategy consisted on anticoagulation, the aplication of the mammary arteries (one or two whenever possible, and revascularization as complete as possible. Most patients showed uneventfull evolution and a quarter of them presented some kind of non-fatal complication with good response to specific therapeutic measures. The overall mortality was about 9%. Patients with atherosclerotic lesions in native coronary circulation presented the greater morbidity, but in those with atherosclerotic lesions both in the grafts and coronary native circulation, the mortality was higher. Contrary to expectation, the younger group showed higher mortality, and the older group presented higher morbidity. The aplication of the IMA's on the reintervention does not add morbidity or mortality, but the concomitant correction of the associated cardiac pathologies represented a higher risk in the procedure. Recent myocardial infarction influenced also morbidity. The third intervention, failure transluminal angioplastic coronary dilatation and the presence of previous IMA does not exert deleterious impact on the morbidity or mortality.

  14. Study on unplanned re-operation after radical gastrectomy for gastric cancer: Seven years' experience%胃癌根治术后非计划再手术35例

    黄嫣妮; 钱雷敏; 黄建明; 戈军刚; 高林; 刘惠钧


    Objective To investigate the causes of unplanned re-operation following radical surgery for gastric cancer and to summarize clinical experience.Methods The clinical data of gastric cancer patients who underwent radical gastrectomy from Jan.2006 to Dec.2012 were retrospectively analyzed in the study,especially focusing on the preoperative,intraoperative and postoperative situations of unplanned re-operation cases at the same hospitalization.Results During seven years,radical gastrectomy for gastric cancer was implemented in 1707 cases,35 of which had unplanned re-operations.The rate of such re-operation was 2.05 %,following the mortality rate of 8.57%.Besides age,basic chronic illness and TNM stage,the primary operation way,which caused the higher incidence of unplanned re-operation,was radical total gastrectomy.Some complications after radical gastrectomy required unplanned re-operations,of which the most common was wound disruption and others,in turn,were pleural effusions/ascites,post-traumatic focal pancreatitis (PTFP),intestinal obstruction,intraperitoneal hemorrhage,while the most serious consequence was anastomotic leakage or stump fistula and partly led to death.Conclusion Unplanned re-operation after radical gastrectomy for gastric cancer can increase residential time,total treatment cost and the mortality rate.Comprehensive preoperative analysis,correct intraoperative and postoperative management,as well as timely treatment of complications are important measures to reduce the incidence of those unplanned re-operations.%目的 探讨胃癌根治术后非计划再手术的原因及总结临床治疗体会.方法 回顾性分析2006年1月—2012年12月间行胃癌根治术患者的临床资料,并重点分析同一住院期间非计划再手术病例的术前、手术及术后情况.结果 7年间共实施胃癌根治术1 707例,发生非计划再手术35例,再手术率2.05%,再手术死亡率8.57%.发生率较高者的初次手术方式为根治

  15. 机械瓣膜置换术后瓣膜故障再次手术换瓣临床分析%Clinical analysis of reoperation due to valve dysfunction after mechanical valve replacement

    黄国晖; 张健群; 孙广龙; 迟立群; 穆军升


    Objective To observe the effect of the re-operation after mechanical valve replacement and to analyze dysfunction reason,operation time and operation effect of reoperation.Methods Thirty-three cases with reoperation of valve replacement were chosen from March 2003 to May 2010,including 17 cases of mitral valve replacement,9 aortic valve replacement,2 mitral valve and aortic valve replacement,2 mitral valve replacement and 3 tricuspid valve annuloplasty and 3 tricuspid valve replacement Heart function was compared before and after operation according to the New York Heart Association (NYHA).Results Among 33 cases of reoperation,1 case (3.0%)died and heart function of 32 survival cases improved significantly.The number of preoperative heart function grade Ⅰ,Ⅱ,Ⅲ,Ⅳ was 0,13 (39.4% ),15 (45.4%)and 5 (15.2% ).After 6 months,32 patients survived;the number of preoperative heart function grade Ⅰ, Ⅱ,Ⅲ,Ⅳ was 16 (50.0%),12 (37.5%),4 (12.5% )and 0.The proportion of the patients in grade Ⅰ,Ⅲ,Ⅳ showed statistical difference (P <0.05).Conclusion Reoperation is the main therapy method of treating valve dysfunction after mechanical valve replacement;we should pay attention to operation time,operation method and selection of valve type.%目的 观察机械瓣膜置换术后瓣膜故障再次手术换瓣临床效果,分析故障原因、手术时机选择及手术效果.方法 选择2003年3月至2010年5月行再次手术换瓣患者33例,其中二尖瓣置换术17例、主动脉瓣置换术9例、二尖瓣+主动脉瓣置换术2例、二尖瓣置换+三尖瓣成形术2例、三尖瓣置换术3例.治疗前后对患者行心功能评级,参照纽约心脏病协会(NYHA)心功能标准,进行比较分析.结果 33例再次手术换瓣患者中,死亡1例(3.0%),32例存活患者心功能明显改善.33例患者术前心功能分级Ⅰ级0例,Ⅱ级13例(39.4%),Ⅲ级15例(45.4%),Ⅳ级5例(15.2%);术后6个月复查,32例患

  16. Reoperation for recurrent cardiac valve disease%复发性心脏瓣膜病再次外科治疗效果及其相关因素

    陈文生; 段维勋; 俞世强; 张金洲; 郑奇军; 王红兵; 易定华


    AIM: To retrospectively review the experience of valve replacement after closed mitral commissurotomy, valvuloplasty, perivalvular leakage, prosthetic valve obstruction and dysfunction of bioprosthetic valve in 331 patients.METHODS: Three hundred and thirty-one patients (143 males and 188 females) with ages ranging from 12 to 73 years (45.6 ± 12.2 years) with recurrent cardiac valve disease underwent valve replacement.Duration between reoperation and former surgery was 3 months to 25 years ( 17.3 ± 8.1 years).The reasons for reoperation included mitral valve restenosis after closed mitral commisurotomy (143 cases), valve restenosis and/or insufficiency after mitral or aortic valvuloplasty (53 cases), bioprosthetic valve decline (32 cases), perivaivular leakage (26 cases), other valve diseases after primary valve replacement (21 cases), infective endocarditis after valve replacement,valvuloplasty and repair of ventricular septal defect (24 cases), trieuspid insufficiency after repair of Ebstein's anomaly (15 cases), prosthetic valve obstruction (9 cases), mitral or tricuspid insufficiency after repair of congenital heart disease (6 cases), and mitral valve restenosis after percutaneous balloon mitral valvuloplasty (2 cases).Reoperations included mitral valve replacement, aortic valve replacement, aortic and mitral valve replacement, tricuspid valve replacement, repair of perivalvular leakage,and valvuloplasty.RESULTS: Four patients died during surgery and 23 patients died during the early postoperative stage.The main causes of early-stage deaths were low cardiac output syndrome, ventricular arrhythmia, multiple organ dysfunction failure, left ventricle rupture, infective endocarditis and renal failure.Three hundred and four patients recovered.Follow-up was performed in 259 patients and duration was from 6 months to 21 years (9.5 ±6.8 years).NYHA cardiac functional status Ⅰ to Ⅱ was found in 189 cases.CONCLUSION: Risk factors for reoperation for heart valve

  17. 浆细胞性乳腺炎再次手术原因分析及治疗研究%Analysis on Reason of Plasma Cell Mastitis Reoperation and Study on the Treatment



    目的:探讨浆细胞性乳腺炎需要再次手术的原因、手术时机的选择以及相应的手术方法。方法选择2010年12月至2012年12月北京市怀柔区中医医院收治的26例复发性浆细胞性乳腺炎患者作为研究对象,对其复发原因,治疗时机选择以及治疗方法进行分析。结果26例患者中有14例患者(53.84%)因乳房脓肿而需多次切开引流手术、6例患者(23.08%)因肿块切除后再次出现或不愈合、6例患者(23.08%)术后乳晕部炎症多次发作且面积相对较大而需再次实施手术治疗。对于处于炎症期的患者予以消炎治疗,对于乳房脓肿患者行脓肿切开引流,缩小炎症范围后再予手术治疗。手术治疗时需切除包括溃疡周围1 cm正常的皮肤组织以及病变乳管,术后随访9~50个月均无复发现象。结论浆细胞性乳腺炎再次复发的原因主要与临床医师对本病认识不够、处理方法不当等有关,再次手术治疗时应把握手术时机,完全切除病变组织,并对受累的乳管进行处理,以有效地降低再次手术的风险,防止再次复发。%Objective To investigate the reasons of plasma cell mastitis reoperation,operation timing selection and operation methods.Methods Total of 26 recurrent plasma cell mastitis patients in Huairou District Chinese Medicine Hospital of Beijing from Dec.2010 to Dec.2012 were selected,and the relapse rea-son,treatment timing and methods of treatment were analyzed.Results Among the 26 patients,14 patients (53.84%) were due to breast abscess requiring multiple incision and drainage,6 patients(23.08%) were due to lump reappearance or disunion,6 patients(23.08%) were due to multiple episodes of areola papil-laris inflammation with relatively large area involved needing surgery treatment .For the patients in inflamma-tory phase anti-inflammatory treatment was given first,galactapostema was given incision and drainage

  18. 神经外科开颅术后再次手术的临床疗效观察%Observation Clinical Curative Effect on Neurosurgery Craniotomy of Reoperation



    Objective To explore the effectiveness of implementation of neurosurgical patients after craniotomy line reoperation. Methods Selected 40 cases with implemented postoperative craniotomy surgery again from January 2015 to January 2014 in our hospital neurosurgery, the effectiveness of the treatment of patients and their medical records were reviewed relevant Results 40 cases with the line craniotomy surgery again, according to the GOS score, which GOS 1 level, GOS 2 level, GOS 3 level, GOS 4 level , GOS 5 level number respectively was ifve cases, two cases, 7 cases, 20 cases and six cases Conclusion Neurosurgical diseases were higher probability of reoperation, and therefore must be under the premise of an accurate analysis of the cause of surgery, accurately grasp the timing of treatment, in order to upgrade and improve the survival and quality of life of patients.%目的:探讨神经外科患者实施开颅术后行再次手术治疗的成效。方法选取2014年1月~2015年1月于我院神经外科实施开颅术后行再次手术治疗的患者40例作为研究对象,对治疗成效及其相关病历资料进行回顾分析。结果40例开颅患者在行再次手术后,其中GOS 1级、GOS 2级、GOS 3级、GOS 4级、GOS 5级人数分别为5例、2例、7例、20例和6例。结论神经外科疾病行再次手术的几率较高,因此必须在准确分析手术病因的前提下,准确把握治疗时机,提升和改善患者的生存率和生活质量。

  19. Avaliação dos resultados das reoperações de pacientes com lesões do manguito rotador Evaluation of the results from reoperations on patients with rotator cuff lesions

    Alberto Naoki Miyazaki


    Full Text Available OBJETIVOS: Avaliar o resultado do tratamento cirúrgico, por via aberta ou artroscópica, dos pacientes com recidiva sintomática da lesão do manguito rotador. MÉTODOS: Foram avaliados 30 pacientes entre dezembro de 1990 e julho de 2007 submetidos a um novo procedimento cirúrgico pelo Grupo de Cirurgia de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Santa Casa de São Paulo - Pavilhão Fernandinho Simonsen devido à deiscência da sutura do manguito rotador. Foram incluídos pacientes com recidivas sintomáticas da lesão e com tempo de seguimento mínimo pós-operatório de 24 meses. RESULTADOS: Pelos critérios de avaliação da UCLA, 21 (70% pacientes tiveram resultados excelentes e bons; nove (30% pacientes tiveram resultados regulares e ruins. CONCLUSÃO: O tratamento cirúrgico, por via aberta e artroscópica, das recidivas da lesão do manguito rotador tende a apresentar resultados piores que o reparo primário. Neste estudo, obtivemos 70% de resultados excelentes e bons. A presença de lesões extensas na segunda operação tende a evoluir com um maior número de resultados insatisfatórios. No nosso estudo, obtivemos melhores resultados com a cirurgia realizada por via artroscópica em comparação com a via aberta.OBJECTIVES: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. METHODS: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow- up. RESULTS: According to the UCLA evaluation criteria, 21 patients (70% showed excellent or good outcomes; and nine patients (30% showed fair

  20. Re-operation of tricuspid regurgitation after mitral valve replacement with rheumatic heart disease%风湿性心脏病二尖瓣置换术后三尖瓣返流的再手术治疗

    罗又桥; 方海宁; 谭伟; 李树松; 曹辉庆; 赖纪昌


    Objective To analyze clinical manifestation and investigate therapy effect of re-operation of tricuspid regurgitation (TR) after mitral valve replacement with rheumatic heart disease.Methods Seventeen cases with rheumatic heart disease recurred TR after mitral valve replacement surgery,underwent tricuspid valve surgery again in the Third People's Hospital of Nanchang from January 2000 to December 2011.Of 17 cases,10cases underwent tricuspid valve annuloplasty including 1 case for pure De Vega plasty,9 cases for the valve leaflets forming + artificial valve ring forming.Another 7 cases underwent tricuspid valve replacement surgery including 4 cases for biological valve replacement and 3 cases for mechanical valve.Retrospective analyzed the clinical manifestations,treatment process and condition of prognosis.Results One case was with early postoperative deaths (5.88%,1717),and died of postoperative left ventricular failure.Three cases were postoperative low cardiac output syndrome,2 cases were renal insufficiency,and 2 cases were respiratory insufficiency,all those cases were successfully cured.Sixteen cases were followed up from 3 months to 9 years and 2 cases were lost.Of 14,2 cases were NYHA class Ⅰ,8 cases for grade Ⅱ,4 cases for grade Ⅲ.Conclusion After mitral valve replacement in patients with rheumatic heart disease,TR in patients with reoperation is a suitable choice.Reasonable surgical indications,timing of surgery and good perioperative management are the keys to improve the success rate of surgery.%目的 分析风湿性心脏病二尖瓣置换术后再发三尖瓣返流(TR)患者的临床特点、外科手术方法和疗效,总结围手术期处理经验.方法 2000年1月至2011年12月,17例风湿性心脏病二尖瓣置换术后再发三尖瓣返流的患者在我院接受单纯再次三尖瓣手术,行三尖瓣成形术10例,包括单纯DeVega成形术1例、瓣叶成形+人工瓣环成形9例;行三尖瓣置换术7例,其中置换生物瓣4

  1. Aortic rupture during reoperative bariatric surgery

    Sorin Hostiuc


    Full Text Available Abstract Morbid obesity has become a very common problem worldwide, causing severe health-related consequences including cardiovascular or metabolic diseases, arthritis, sleep apnea, or an increased risk of cancer. Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities. The purpose of this article is to present a case of bariatric surgery complicated with lesion of the aorta with a lethal outcome.

  2. Reoperation on aortic disease in patients with previous aortic valve surgery%主动脉瓣置换术后患者再次主动脉外科干预47例

    张良; 常谦; 孙晓刚; 于存涛; 钱向阳


    Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50%,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P < 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83

  3. Análise de 1071 reoperações para revascularização do miocárdio: resultados obtidos e conduta sugerida com base nessa experiência Evaluation of 1071 reoperations for myocardial revascularization

    Luís Alberto Dallan


    encontravam-se em CF I ou II, dos quais 7 (2,2% faleceram; 449 em CF III, com 34 (7,6% óbitos e 305 em CF IV, com 46 (15,1% óbitos; 3 comprometimento triarterial associado ou não a lesão de tronco: 788 apresentavam tal tipo de comprometimento arterial, dos quais 74 (9,4% faleceram. Dentre 283 com lesão uni ou biarterial, 13 (4,6% foram a óbito; 4 caráter de emergência da cirurgia: dentre 110 operações de emergência, foram observados 35 (31,8% óbitos. Dentre 961 cirurgias eletivas, houve 52 (5,4% óbitos. Nos últimos dois anos, entretanto, foram realizadas 379 re-revascularizações do miocárdio, tendo sido observados apenas 13 (3,4% óbitos. Esse decréscimo de mortalidade em relação aos anos anteriores foi atribuído, entre outros fatores, aos métodos de proteção miocárdica empregados, especialmente nos doentes com pior função ventricular. Nesses dois anos foi também dado especial destaque ao emprego de enxertos arteriais na re-revascularizaçáo do miocárdio. A média da utilização de ao menos um enxerto arterial na reoperação coronária elevou para 82,2% (259/315. Acreditamos que, através da abordagem cirúrgica adequada, da utilização crescente de enxertos arteriais e, especialmente, pela indicação cirúrgica precoce, permitindo a re-revascularização de forma eletiva e, ainda, com boa viabilidade miocárdica, os resultados futuros serão mais promissores.Between January 1979 and January 1992, 1071 coronary bypass graft reoperations were performed at the Heart Institute and Beneficencia Portuguesa Hospital. Of these, 1015 were reoperated upon once, 53 twice and 3 three times. The surgeries were due to spread of coronary atherosclerosis in 117 patients (10.9%, partial or total graft occlusion in 183 (17.1%, combination of the prior factors in 728 (67.9%, technical problems in 21 (1.9%, and others in 22 (2.1%. The patients ages varied from 34 to 84 years (mean 61.6, predominantly male (86.1% and Caucasian (96.5%. The period between the

  4. 达芬奇机器人手术系统再手术入路的选择%Selection of surgical approach for patients with reoperation using Da Vinci surgical system

    陈军周; 周宁新; 刘全达; 张效东; 刘军桂; 陈蒈; 张涛


    Objective To summarize the clinical experience of operations with Da Vinci surgical system in 27 patients with previous abdominal surgery.Methods The clinical data of 27 patients with previous abdominal surgery who had received reoperation using Da Vinci surgical system at General Hospital of Second Artillery of PLA from January to December 2009 were retrospectively analysed.The distribution of trocars was designed according to the surgical sites and previous surgical incision sites.The operation was divided into 2 steps:firstly,intraabdominal adhesion was dissected and the robotic arms were set up;secondly,the lesions were resected.Experience in trocars placement,surgical approach and management of complications were summarized.Results Six approaches were designed according to previous incision sites.Of all patients,22 were with severe intraabdominal and hepatic hilar band adhesion,and 5 with strip adhesion.One patient who underwent intraabdominal radiotherapy and chemotherapy abandoned robotic surgery because of the failure in trocar placement and pneumoperitoneum establishment.Twenty-six patients had successfully undergone robotic surgery and the success rate was 96%(26/27).Of the 26 patients,1 was complicated with enterorrhexis intraoperatively and received repairment.No postoperative complication was observed.Conclusions Previous abdominal surgery has little influence on robotic surgery with Da Vinci system. Pneumoperitoneum establishment,insertion point of the first trocar and dissection of the intraabdominal adhesions are key points for success of operation.%目的 总结达芬奇机器人手术系统在27例有腹部手术史患者中应用的临床经验.方法 回顾性分析2009年1月至12月解放军第二炮兵总医院应用达芬奇机器人手术系统对27例有腹部手术史患者进行手术的临床资料.根据手术部位以及原手术切口的位置设计Trocar排布,整个手术过程分为两步,第1步游离腹

  5. Acesso transeptal vertical ampliado em reoperações valvares mitrais com átrio esquerdo pequeno Extended vertical transseptal approach in mitral valve reoperation with a small left atrium

    Walter Vosgrau Fagundes


    Full Text Available OBJETIVO: Avaliar a abordagem transeptal vertical ampliada em reoperações da valva mitral com átrio esquerdo pequeno. MÉTODO: De janeiro de 2001 a dezembro de 2002, 15 pacientes portadores de doença valvar mitral com indicação de reintervenção cirúrgica, átrio esquerdo pequeno (menor ou igual a 4,0 cm e fibrilação atrial crônica, foram submetidos à abordagem transeptal vertical ampliada da valva mitral. Nove pacientes (pt eram do sexo feminino. A idade variou de 22 a 48 anos. As indicações cirúrgicas foram: disfunção de prótese mitral (seis pt; insuficiência mitral (cinco pt e dupla lesão mitral (quatro pt. Três pacientes apresentavam insuficiência aórtica associada e um pt, insuficiência tricúspide. Nove (60% pacientes encontravam-se em ICC CF III da NYHA e seis (40%, em CF IV. RESULTADOS: A exposição do aparelho valvar mitral foi excelente. O tempo de circulação extracorpórea variou de 65 a 150 min (média = 95min. Foram implantadas próteses em todos os pacientes (15 mitrais, três aórticas e um tricúspide. A mortalidade hospitalar foi de 6,7%, com um óbito devido a baixo débito cardíaco e falência de múltiplos órgãos. Um (6,7% paciente apresentou broncopneumonia na fase hospitalar. Dez pacientes permaneceram com fibrilação atrial, três pt reverteram para ritmo sinusal e um evoluiu com ritmo juncional. A permanência hospitalar média foi de 8,2 dias. Doze (85,7% pacientes encontram-se em CF I e dois (14,3% em CF II. A curva atuarial de sobrevida é de 92,5 % em 22 meses de seguimento. CONCLUSÃO: A técnica cirúrgica empregada proporciona excelente visibilização do aparelho valvar mitral, com baixo índice de complicações.OBJECTIVE: To evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. METHOD: From January 2001 to December 2002, 15 patients with previous mitral operations, small left atrium and atrial fibrillation

  6. Aspectos práticos na indicação de revisão de hemostasia no pós-operatório imediato de cirurgia cardíaca Practical aspects in the recommendation for reoperation in immediate postoperative phase of cardiac surgery

    Luís Alberto Dallan


    Full Text Available Foram estudados restrospectivamente os coagulogramas de 65 pacientes submetidos a revisão de hemostasia no pós-operatório imediato de cirurgia cardíaca. Os coagulogramas foram considerados compatíveis ou não com distúrbio da coagulação sangüínea, por hematologista que desconhecia o achado cirúrgico. Dentre 51 pacientes cujos valores do coagulograma foram considerados normais, 46 (90,2% apresentavam sangramento ativo localizado, passível de correção cirúrgica. Os 5 (9,8% demais pacientes apresentavam sangramento difuso. Dentre os 14 pacientes restantes, cujo coagulograma encontrava-se alterado, 8 (57,2% apresentavam sangramento difuso e 6 (42,8%, localizado. Os autores concluem que, na persistência de sangramento excessivo pós-operatório e coagulograma normal, a revisão de hemostasia deverá ser prontamente indicada. Entretanto, se houver alteração do coagulograma, dever-se-à empregar, inicialmente, o tratamento clínico, desde que o ritmo do sangramento o permita. Caso o sangramento persista, mesmo com melhora do coagulograma, deverá ser pesquisada a presença de coágulos retidos no mediastino. Se positiva, deve-se programar nova toracotomia, visando à remoção de coágulos do mediastino.Blood coagulation of 65 patients that needed reoperation to control excessive bleeding after cardiopulmonary bypass surgery was evaluated by hematologist that didn't know the reoperation findings. Forty-six (90.2% of 51 patients with normal tests before the reintervention had localizated bleeding, and five (9.8% had difuse hemorrhage. From 14 patients with abnormal coagulation tests, eight (57.2% had difuse bleeding and six (42.8% had a localizated bleeding. The authors concluded that with normal coagulation tests and excessive bleeding after cardiopulmonary bypass surgery a new reoperation is indicated. Otherwise, patients with abnormal coagulation tests can receive initial clinical treatment.

  7. Clinical characteristics and reoperation of symptomatic adjacent segment degeneration post-operation of lumbar fusion%腰椎融合术后症状性邻近节段退变的临床特点和再手术治疗

    孙浩林; 李淳德; 刘宪义; 邑晓东; 刘洪; 卢海霖; 李宏; 于峥嵘; 赵硕


    Objective:To evaluate the clinical characteristics and reoperation of symptomatic adjacent segment degeneration post-operation of lumbar fusion. Methods;In the study, 28 cases of symptomatic adjacent segment degeneration post-operation of lumbar fusion from May 2007 to April 2012 were retrospectively reviewed,with an average age of (64. 3±8. 7) years. The mean period between reoperation and primary fusion surgery was (47. 5 ±30. 8) months. Symptomatic adjacent segment degeneration located in cephalic segments in 12 cases, in caudal segments in 14 cases and in both segments in 2 cases. Of all the 28 patients, 12 suffered from lumbar stenosis, other 13 from lumbar disc herniation and still other 3 from both lumbar stenosis and disc herniation, of whom 11 were together with segment instability. Localization diagnoses of 19 cases were clear and other 9 received diagnostic nerve root block. The cases were divided into two groups by the type of reoperation, of which 8 cases were in adjacent degenerative segment nonfusion group and the other 20 cases in adjacent degenerative segment fusion group. The clinical results were assessed by lumbar pain visual analog score (VAS) and lower limber pain VAS, lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score before operation and in the final follow-up. Results; In adjacent degenerative segment nonfusion group, the average operation time was (86. 3±17. 1) min and average blood volume was (125. 0±37. 8 ) mL of reoperation and 1 case with dural injury; and in adjacent degenerative segment fusion group, the average operation time was (201.6± 71. 0) min and average blood volume was (313. 6±18. 9) mL of revision surgery and 4 cases with dural injury. The average follow-up period was 25. 5 months. In the final follow-up,lumbar pain VAS,lower limber pain VAS, lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 2.4± 1. 2, 2. 8±1.4,23. 5±4. 2 and 8. 2±1

  8. 结直肠癌术后复发模式的临床研究及再手术治疗的预后分析%Clinical study and prognosis analysis of reoperation treatment and recurrence model for postoperative recurrent colorectal carcinoma

    陈宁波; 曾杰


    ObjectiveTo summarize the clinical character and the reason of postoperative recurrent colorectal carcinoma, investigate the methods, prognosis of reoperation for postoperative recurrent colorectal carcinoma.Methods 96 cases of postoperative recurrent colorectal carcinoma who were cured at the surgical department in the emergency center of Sichuan Province hospital from 2000 to 2012 were analyzed retrospectively. Patients were divided into two groups according to liver metastasis or not. To analyze the clinical character of postoperative recurrent colorectal carcinoma, investigate the methods and prognosis of reoperation respectively.ResultsNeoadjuvant chemotherapy was arranged in 13 cases, adjuvant chemotherapy was accepted for 41 cases. 45 cases were recurrent rectum carcinoma after operation and 51 cases were recurrent colon carcinoma after operation. 76 cases were liver metastasis after operation (29 cases were recurrent rectum carcinoma and 47 cases were recurrent colon carcinoma), 20 cases were non-liver metastasis after operation (16 cases were recurrent rectum carcinoma and 4 cases were recurrent colon carcinoma). 44 cases were simple isolated liver metastasis in the first group, 40 cases were treated with radical operation (22 cases were recurrent rectum carcinoma and 18 cases were recurrent colon carcinoma), 32 cases were multiple liver metastasis, 26 cases were treated with palliative surgery (3 cases were recurrent rectum carcinoma and 23 cases were recurrent colon carcinoma), 6 cases were abandon reoperation because of metastasis generally (3 cases were recurrent rectum carcinoma and 3 cases were recurrent colon carcinoma). 18 cases were treated with radical operation in the non-liver metastasis group (15 cases were recurrent rectum carcinoma and 3 cases were recurrent colon carcinoma). 64 cases were treated with radical operation in two groups, the rate of radical operation was 60.4%; 26 cases were treated with palliative surgery, the rate was 27

  9. [Reoperations in surgical oncology: recurrence of colon carcinoma after surgery].

    Grassi, G B; Drago, S; Mancini, S; Remedi, M; Manfroni, S; Ferrante, D; Antonellis, D


    Colon cancer is the second leading cause of death for cancer disease, after lung cancer, with nearly 18,000 deaths per year in Italy. In spite of the progress that have taken place over the past 30 years, little improvement has been gained in this dismal outcome, and the 5-year survival remains around 50%. Over one half of the patients will suffer from recurrence after a potentially curative resection. A major challenge lies in better detection of recurrences in order to diagnose those patients still amenable to curative resection. Locoregional recurrence is of particular interest and its frequency, diagnostic limitations and surgical treatment are herein discussed.

  10. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

    Nicole Pech


    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  11. Scoliosis surgery in the elderly: Complications, readmissions, reoperations and mortality.

    Drazin, Doniel; Al-Khouja, Lutfi; Lagman, Carlito; Ugiliweneza, Beatrice; Shweikeh, Faris; Johnson, J Patrick; Kim, Terrence T; Boakye, Maxwell


    The operative management of scoliosis in the elderly remains controversial. The authors of this study sought to evaluate outcomes in elderly patients with scoliosis undergoing deformity correction. Patient data was obtained from a 5% sample of the Medicare Provided Analysis and Review database (MEDPAR). Patients over 65years of age with scoliosis undergoing corrective surgery were identified between the years 2005 to 2011. A total of 453 patients were analyzed: 262 (57%) between ages 66 to 74years, and 191 (42%) over the age of 75years. Female predominance (78%) was observed in this sample. Pre-diagnosis follow-up averaged 118months. Post-surgery follow-up averaged 33months. Patients between 66 and 74years old were mostly discharged home, while patients over the age of 75years were discharged to skilled nursing facilities (SNFs) (38.55% versus 34.04%, p value=0.0011). Readmission rates were lower in patients between 66 and 74years old when compared to patients over the age of 75years (9.92% versus 17.28%, p value=0.0217). Complication rates 30-days after discharge were less in patients between 66 and 74years, compared to those over 75years (21% versus 26.6%, respectively), but this was not statistically significant. These findings suggest varying outcomes following scoliosis surgery in the elderly, but interpretation of these results is weakened by the inherent limitations of database utilization. Future prospective studies are needed to understand risk factors and other confounding variables, such as discharge disposition, that may influence outcomes.

  12. [Deep neck abscess. Factors related to reoperation and mortality].

    Obregón-Guerrero, Gabriela; Martínez-Ordaz, José Luis; Moreno-Aguilera, Eduardo; Ramírez-Martinez, Martha; Peña-García, Juan Francisco; Pérez-Álvarez, Claudia


    Antecedentes: los abscesos profundos de cuello son complicaciones de infecciones, principalmente de origen odontogénico y de vías aéreas superiores, que afectan con mayor frecuencia a pacientes con morbilidades que favorecen la diseminación de la infección. Muchos requieren tratamiento quirúrgico, evaluación y drenaje apropiado para obtener los mejores resultados. Objetivo: identificar los factores relacionados con la reoperación y la mortalidad en pacientes con drenaje quirúrgico por absceso profundo de cuello. Material y métodos: estudio longitudinal, retrospectivo, observacional y comparativo efectuado con base en la revisión de todos los pacientes con absceso profundo de cuello que se operaron en un servicio de cabeza y cuello de un hospital de tercer nivel. Resultados: se estudiaron 87 pacientes, 44 de ellos eran mujeres. La mediana de edad fue de 49 años. El 40% tenían comorbilidades (35 pacientes) y la diabetes melltitus fue la más frecuente en 30 pacientes (34%). Se reoperaron 21 pacientes (24%), la mayoría por drenaje incompleto. Los factores de riesgo identificados fueron: comorbilidades (principalmente diabetes mellitus) (pabscesos profundos de cuello la evaluación preoperatoria y el drenaje quirúrgico completo de todos los espacios afectados son primordiales para evitar la reoperación y mejorar la supervivencia.

  13. Clinical study on the causes of recurrence of inguinal hernia after tension-free hernioplasty and methods of reoperation: a report of 108 cases%腹股沟疝无张力修补术后复发原因及再手术方法探讨(附108例报告)

    郑启昌; 翟东升


    Objective To investigate the causes of recurrence of inguinal hernia after tension-free hernioplasty and study the reoperative methods.Mothods The 108 cases between 2003 and 2008 of recurrent inguinal hernia after tension-free hemioplasty were studied and analyzed retrospectively.Results 73 cases recurred in primary operative position,including 34 cases of justominor mesh,19 cases of displaced patch or mesh,14 cases of deformation or curling mesh and 6 cases Patch or mesh at the wrong position.35 cases (miss hernia)recurred outside primary operative position,including 16 cases of missing direct hernia, 11 cases of femoral hernia, 8 cases of indirect hernia. Kugel and Prolene-polypropylene hernia system(PHS)was conducted for 108 cases. No postoperative recurrence was found after 1 month to 5 years followed-up.Conclusions Many factors can cause inguinal hernia to recur after tension-free hernioplasty,such as miss hernia, displaced patch or mesh, inappropriate choice of size of mesh and operation method et al. Stoppa operation is an effective way for the treatment of recurrence of inguinal hernia after tension -free hernioplasty.%目的 讨论无张力疝修补术后腹股沟疝复发原因及再次手术方法.方法 对2003年4月至2008年3月间收治的108例无张力疝修补术后腹股沟复发疝患者的资料进行回顾性分析.结果 原修补部位复发73例,其中平片过小34例,网塞或补片移位19例,平片变形、卷曲14例,补片位置放置错误6例.在修补部位以外(术中遗漏疝 miss hernia)复发35例,其中遗漏直疝16例,股疝11例,斜疝8例.再次手术均应用腹膜前间隙修补,采用PHS及Kugel补片,术后随访1个月~5年均未复发.结论 无张力修补术后腹股沟疝复发与患者术中遗留疝、补片移位、补片大小及手术方式选择不当等因素相关;选择腹膜前间隙修补是治疗无张力疝修补术后腹股沟疝复发的有效方式.

  14. Efficacy of Seprafilm for reducing reoperative risk in pediatric surgical patients undergoing abdominal surgery.

    Inoue, Mikihiro; Uchida, Keiichi; Miki, Chikao; Kusunoki, Masato


    The safety and efficacy of Seprafilm (Genzyme Corporation, Cambridge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in pediatric surgical patients. One hundred twenty-two pediatric abdominal surgery patients were enrolled. Sixty-seven patients received Seprafilm application. Of these patients, 18 again received Seprafilm at abdominal closure during a second surgery, and of the 18, 4 received Seprafilm at closure after a third surgery. Of the 55 control patients who did not receive Seprafilm, 14 had a second surgery, and of these 14 patients, 4 had a third surgery. Adverse events, operation time, and blood loss were compared with assessed Seprafilm safety. Seprafilm efficacy evaluations included incidence and severity of adhesions in those patients who required relaparotomy. The incidence (Seprafilm, 40.9%; control, 82.4%) and severity (Seprafilm: 59.1%, grade 0; control: 17.6%, grade 0) of adhesions under the abdominal incision site were significantly reduced in the Seprafilm group (P = .007 and P = .0009, respectively). In addition, mean relaparotomy operation time was significantly shorter for Seprafilm patients (P = .004). At relaparotomy, blood loss/body weight ratio for Seprafilm patients compared with control patients showed a trend toward but did not reach significance (P = .09). Decreased incidence and severity of postsurgical adhesions with Seprafilm in pediatric patients may lead to reduction of the risks associated with subsequent operation.

  15. Mesenteric autotransplantation: an alternative technique for reoperation and bypass of the superior mesenteric artery.

    Carson, John G; Loor, Gabriel; Millis, Micheal J; Testa, Giuliano; Piano, Giancarlo


    Superior mesenteric artery (SMA) aneurysms represent a minority of visceral aneurysms but may result in lethal complications if left untreated. Options for treatment include aneurysmorraphy, bypass, ligation, or embolization. Here we present a case of a man with a history of celiac graft thrombosis who presents with a recurrent symptomatic SMA aneurysm. Given his compromised celiac axis, ligation was not an option. His SMA aneurysm was repaired with a PTFE patch. However, to secure longstanding blood flow to the small bowel in the event of graft thrombosis, the distal SMA pedicle was dissected free of the ileocolic vessels and anastomosed to the aorta. Follow-up studies demonstrated an occluded PTFE patch with a patent SMA autotransplant. This case depicts a novel approach to the surgical management of complex recurrent SMA aneurysms.

  16. High Re-Operation Rates Using Conserve Metal-On-Metal Total Hip Articulations

    Mogensen, S L; Jakobsen, Thomas; Christoffersen, Hardy;


    INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two...

  17. Fewer Cancer Reoperations for Medullary Thyroid Cancer After Initial Surgery According to ATA Guidelines

    Verbeek, Hans H. G.; Meijer, Johannes A. A.; Zandee, Wouter T.; Kramp, Kelvin H.; Sluiter, Willem; Smit, Johannes W.; Kievit, Job; Links, Thera P.; Plukker, John Th M.


    Surgery is still the only curative treatment for medullary thyroid cancer (MTC). We evaluated clinical outcome in patients with locoregional MTC with regard to adequacy of treatment following ATA guidelines and number of sessions to first intended curative surgery in different hospitals. We reviewed

  18. [Reoperations of rectal resection for recurrence after previous resection for rectosigmoid cancer].

    Paineau, J; Letessier, E; Hamy, A; Hamelin, E; Courant, O; Visset, J


    From June 1986 to December 1992, 16 patients (12 men and 4 women, 63 years-old [36 to 79]) who underwent a prior sphincter-saving resection for colorectal adenocarcinoma were operated on for locoregional recurrence with a surgical resection. Eight patients had a second anterior resection (5 colorectal, 2 coloanal and 1 ileoanal anastomosis), one a resection without anastomosis, and 7 an abdomino-perineal resection. Nine patients received an intraoperative irradiation (10 to 25 Gy). Excisions of surrounding organs were often necessary. Post-operative complications occurred in most of the patients. Excluding 3 post-operative deaths, 9 patients died of disease in a median of 12.9 months after surgery (range: 3 to 32 months). Four patients are still living 5 to 14 months after the second resection. There is little in the surgical literature dealing with these difficult surgical problem of which results are always uncertain. An earlier diagnosis of the recurrence would result in a more satisfactory procedure, but is difficult because of the limited possibilities of detection after surgical treatment and often external irradiation.

  19. Human tissue valves in aortic position: determinants of reoperation and valve regurgitation

    T.P. Willems (Tineke); E.W. Steyerberg (Ewout); V.E. Kleyburg-Linkers; E. Bos (Egbert); L.A. van Herwerden (Lex); J.R.T.C. Roelandt (Jos); J.J.M. Takkenberg (Hanneke)


    textabstractBACKGROUND: Human tissue valves for aortic valve replacement have a limited durability that is influenced by interrelated determinants. Hierarchical linear modeling was used to analyze the relation between these determinants of durability and valve

  20. Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer

    Hemmat Maghsoudi


    Full Text Available Background/Aim: Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Patients and Methods: Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Results: Seventeen (4% patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Conclusions: Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.

  1. Spontaneous reossification of the sella in transsphenoidal reoperation associated with strontium ranelate

    Maria Mercedes Pineyro


    Full Text Available Spontaneous reossification of the sellar floor after transsphenoidal surgery has been rarely reported. Strontium ranelate, a divalent strontium salt, has been shown to increase bone formation, increasing osteoblast activity. We describe an unusual case of a young patient with Cushing’s disease who was treated with strontium ranelate for low bone mass who experienced spontaneous sellar reossification after transsphenoidal surgery. A 21-year-old male presented with Cushing’s features. His past medical history included delayed puberty diagnosed at 16 years, treated with testosterone for 3 years without further work-up. He was diagnosed with Cushing’s disease initially treated with transsphenoidal surgery, which was not curative. The patient did not come to follow-up visits for more than 1 year. He was prescribed strontium ranelate 2 g orally once daily for low bone mass by an outside endocrinologist, which he received for more than 1 year. Two years after first surgery he was reevaluated and persisted with active Cushing’s disease. Magnetic resonance image revealed a left 4 mm hypointense mass, with sphenoid sinus occupation by a hyperintense material. At repeated transsphenoidal surgery, sellar bone had a very hard consistency; surgery was complicated and the patient died. Sellar reossification negatively impacted surgery outcomes in this patient. While this entity is possible after transsphenoidal surgery, it remains unclear whether strontium ranelate could have affected sellar ossification.

  2. Assessing an avoidable and dispensable reoperative entity: Self-referred flawed cleft lip and palate repair.

    Foroglou, Pericles; Tsimponis, Antonis; Goula, Olga-Christina; Demiri, Efterpi


    Cleft lip and palate (CLP) is comprised within the wide range of congenital deformities of the maxillofacial region with an overall incidence on the increase from 1:1000 to 1:700 live births thus being the most common congenital birth error. Failure of the lateral and medial nasal processes to fuse with the anterior extension of maxillary processes and of the palatal shelves between the 4th and 8th gestational week results in cleft lip and palate. Clefts include different types with variable severity, confirming the complexity and unpredictable expression of cleft modality and have a multifactorial aetiology. Functional impairment, aesthetic disturbances and psychosocial effects are common sequalae in patients with cleft lip and palate. The main long-term morbidity of this condition may include dysfunctional speech, impaired hearing and communication, as well as dental problems. These complications are followed by unfavourable surgical outcome and aesthetic appearance, which all seem to affect this group of patients significantly and have an impact significantly both quality of life and healthcare. Treatment requirements of cleft patients are multifactorial and a multi-disciplinary approach and intervention at multiple levels is necessary. Yet, in this country, resources available to parents and consistent publicity given to this issue and its treatment are still inadequate in spite of the introduction of "Centres of Excellence" and Unified Hospitalization Coding or DRG equivalents to optimize health management. The multi-disciplinary approach to cleft management has been a reality for over a century while cleft treatment protocols are still being evaluated in order to optimise standards of cleft care. According to relevant guidelines primary surgical management of lip and palate defects is performed during the first 3 to 9 months of life. Secondary operations in the form of revisional lip and nose procedures are performed at later stages aiming with an aesthetically improved outcome. Indications for surgery include widened scars, lip contour deformities, shortened lips, poorly defined and flattened nasal tip, short columella and irregularities of the nostrils (narrow or high-riding) and cartilages. Wound dehiscence, contractures, vermilion notching, white roll malalignment and orovestibular fistulas are possible unfavourable results after cleft lip repair. The psychological status of children and adults with repaired cleft lip and palate has been the subject of extensive research especially regarding the way of their evaluation facial appearance, satisfaction and need for secondary corrective surgical procedures in the hope of increasing their self-esteem and self-confidence. The aim of this study was to assess secondary CLP deformity management in an accredited present-day tertiary hospital facility with an existing infrastructure of a specialist teams however not formed in a multidisciplinary group. Equally, to answer questions of specific operation indications and choice as related to prior surgeries, hospitalization time and cost, provision of adequate preoperative information, correlation between paediatric and plastic surgeons and effect of post-plastic surgical care on patients' health and well-being. It also aims at presenting, beyond our current primary cleft lip and palate repair approach, appropriate indications and timing of secondary repair and achieved results.

  3. Disc impediment in medtronic-Hall aortic valve prosthesis followed by successful reoperation.

    Glaveckaitė, Sigita; Peldžius, Ričardas; Grebelis, Arimantas; Serpytis, Pranas; Laucevičius, Aleksandras


    This case report describes the diagnostic and treatment challenges of the combined disc impediment caused by pannus ingrowth in combination with thrombus formation in a 21-mm Medtronic-Hall aortic valve prosthesis. A combined obstruction of a Medtronic-Hall prosthesis in the aortic position is a rare, but potentially fatal clinical condition for the first time reported in Vilnius University Hospital Santariškių Klinikos. Despite the difficulties in determining a correct diagnosis, our critically ill patient was clinically stabilized by partially successful thrombolysis and then successfully treated by a surgical thrombectomy together with pannus excision during the rotation of the disc within the valve housing 3 years after the valve implantation.

  4. Fewer cancer reoperations for medullary thyroid cancer after initial surgery according to ATA guidelines

    Verbeek, H.H.; Meijer, J.A.M.; Zandee, W.T.; Kramp, K.H.; Sluiter, W.J.; Smit, J.W.A.; Kievit, J.; Links, T.P.; Plukker, J.T.


    BACKGROUND: Surgery is still the only curative treatment for medullary thyroid cancer (MTC). We evaluated clinical outcome in patients with locoregional MTC with regard to adequacy of treatment following ATA guidelines and number of sessions to first intended curative surgery in different hospitals.

  5. Room for improvement in reoperation for varicosities of the small saphenous vein

    Flamand, Mette Kehlet; Bækgaard, Niels


    This study was conducted to evaluate the qualitative and quantitative effects of surgery for recurrent varicosities of the small saphenous vein (SSV). To our knowledge, English-language original articles on this subject have not previously been published....

  6. Re-admissions, re-operations and length of stay in hospital after aseptic revision knee replacement in Denmark

    Lindberg-Larsen, M; Jørgensen, C C; Bæk Hansen, T;


    We present detailed information about early morbidity after aseptic revision knee replacement from a nationwide study. All aseptic revision knee replacements undertaken between 1st October 2009 and 30th September 2011 were analysed using the Danish National Patient Registry with additional inform...

  7. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture

    Viberg, Bjarke; Overgaard, Søren; Lauritsen, Jens;


    treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up. Methods 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1...... an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex. Results Cemented HA had...

  8. Reoperation risk following the first operation for internal herniation in patients with laparoscopic Roux-en-Y gastric bypass

    Danshøj Kristensen, S; Jess, P; Floyd, A K


    BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most commonly used surgical procedure in the treatment of morbid obesity in Denmark. Internal herniation (IH) and intermittent internal herniation (IIH) are probably the most common late complications in patients with LRYGB. The aim...

  9. Thrombogenicity and Reoperation of the St. Jude Medical Silzone (R) valve : A comparison with the conventional St. Jude medical valve

    Stalenhoef, JE; Mellema, EC; Veeger, NJGM; Ebels, T


    Background and aim of the study: The St. Jude Medical Silzone(R) valve was withdrawn from the market after an interim analysis of the AVERT study revealed a 2.76% incidence of paravalvar leakage leading to valve re-replacement, compared with only 1.02% in the control group. Additionally, an increase

  10. Improved three-tubing approach for the reoperation of perforation suturing anastomotic fistula after radical radiotherapy of upper thoracic esophgeal squamous cell carcinoma.

    Ke, Honggang; Zhao, Hui; Qiu, Xiaojun; Dong, Hanxuan; You, Qingsheng


    As we all know that traditional three tubes treatment for the anastomotic fistula after esophagectomy is easy and efficient, but there are still so many problems such as pain, intubation discomfort, psychological pressure and prognosis slowly. Our report would introduce a new method to cure the anastomotic fistula for the patient after radical radiotherapy. CT and DSA-guided percutaneous cervical gastric wall puncture were performed for the patient while the Flocare tube was introduced entering the mediastinum via the anastomotic fistula under the guidance of contrast medium followed by the procedure of persistent vacuum-suction for 24 hours. Meanwhile, the patient underwent the treatments such as fasting, gastrointestinal decompression, anti-inflammation and nutritional support. Four months later, the patient was discharged after the healing of gastroesophageal anastomotic fistula, significant shrink of tracheo-mediastinal fistula and no discomfort when taking semi-liquid diet. With the benefits of long-term tube retention, improved three-tubing will lead to positive and effective treatment, especially for the patient who has the healing capacity of the tissue decreases due to radical radiotherapy.

  11. Psychological Nursing of Patients with Orthopedics Non-planed Reoperation%骨科非计划再手术患者心理护理体会



    Objective On patients with orthopedics plans and the psychological condition and nursing measures.Methods On the basis of routine treatment and nursing, psychological nursing according to dif erent patients.Results Through the implementation of appropriate psychological intervention on the patients, patients in psychological security and trust, from two aspects of body and mind to accept and comply with the operation.Conclusion Proper psychological nursing, patients can reduce the operation of the fear and anxiety, and increase confidence in surgical treatment of patients, rehabilitation of the patients with good ef ect.%目的探讨骨科非计划再手术患者的心理状况及护理措施。方法在常规治疗、护理的基础上,针对不同患者实施心理护理。结果通过对患者实施相应的心理干预后,患者在心理上获得安全感和信任感,从身心两方面接受并配合手术。结论恰当的心理护理,可以减轻患者对手术的恐惧和忧虑,增加患者对手术治疗的信心,对患者的康复起到了良好的效果。

  12. Postoperative Use of Anti-TNF-α Agents in Patients with Crohn's Disease and Risk of Reoperation-A Nationwide Cohort Study

    Kjeldsen, Jens; Nielsen, Jan; Larsen, Michael Due


    BACKGROUND: Approximately 80% of patients with Crohn's disease will require surgery. Surgery for Crohn's disease is not curative, and recurrence is typical. In this cohort study, based on nationwide Danish registries, we examined the association between postoperative treatment with anti...... postoperative exposure to anti-TNF-α agents as at least 1 treatment within 6 months after the first operation and the reference cohorts were those not treated. Patients were followed from 6 months after operation and until 5 years. We used Cox proportional-hazards regression to compute adjusted hazard ratios...... is not associated with a reduction in the need for subsequent operation. Uncontrolled confounding might have influenced our results, and, furthermore, future studies are warranted to clarify whether our study population is different from populations most often associated with postoperative anti-TNF-α treatment....

  13. Reoperation experience of recurrent inguinal hernia in 58 cases%腹股沟复发疝58例再手术体会

    何仲卿; 苏松茂


    Objective To discuss the prevention and treatment of recurrent inguinal hernia. Methods The clinical data of 58 cases of recurrent inguinal hernia from February 2000 to February 2008 at Dengfeng Population and Family Planning Hospital and Dengfeng 2th Hospital in Henan were analyzed retrospectively. Results According to the eateguries of the recurrent inguinal hernia, 30 cases were re -operated with traditional hernia repair, 26 cases were offered with tension- free hernia repair,2 cases were underwent with the laparoseopic hernia repair. With the excep-tion of 2 cases, the follow - up period from 12 to 24 months and no recurrence was observed. Conclusions It is satis-factory to apply the individuation project to prevent and treat the recurrent inguinal hernia.%目的 探讨腹股沟复发疝的预防和治疗.方法 回顾性分析2000年2月至2008年2月登封市人口和计划生育医院、登封市第二人民医院收住的58例腹股沟复发疝患者的临床资料.结果 根据复发疝的类型,再手术采用传统疝修补术30例,无张力疝修补术26例,腹腔镜疝修补术2例.术后2例失防,其余病例随访时间12~24个月,未见复发.结论 个体化方案用于预防和治疗腹股沟复发病效果满意.

  14. Economic effects of a reservoir re-operation policy in the Rio Grande/Bravo for integrated human and environmental water management

    J. Pablo Ortiz-Partida


    New hydrological insights: This study determines the economic feasibility of the EF policy. Results show that a proposed Environmental Flow policy would increase irrigated agriculture profit, slightly decrease recreational activities profit, and reduce costs from flood damage and environmental restoration compared to the baseline policy. In addition to supporting ecological objectives, the proposed EF policy would increase the economic benefits of water management objectives.

  15. 颅脑损伤术后非手术区迟发血肿再手术临床分析%Clinical Analysis of Reoperation for Nonsurgical Area Delayed Hematoma from Postoperative Intracranial Hematoma

    许悦; 张瑜; 沈旭明; 舒张; 孙晓全; 徐清; 冯晓东; 陆小军


    Objective To explore the causes, mechanism, diagnosis and treatment of postoperative delayed traumatic intracranial hematoma. Methods The clinical information of 54 cases with postoperative delayed traumatic intracranial hematoma from 2005 to 2013 were retrospectively analyzed and studied. Results Of 54 cases, there were 11 cases of gradeⅠ, 10 cases of gradeⅡ, 11 cases of gradeⅢ, 13 cases of gradeⅣ, 9 cases of gradeⅤ. Conclusion Early diagnosis and treatment can improve prognosis and efficacy of the postoperative delayed traumatic intracranial hematoma. Intracranial pressure monitoring and timely review CT contribute to early detection of partially delayed traumatic intracranial hematoma for patients with risk factors.%目的:探讨颅脑损伤术后非手术区迟发性血肿的形成原因、发生机制及临床诊治。方法回顾性分析2005年1月~2013年12月54例颅脑损伤患者术后出现非手术区迟发性颅内血肿并再次手术的临床资料。结果54例患者伤后6个月时GOS评分:Ⅰ级11例,Ⅱ级10例,Ⅲ级11例,Ⅳ级13例,Ⅴ级9例。结论颅脑损伤术后发生非手术区迟发性血肿患者的预后取决于早期预防、早期发现,及早治疗。对存在高危因素者进行颅内压监测并动态复查CT,能够早期发现部分迟发性颅内血肿,改善预后。

  16. Clinical reasearch of re-operation for postoperative recurrence of chronic dacryocystitis%慢性泪囊炎术后复发再手术的临床研究

    周昆; 刘玥; 周明辉


    目的:对比改良型外径路和鼻内镜下泪囊鼻腔吻合术对慢性泪囊炎术后复发患者的疗效。方法术后复发的慢性泪囊炎18例(18眼)随机分成两组;A组行外径路泪囊鼻腔吻合术,B组行鼻内镜下泪囊鼻腔吻合术。术后随访6个月。结果 A组8眼中治愈6眼、好转1眼,无效1眼。总体有效率87.50%;B组10眼中治愈9眼、好转1眼,总体有效率100%。两组差异具有统计学意义(χ2=7.8030,P=0.0019)。结论慢性泪囊炎术后复发患者,鼻内镜下泪囊鼻腔吻合术为更适合的手术方式,术前术后需要眼科及耳鼻喉科医师的跨学科合作。%Objective To compare the effect of improved exterior route dacryocystorhinostomy and nasal endoscopic dacryocystorhinostomy for postoperatively recurrent chronic dacryocystitis .Methods Eighteen eyes of 18 cases with postoperative recurrence of chronic dacryocystitis were randomly divided into two groups.8 eyes of group A was treated with improved dacryocystorhinostomy , and 10 eyes of group B was treated with improved nasal endoscopic dacryocystorhinostomy .All patients were followed up for 6 months. Results In group A, 6 eyes were cured, 1 eyes was improved and 1 eye was noneffective; the total therapeutic effective rate was 87.5%.In group B, 9 eyes were cured, 1 eyes was improved and none was noneffective;the total treatment effective rate was 100%.The difference between two groups was statistically significant(χ2 =7.8030,P=0.0019).Conclusion Nasal endoscopic dacryocystorhinostomy is suitable for postoperative recurrence chronic dacryocystitis .Interdisciplinary cooperation between ophthalmologist and rhinologist is required .

  17. 胸内食管胃吻合口瘘再手术病人的护理%Nursing Care of Patients Undergoing Re-operation due to Intrathoracic Esophagogastroanastomosis Fistula

    陈明松; 薛培青; 冯玉玲



  18. Análise de 1071 reoperações para revascularização do miocárdio: resultados obtidos e conduta sugerida com base nessa experiência Evaluation of 1071 reoperations for myocardial revascularization

    Luís Alberto Dallan; Sérgio Almeida de Oliveira; Souza,Januário M.; Jatene,Marcelo B; Iglézias,José Carlos R; Lemos,Pedro Carlos P; Auler Júnior,José Otávio C; Geraldo Verginelli; Fúlvio Pileggi; Adib D. Jatene


    Entre janeiro de 1979 e janeiro de 1992, foram realizadas 1071 reoperações para revascularização do miocárdio, no Instituto do Coração e em um de seus Serviços afiliados (Hospital da Beneficência Portuguesa - São Paulo). Destas, 1015 consistiam na primeira reoperação, 53 na segunda e 3 na terceira. A reoperaçáo foi motivada por progressão da aterosclerose coronária em 117 (10,9%) casos, oclusão parcial ou total dos enxertos em 183 (17,1%), sua associação em 728 (67,9%), por problemas técnicos...

  19. Analysis of the curative effects of reoperation on recurrent calculus of intrahepatic duct%复发性肝内胆管结石再手术的疗效分析

    谢放; 黄强; 王世杰


    目的:探讨不同术式治疗复发性肝内胆管结石的近远期效果.方法:回顾性分析76例复发性肝内胆管结石再手术患者的既往病史及手术方式、结石再发部位、治疗效果及随访结果等临床资料.以术后情况作为近期疗效分析的依据,以随访结果作为远期疗效分析的依据.结果:患者平均住院时间为10.4 d,术后并发症发生率为14.5%.院外随访8个月~8年,平均复发率为38.2%,联合式手术较单一式手术的复发率低(P<0.05).结论:肝内胆管结石复发率高,应强调严格遵循"解除梗阻、去除病灶、通畅引流"的基本原则,重视首次手术.选择合适的手术方式是减少术后胆管结石复发、提高近远期疗效的关键.

  20. Preserved urethral plate urethroplasty for failed hypospadias repair: report of 249 cases

    ZHANG Wei-ping; TIAN Jun; LI Ming-lei; SONG Hong-cheng; BAI Ji-wu; HUANG Cheng-ru; SUN Ning


    @@ Hypospadias is one of the most common abnormalities of the external male genitalia but is very difficult to repair. Hypospadias reoperation is also a common practice for pediatric urologists, though repair of hypospadias at reoperation is much more difficult.

  1. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair

    Bisgaard, Thue; Bay-Nielsen, M.; Kehlet, H.


    OBJECTIVES: We analyze, on a nationwide basis, the risk of re-reoperation with reference to previous inguinal hernia repair technique. SUMMARY BACKGROUND DATA: Operation for a recurrent inguinal hernia is common and the risk of re-recurrence is high. There are no large-scale data evaluating...... the surgical strategy and results after recurrent inguinal hernia repairs. METHODS: Prospective recording of all primary and subsequent recurrent inguinal hernia repairs from January 1, 1998 to December 31, 2005, in the national Danish Hernia Database, using the reoperation rate as a proxy for recurrence....... The re-reoperation rate was analyzed with reference to the technique of primary and recurrent inguinal hernia repair. RESULTS: After 67,306 primary hernia repairs there were 2117 reoperations (3.1%) and 187 re-reoperations (8.8%). The cumulated re-reoperation rate after primary Lichtenstein repair (n...

  2. Surgical approach for recurrent inguinal hernias: a Nationwide Cohort Study.

    Öberg, S; Andresen, K; Rosenberg, J


    Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior-posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates between repairs performed according to the guidelines with the ones performed against it. This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein-Lichtenstein vs. Lichtenstein-Laparoscopy, and Laparoscopy-Laparoscopy vs. Laparoscopy-Lichtenstein. The outcome was re-reoperation rates, which were compared by crude rates, cumulated rates, and hazard ratios. There was no difference in the re-reoperation rates when the primary repair was laparoscopic, regardless of the type of reoperation. However, Lichtenstein-Lichtenstein had a significantly higher re-reoperation rate compared with Lichtenstein-Laparoscopy (crude rate 8.7 vs. 3.1 %, p value hernia was medial. A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein or a laparoscopic repair according to surgeon's choice. For a primary laparoscopic operation, the method of repair of a recurrent hernia did not affect the re-reoperation rate.

  3. Optimal management strategies for placenta accreta

    Eller; Porter; Soisson; Silver


    ..., and hypogastric artery ligation. Main outcome measures Early morbidity (prolonged maternal intensive care unit admission, large volume of blood transfusion, coagulopathy, ureteral injury, or early re-operation...

  4. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: five-year update on a previously published cohort.

    Ramo, Brandon A; Richards, B Stephens


    A retrospective case series. To identify the overall reoperation rate and factors contributing to reoperation in a recent 5-year cohort of patients (2003-2007) undergoing spinal deformity surgery. These patients were compared with a previously published 15-year cohort of consecutive patients (1988-2002) from the same institution to assess for any significant differences in reoperation rates. In a previously published report from this institution, the reoperation rate for patients with idiopathic scoliosis treated during a 15-year period (1988-2002) was 12.9%. That group was predominantly treated with first-generation TSRH (Medtronic, Memphis, TN) implants and CD implants. Lower profile, more rigid implant systems are now used along with refined techniques for correction of scoliosis deformity. We hypothesized that these factors would lead to lower rates of reoperation. METHODS.: The medical records of 452 consecutive patients (older than 9 yr) surgically treated for idiopathic scoliosis at one institution during 5 years (2003-2007) were reviewed to identify those who required reoperation. The reoperation rate for this cohort was 7.5% (34 of 452 patients). Compared with the prior cohort, significant decreases were noted with regard to total reoperation rate as well as reoperation due to infection and pseudarthrosis. Trends were noted toward decreased rates of reoperation due to prominent implants, dislodged implants, and implant proximity to vital structures. Within the newer cohort, a trend toward decreased reoperation rate was also noted for lower profile implant systems compared with first-generation TSRH implants. With the evolution of newer lower profile segmental implant systems that provide more rigid fixation and with the advancements in techniques for deformity correction, the repeat surgical intervention rate for idiopathic scoliosis has decreased.

  5. Risk factors for lead complications in cardiac pacing

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nøhr, Ellen Aagaard;


    Lead complications are the main reason for reoperation after implantation of pacemakers (PM) or cardiac resynchronization therapy (CRT-P) devices.......Lead complications are the main reason for reoperation after implantation of pacemakers (PM) or cardiac resynchronization therapy (CRT-P) devices....

  6. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease

    Hoendermis, Elke S.; den Hamer, Inez J.; Ebels, Tjark; Waterbolk, T


    Objective: Pulmonary valve replacement is performed increasingly late after correction of Tetralogy of Fallot. Most reports deal with pulmonary allografts as the valvar substitute of choice, although late deterioration and reoperation(s) are the rule. Mechanical valves are scarcely reported and if s

  7. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C.; Solgaard, Søren


    fractures ≤ 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134...

  8. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease

    Hoendermis, Elke S.; den Hamer, Inez J.; Ebels, Tjark; Waterbolk, T

    Objective: Pulmonary valve replacement is performed increasingly late after correction of Tetralogy of Fallot. Most reports deal with pulmonary allografts as the valvar substitute of choice, although late deterioration and reoperation(s) are the rule. Mechanical valves are scarcely reported and if

  9. Implementing, Adapting, and Validating an Evidence-Based Algorithm for Hip Fracture Surgery

    Ban, I.; Palm, H.; Birkelund, Lasse;


    Reoperations are common after surgical treatment of hip fractures but may be reduced by optimal choice of implant based on fracture classification. We hypothesized that implementing a surgical treatment algorithm was possible in our hospital and would result in a reduced reoperation rate....

  10. Gastroskopisk behandling af penetrerende gastrisk bånd

    Fonnest, G F; Jess, Per


    Gastric wall penetration of a gastric band after operation for morbid obesity is a well known late complication. The treatment is usually reoperation. In this case report we show that a band penetrating the gastric wall can be successfully treated by gastroscopic operation. This technique is more...... simple than reoperation, especially in case of morbid obesity at the time of the complication....

  11. Surgical approach for recurrent inguinal hernias

    Öberg, S; Andresen, K; Rosenberg, J


    Purpose: Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior–posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates...... between repairs performed according to the guidelines with the ones performed against it. Methods: This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows: Lichtenstein–Lichtenstein vs......-reoperation for Lichtenstein–Lichtenstein was only seen if the primary hernia was medial. Conclusions: A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein...

  12. Repair of recurrent hernia is often performed at a different clinic

    Nolsøe, A; Andresen, K; Rosenberg, J


    were performed at a different healthcare facility. Time to reoperation, age at time of repair and having the primary repair performed at a private facility were all independent risk factors for being reoperated at a different facility in a logistic regression model. CONCLUSION: One in four patients......PURPOSE: The aim of this study was to assess the extent of reoperations after hernia repair in Denmark that are being performed at a different facility than the primary repair and thereby investigate whether or not reoperation is a reliable basis for assessment of personal- or facility recurrence...... underwent repair for recurrent hernia at a different facility than the prior repair. Having the primary repair performed at a private hospital increased the risk of being reoperated at a different facility compared to having it performed at a public facility. This indicates that personal or institutional...

  13. Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias

    Christoffersen, Mette W; Helgstrand, Frederik; Rosenberg, Jacob;


    and risk of chronic pain in small primary ventral hernias. METHODS: A cohort study with questionnaire and clinical follow-up was conducted. Patients with primary, elective, open mesh or sutured repair for a small umbilical or epigastric hernia (≤ 2 cm) were included. RESULTS: One thousand three hundred......BACKGROUND: Mesh repair reduces the risk of reoperation for recurrence in patients with primary ventral hernias. However, reoperation for recurrence underestimates total recurrence (reoperation + clinical) and mesh reinforcement may induce chronic pain. This study investigated the total recurrence......-term risk of recurrence after repair for small ventral hernias without increased risk of chronic pain....

  14. Combined use of radioiodine therapy and radiofrequency ablation in treating postsurgical thyroid remnant of differentiated thyroid carcinoma

    Bin Long


    Conclusion: Combined use of RAI therapy and radiofrequency ablation in treating excessive postsurgical thyroid remnant of DTC can be an effective approach and avoids re-operation. Long-term efficacy monitoring would further determine its feasibility.

  15. Use of locking plates for fixation of the greater trochanter in patients with hip replacement

    Allison K. Tetreault, BA


    Conclusions: Locking plate technology is a successful method of fixation of the greater trochanter in patients with THA. Postoperative trochanteric pain and reoperation for hardware-related issues remain a challenge.

  16. Reflections on the 24 years durability of an isolate tricuspid bovine pericardium IMC/Braile bioprosthesis.

    Bassetto, Solange; Menardi, Antonio Carlos; Alves Junior, Lafaiete; Rodrigues, Alfredo José; Évora, Paulo Roberto Barbosa


    We were challenged by the experience of one patient reoperation for a bioprosthetic bovine pericardium degenerative stenosis, 24 years after implantation. This bioprosthesis was implanted due to tricuspid valve bacterial staphylococcal endocarditis after septic abortion.

  17. Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade.

    Nandi, P; Leung, J S; Cheung, K L


    Between July 1968 and December 1975, 821 patients underwent open heart operations. In 596 cases the pericardium was left open and in 225 the pericardium was closed. Forty-one patients in the open pericardium group required reoperation and 23 of these had tamponade. Four patients in the closed pericardium group had reoperation but there was not a single case of tamponade. In most cases that required reoperation the bleeding was from extrapericardial sources. Absence of tamponade in the closed pericardium group can be explained by the fact that blood from extrapericardial sources of bleeding cannot collect round the heart because the pericardium is closed. Thus closure of pericardium helps to prevent tamponade. Reoperations some months or years after the original operation are technically easier and less hazardous if the pericardium has been closed because the closed pericardium prevents the heart from becoming adherent to the back of sternum and also because there are fewer adhesions in the pericardial cavity. PMID:795444

  18. Evolution of management of gastroschisis

    this study was to evaluate the evolution in management and outcome ... Historically, many surgeons used drastic measures to decrease .... decompression planning for reoperation. .... strategy, whereas operative staged reduction is frequently.

  19. [Long-term results of the surgical treatment of ileo-colonic Crohn disease].

    Forni, E; Orlandoni, G; Voltolini, P; Zadra, F; Stradiotti, G; Bordoni, P; Spelzini, P


    18 patients with Crohn's disease primarily treated with excisional surgery were studied. The crude recurrence and reoperation rate were analyzed. The influence of sex, age and length of history prior to operation was in this respect also studied.

  20. Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia

    Ware, P; Bay-Nielsen, M; Juul, P


    BACKGROUND: According to a Cochrane review, laparoscopic inguinal hernia repair compares favourably with open mesh repair, but few data exist from surgical practice outside departments with a special interest in hernia surgery. This study compared nationwide reoperation rates after laparoscopic...... and Lichtenstein repair, adjusting for factors predisposing to recurrence. METHODS: Some 3606 consecutive laparoscopic repairs were compared with 39 537 Lichtenstein repairs that were prospectively recorded in a nationwide registry between 1998 and 2003. Patients were subgrouped according to type of hernia......: primary or recurrent and unilateral or bilateral. Overall reoperation rates and 95 per cent confidence intervals were calculated. Long-term reoperation rates were estimated using the Kaplan-Meier method. RESULTS: The overall reoperation rates after laparoscopic and Lichtenstein repair of unilateral...

  1. Burden of adhesions in abdominal and pelvic surgery: Systematic review and met-analysis

    P.G. Richard (P.); Y. Issa (Yama); E.J. van Santbrink (Evert); N.D. Kannekens-Bouvy (Nicole); R.F.M.P. Kruitwagen (Roy); J. Jeekel (Hans); E.A. Bakkum (Erica); M.M. Rovers (Maroeska); H. van Goor (Harry)


    markdownabstractAbstract Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain. Design Systematic review and meta-analyses. Data sources Searches of Pu

  2. Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography

    Bateman, T.M.; Czer, L.S.; Gray, R.J.; Kass, R.M.; Raymond, M.J.; Garcia, E.V.; Chaux, A.; Matloff, J.M.; Berman, D.S.


    Pericardial or mediastinal hemorrhage requiring reoperation occurs in 2% to 5% of patients, usually early (0 to 48 hours), after open-heart surgery. This hemorrhage may be occult, and resulting cardiac tamponade may easily be misinterpreted as ventricular dysfunction, common early postoperatively. In such cases, appropriate and timely intervention may not occur. Of 50 patients evaluated by technetium-99m red blood cell gated equilibrium radionuclide ventriculography (RNV) because of early postoperative cardiogenic shock of uncertain etiology, 17 had unique scintigraphic images suggestive of intrathoracic hemorrhage. Of these 17, 5 had a generalized halo of abnormal radioactivity surrounding small hyperdynamic right and left ventricles, 11 had localized regions of intense blood pool activity outside the cardiac chambers (two with compression of single chambers), and one demonstrated marked radionuclide activity in the right hemithorax (2000 ml of blood at reoperation). Twelve patients had exploratory reoperation for control of hemorrhage as a direct result of the scintigraphic findings, three were successfully treated with fresh frozen plasma and platelet infusions along with medical interventions to optimize cardiac performance, and two patients died in cardiogenic shock (presumed tamponade) without reoperation. In the 12 reoperated patients, all were confirmed to have active pericardial bleeding. Scintigraphic localization of abnormal blood pools within the pericardium corresponded to the sites at which active bleeding was witnessed at reoperation. The abnormal bleeding was etiologically related to the tamponade state, with marked improvement in hemodynamics after reoperation. Nine additional patients were reoperated for presumed tamponade after RNV revealed an exaggerated halo of photon deficiency surrounding the cardiac chambers.

  3. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients


    PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP) urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years), were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional l...

  4. Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves

    Dvir, Danny; Webb, John; Brecker, Stephen;


    Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.......Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry....

  5. Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction

    Ding, David; Group, Mars


    Objectives: Failure or reinjury after anterior cruciate ligament (ACL) reconstruction can lead to recurrent instability and concomitant intra-articular injuries. While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. Yet, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. Methods: 1205 patients who underwent rACLR were enrolled between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categoriezed. A repeated meaures ANOVA was used to reveal significatnt differences in patient reported outcomes. Multivariate regression analysis was performed to determine independent risk factors for reoperation. Results: One hundred and twenty-two patients (10.1%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperation procedures, 26.7% were meniscus procedures (69% meniscectomy, 26% repair), 18.6% were subsequent rACLR, 17.4% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 10% hardware removal, and 9.3% were procedures for arthrofibrosis such has lysis of adhesions and synovectomy. Patients who had reoperations had significantly lower IKDC, KOOS symptoms and pain scores, and WOMAC stiffness scores at two-year follow up. Multivariate analysis revealed that patients under 20 years old were 2.1 times more likely than patients aged 20-29 to have a reoperation. Use of allograft at the time of rACLR and staged revision (bone grafting of

  6. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

    Seyed A. Mousavi


    Full Text Available PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years, were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. The original location, associated complications and results were recorded. RESULTS: There were 4 (30.7%, incidences of complications of TIP re-operation, 2 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6% and the others were cured by dilatation. No complications occurred in the circumcised patents. CONCLUSION: Using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. It can also be used successfully in patients, who do not have a healthy skin flap and in circumcised patients when there is a lack of foreskin.

  7. The vertical hip fracture – a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw

    Enocson Anders


    Full Text Available Abstract Background Femoral neck fractures with a vertical orientation have been associated with an increased risk for failure as they are both axial and rotational unstable and experience increased shear forces compared to the conventional and more horizontally oriented femoral neck fractures. The purpose of this study was to analyse outcome and risk factors for reoperation of these uncommon fractures. Methods A cohort study with a consecutive series of 137 hips suffering from a vertical hip fracture, treated with one method: a sliding hips screw with plate and an antirotation screw. Median follow-up time was 4.8 years. Reoperation data was validated against the National Board of Health and Welfare’s national registry using the unique Swedish personal identification number. Results The total reoperation rate was 18%. After multivariable Logistic regression analysis adjusting for possible confounding factors there was an increased risk for reoperation for displaced fractures (22% compared to undisplaced fractures (3%, and for fractures with poor implant position (38% compared to fractures with adequate implant position (15%. Conclusions The reoperation rate was high, and special attention should be given to achieve an appropriate position of the implant.

  8. The Thrust Plate Prosthesis: long-term clinical and radiological results.

    Diederix, Leon W; Van Winterswijk, Peter J T S; Schouten, Sander B; Bakx, Pieter A G M; Huij, Jaap


    The Thrust Plate Prosthesis is a femoral implant designed for total hip arthroplasty, based on the principles of physiologic loading of the metaphysis of the proximal femur, and preserving the bone stock. This study presents the long-term clinical and radiological results of 34 patients with 36 Thrust Plate Prostheses. In a retrospective analysis, we investigated the reoperation-free survival as well as the clinical and radiological results. Mean age at operation was 51 +/- 6.4 years. Mean follow-up length was 11.9 +/- 1.6 years. Reoperation-free survival was 88.9%. Four (11.1%) reoperations were performed, in three patients due to aseptic loosening and in one patient because of a fracture distal to the lateral plate. Three of the reoperations were performed between 12 and 32 months postoperatively. The major complaint was pain at the lateral side of the hip (44%). Radiolucencies did not exceed 1 mm, but 35% of the hips showed resorption of the cortex directly under the thrust plate, together with cancellous bone hypertrophy at the calcar, noted in 97%. Because of the relatively high reoperation-free survival and favourable radiological results, the Thrust Plate Prosthesis appears as a possible alternative to stemmed total hip arthroplasty, especially in relatively young patients.

  9. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian


    ), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. RESULTS: A total of 5,893 females with primary elective inguinal hernia operation...... on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall...... reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p 

  10. Impact of surgical complications on length of stay after hip fracture surgery

    Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael;


    BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... of surgical complications has not been examined in detail. METHODS: All 600 consecutive patients included were admitted with primary hip fracture and received primary surgical intervention with multimodal rehabilitation. Surgical complications were audited and classified as being due to a patient fall......, infection or suboptimal surgery, stratified into either requiring reoperation or not allowing mobilisation because of instability. RESULTS: Of the 600, 116 (19.3, 95% CI 16-22%) patients underwent reoperation or immobilisation; 27.1% of bed-day consumption resulted from surgical complications. The audit...

  11. Impact of surgical complications on length of stay after hip fracture surgery

    Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael


    BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... showed that 64 complications (55%) were due to suboptimal surgery, 18 (16%) to infection, 6 (5%) to falls and 28 (24%) to no obvious cause. CONCLUSION: Surgical complications secondary to primary hip fracture surgery account for 27.1% of total hospital bed consumption within 6 months. Approximately, 50......, infection or suboptimal surgery, stratified into either requiring reoperation or not allowing mobilisation because of instability. RESULTS: Of the 600, 116 (19.3, 95% CI 16-22%) patients underwent reoperation or immobilisation; 27.1% of bed-day consumption resulted from surgical complications. The audit...

  12. Recurrence patterns of direct and indirect inguinal hernias in a nationwide population in Denmark

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian;


    hernia [DIH]), we found an overall reoperation rate of 3.8%. More primary IIHs were operated by Lichtenstein's technique than primary DIH (90.7% vs 85.4%, respectively; P hernias, and 3.9% were for femoral hernias. DIHs resulted more often......BACKGROUND: Detailed knowledge on risk of reoperation after direct and indirect inguinal hernia (IIH) repair could be useful in preoperative counseling as well as in the planning of postoperative follow-up. This knowledge is not available in the literature. METHODS: Using data from the Danish...... Hernia Database, we included all male patients operated on for an elective, primary inguinal hernia from 1998 to 2012. Within this prospectively collected cohort, the type of inguinal hernia at primary and recurrent procedures was registered. Furthermore, time from primary procedure to reoperation...

  13. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients

    Mohamad Bydon


    Full Text Available Background: The objective of this study is to determine the clinical and surgical outcomes following lumbar laminectomy. Methods: We retrospectively reviewed medical records of neurosurgical patients who underwent first-time, bilateral, 1-3 level laminectomies for degenerative lumbar disease. Patients with discectomy, complete facetectomy, and fusion were excluded. Results: Five hundred patients were followed for an average of 46.79 months. Following lumbar laminectomy, patients experienced statistically significant improvement in back pain, neurogenic claudication, radiculopathy, weakness, and sensory deficits. The rate of intraoperative durotomy was 10.00%; however, 1.60% experienced a postoperative cerebrospinal fluid leak. The risk of experiencing at least one postoperative complication with a lumbar laminectomy was 5.60%. Seventy-two patients (14.40% required reoperations for progression of degenerative disease over a mean of 3.40 years. The most common symptoms prior to reoperation included back pain (54.17%, radiculopathy (47.22%, weakness (18.06%, sensory deficit (15.28%, and neurogenic claudication (19.44%. The relative risk of reoperation for patients with postoperative back pain was 6.14 times higher than those without postoperative back pain (P < 0.001. Of the 72 patients undergoing reoperations, 55.56% underwent decompression alone, while 44.44% underwent decompression and posterolateral fusions. When considering all-time reoperations, the lifetime risk of requiring a fusion after a lumbar laminectomy based on this study (average follow-up of 46.79 months was 8.0%. Conclusion: Patients experienced statistically significant improvements in back pain, neurogenic claudication, radiculopathy, motor weakness, and sensory deficit following lumbar laminectomy. Incidental durotomy rate was 10.00%. Following a first-time laminectomy, the reoperation rate was 14.4% over a mean of 3.40 years.

  14. Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery.

    Menda, Shivali A; Driver, Todd H; Neiman, Alexandra E; Blumberg, Seth; Naseri, Ayman; Stewart, Jay M


    Investigate risk factors for unplanned return to the operating room after resident-performed cataract surgery. Retrospective case-control study. Institutional. Study population: All patients with reoperation within 90 days of resident-performed phacoemulsification were matched to four control eyes which had surgery within 30 days of the reoperation at the same institution. Billing codes were used to identify all patients who underwent resident-performed intended phacoemulsification with intraocular lens placement from January 2005 to December 2010. Investigated risk factors for reoperation included cataract characteristics and preexisting ocular co-morbidities, including diabetic retinopathy, retinal detachment history, glaucoma, corneal pathology, and uveitis. Additional preoperative risk factors studied included resident training year, history of tamsulosin use, phacodonesis, pupillary dilation, presence of pseudoexfoliation, myopia, history of trauma, visual acuity, and monocular status. Intraoperative variables were the use of iris expansion devices, use of capsular stain, attending type, incision type, use of sutures, vitreous loss, anesthesia type, and phacoemulsification technique. There were 67 returns to the operating room (i.e., cases) over five years that were assigned to 268 control eyes. In preoperative multivariate analysis, phacoemulsification done by a first- or second-year resident (OR 3.2, 95% CI: 1.7-6.0, p risk of reoperation. In postoperative multivariate analysis, only the use of the divide-and-conquer technique (OR 4.0, 95% CI:1.7-9.2, p = 0.001) was associated with an increased risk of reoperation. Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.

  15. Markering af nonpalpable forandringer i brystvæv

    Langhans, Linnea; Vejborg, Thomas S; Vejborg, Ilse


    The Danish national mammography screening programme leads to identification of an increased number of small non-palpable breast tumours, suitable for breast-conserving surgery. Accurate lesion localization is therefore important. The current standard is wire-guided localization and although...... effective it involves a risk of high rates of positive margin and re-operations. New methods are emerging and radioactive seed localization (RSL) seems promising with regards to re-operation rates and logistics. In RSL a small titanium seed containing radioactive iodine is used to mark the lesion....

  16. Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis

    Froberg, Lonnie; Troelsen, Anders; Brix, Michael


    internal fixation, and the introduction of locking-plate osteosynthesis may lead to improved outcome. We evaluated the outcome of Vancouver type B1 and C PFFs treated by locking-plate osteosynthesis, by assessing rates of fracture union and reoperations and by analyzing failure cases.......Historically, the treatment of periprosthetic femoral fractures (PFFs) has been associated with a high frequency of complications and reoperations. The preferred treatment is internal fixation, a revision of the femoral stem, or a combination of both. An improved understanding of plate use during...

  17. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA)

    Thornell, Anders; Angenete, Eva; Gonzales, Elisabeth


    , randomised trial, comparing laparoscopic lavage (LL) to the traditional Hartmann’s Procedure (HP). Primary endpoint is the number of re-operations within 12 months. Secondary endpoints consist of mortality, quality of life (QoL), re-admission, health economy assessment and permanent stoma. Patients...... morbidity. Thus the combined risk of treatment for the patient is high. The aim of the DILALA trial is to evaluate if laparoscopic lavage is a safe, minimally invasive method for patients with perforated diverticulitis Hinchey grade III, resulting in fewer reoperations, decreased morbidity, mortality, costs...

  18. A mycotic aneurysm of the abdominal aorta in a child

    W. Suijker (W.); J.H.L.J. Bergmeijer (Jan Hein); J.J. Hamming (J.); J.C. Molenaar


    textabstractA 6-year-old boy with a previous history of intracardiac correction of a partial atrioventricular canal defect presented with infective endocarditis. Despite antibiotic therapy and reoperation, he developed a mycotic abdominal aneurysm. In situ aortoiliac reconstruction with a prosthesis

  19. Follow-up after repair of vaginal vault prolapse with abdominal colposacropexy

    Pilsgaard, K; Mouritsen, L


    % were cured of prolapse symptoms, one had recurrent vault prolapse and was reoperated, four had rectocele. Five patients developed urge incontinence, while urge incontinence, frequency, nocturia and voiding problems were cured in 75%, 80%, 50% and 100%, respectively. One patient developed fecal...

  20. Delayed breast implant reconstruction

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne;


    We evaluated the association between radiation therapy and severe capsular contracture or reoperation after 717 delayed breast implant reconstruction procedures (288 1- and 429 2-stage procedures) identified in the prospective database of the Danish Registry for Plastic Surgery of the Breast during...... reconstruction approaches other than implants should be seriously considered among women who have received radiation therapy....

  1. Post-operative serious adverse events in a mixed surgical population - a retrospective register study

    Hansen, M S; Petersen, E E; Dahl, J B;


    ; pulmonary embolism; stroke; gastrointestinal bleeding; dialysis or reoperation. METHODS: Data of surgical procedures in the period from January 1, 2012 to June 30, 2012 were retrieved from the Danish Anaesthesia Database (DAD). Follow-up of all patients undergoing hip or knee replacement, abdominal...

  2. Umbilical Hernia Repair: Analysis After 934 Procedures.

    Porrero, José L; Cano-Valderrama, Oscar; Marcos, Alberto; Bonachia, Oscar; Ramos, Beatriz; Alcaide, Benito; Villar, Sol; Sánchez-Cabezudo, Carlos; Quirós, Esther; Alonso, María T; Castillo, María J


    There is a lack of consensus about the surgical management of umbilical hernias. The aim of this study is to analyze the medium-term results of 934 umbilical hernia repairs. In this study, 934 patients with an umbilical hernia underwent surgery between 2004 and 2010, 599 (64.1%) of which were evaluated at least one year after the surgery. Complications, recurrence, and the reoperation rate were analyzed. Complications were observed in 5.7 per cent of the patients. With a mean follow-up time of 35.5 months, recurrence and reoperation rates were 3.8 per cent and 4.7 per cent, respectively. A higher percentage of female patients (60.9 % vs 29 %, P = 0.001) and a longer follow-up time (47.4 vs 35 months, P = 0.037) were observed in patients who developed a recurrence. No significant differences were observed between complications and the reoperation rate in patients who underwent Ventralex(®) preperitoneal mesh reinforcement and suture repair; however, a trend toward a higher recurrence rate was observed in patients with suture repair (6.5 % vs 3.2 %, P = 0.082). Suture repair had lower recurrence and reoperation rates in patients with umbilical hernias less than 1 cm. Suture repair is an appropriate procedure for small umbilical hernias; however, for larger umbilical hernias, mesh reinforcement should be considered.

  3. Infraorbital Nerve Block for Isolated Orbital Floor Fractures Repair: Review of 135 Consecutive Cases

    Giuseppe Spinelli, MD


    Conclusions: There are several advantages to surgically repairing isolated orbital floor fractures under regional and local anesthesia that include the following: surgeons can check the surgical outcome (enophthalmos and extrinsic ocular muscles function intraoperatively, thereby reducing the reoperation rate; patient discomfort due to general anesthesia is eliminated; and the hospital stay is reduced, thus decreasing overall healthcare costs.

  4. Myocardial infarction with ventricular septal rupture complicating elective aortic valve replacement.

    Milhous, J Gerrit-Jan; Heijmen, Robin H; Ball, Egbert T; Plokker, H W Thijs


    Herein is described the case of a 79-year-old woman who underwent elective aortic valve replacement. The procedure was complicated by a particulate embolism into the left anterior descending artery leading to a myocardial infarction, complicated by ventricular septal rupture. Subsequently, the patient was reoperated on and the septal defect closed successfully, with an uneventful recovery.

  5. Human error in strabismus surgery: Quantification with a sensitivity analysis

    S. Schutte (Sander); J.R. Polling; F.C.T. van der Helm (Frans); H.J. Simonsz (Huib)


    textabstractBackground: Reoperations are frequently necessary in strabismus surgery. The goal of this study was to analyze human-error related factors that introduce variability in the results of strabismus surgery in a systematic fashion. Methods: We identified the primary factors that influence th

  6. Human error in strabismus surgery: quantification with a sensitivity analysis

    Schutte, S.; Polling, J.R.; Van der Helm, F.C.T.; Simonsz, H.J.


    Background- Reoperations are frequently necessary in strabismus surgery. The goal of this study was to analyze human-error related factors that introduce variability in the results of strabismus surgery in a systematic fashion. Methods- We identified the primary factors that influence the outcome of

  7. High reliability of an algorithm for choice of implants in hip fracture patients

    Palm, Henrik; Posner, Eva; Ahler-Toftehøj, Hans-Ulrik;


    Hip fracture treatment is controversial, with high complication rates. An algorithm for hip fracture surgery has shown reduced reoperation rates, but choice of implant is based on the commonly used fracture classifications, which were previously evaluated to be unreliable. The purpose of this study...... was to investigate the reliability of the algorithm....

  8. Meniscal Transplants and Scaffolds: A Systematic Review of the Literature

    Dangelmajer, Sean; Familiari, Filippo; Simonetta, Roberto; Kaymakoglu, Mehmet; Huri, Gazi


    The reported incidence of meniscal tears is approximately 61 per 100,000. In instances where preservation of the native meniscus is no longer a feasible option, meniscal allograft transplantation (MAT) and implants or scaffolds may be considered. The goal of this review was to compare the success and failure rates of two techniques, MAT and meniscal scaffolds, and make an inference which treatment is more preferable at the present time and future. Studies that met inclusion criteria were assessed for technique used, type of transplant used, number of procedures included in the study, mean age of patients, mean follow-up time, number of failures, failure rate, and reported reoperation rate. Fifteen studies for the MAT group and 7 studies for the meniscal scaffold group were identified. In this selection of studies, the average failure rate in the MAT group was 18.7% and average reoperation rate was 31.3%. The average failure rate in the meniscal scaffold group was 5.6%, and average reoperation rate was 6.9%. It appears that although MAT is associated with high reoperation and failure rates, the limited number of studies on both MAT and scaffolds and mainly short-term results of scaffold studies make it difficult to make an objective comparison. PMID:28231642

  9. Transcatheter Replacement of Failed Bioprosthetic Valves

    Simonato, Matheus; Webb, John; Kornowski, Ran


    Background-Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets fo...

  10. Cystektomi i Danmark 2000-2005

    Johansen, Lars Søndergaard; Christensen, Tom Howy; Bendixen, Anette;


    INTRODUCTION: The organization and results after cystectomy in Denmark are unknown. MATERIALS AND METHODS: Based upon the Danish National Hospital Register and discharge notes, postoperative hospitalization, readmission within 30 days, re-operations and mortality after cystectomy in Denmark in th...

  11. Quantifying the robustness of optimal reservoir operation for the Xinanjiang-Fuchunjiang Reservoir Cascade

    Vonk, E.; Xu, YuePing; Booij, Martijn J.; Augustijn, Dionysius C.M.


    In this research we investigate the robustness of the common implicit stochastic optimization (ISO) method for dam reoperation. As a case study, we focus on the Xinanjiang-Fuchunjiang reservoir cascade in eastern China, for which adapted operating rules were proposed as a means to reduce the impact

  12. Pneumaturia signaling a fistula between the rectum anastomosis and seminal vesicle as a complication after transanal endorectal pull-through operation for Hirschsprung's disease. A method of repair


    A 2-year-old boy underwent an uneventful transanal endorectal pull-through for Hirschsprung's disease. Postoperatively he suffered from pneumaturia which prompted surgical evaluation. He was found to have a rectum to seminal vesicle fistula. He was re-operated closing the fistula through an anterior transperineal approach with a successful operative outcome.

  13. Hydroxyethyl Starch Reduces Coagulation Competence and Increases Blood Loss During Major Surgery

    Rasmussen, Kirsten C; Johansson, Pär I; Højskov, Michael


    to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer. CONCLUSIONS: Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration...

  14. Adapting multireservoir operation to shifting patterns of water supply and demand

    Vonk, E.; Xu, Y.P.; Booij, M.J.; Zhang, X.; Augustijn, D.C.M.


    The aim of this study is to determine whether dam reoperation (the adjustment of reservoir operating rules) is an effective adaptation strategy to reduce the potential impacts of climate change and regional socio-economic developments. The Xinanjiang-Fuchunjiang reservoir cascade, located in Hangzho

  15. Quantifying the robustness of optimal reservoir operation for the Xinanjiang-Fuchunjiang Reservoir Cascade

    Vonk, E.; Xu, Y.P.; Booij, M.J.; Augustijn, D.C.M.


    In this research we investigate the robustness of the common implicit stochastic optimization (ISO) method for dam reoperation. As a case study, we focus on the Xinanjiang-Fuchunjiang reservoir cascade in eastern China, for which adapted operating rules were proposed as a means to reduce the impact

  16. The Value of Intraoperative Frozen Section Analysis for Margin Status in Breast Conservation Surgery in a Nontertiary Institution

    Mona P. Tan


    Full Text Available Introduction. Breast conservation treatment (BCT for early-stage breast malignancies requires negative margins and good cosmesis. Reoperations may be needed to achieve negative margins, which can have an adverse impact on outcomes. This study was performed to evaluate the efficacy of intraoperative frozen section analysis (IFSA for margin assessment to reduce excision rates. Methods. All patients treated at the authors’ private healthcare facility between 2009 and 2011 for breast cancer were included in the study. Those for whom BCT was intended underwent wide excision with IFSA. Six margins of the excised tissue, and the sentinel lymph node (SLN, where appropriate, were submitted for IFSA. Patient demographics, tumour characteristics, number of operations performed, and outcomes were analysed. Results. Of the 161 patients analysed, 138 (85.7% had successful breast conservation. Four patients required a reoperation for incomplete surgical extirpation. One had a false negative SLN assessment on IFSA, and was returned to the operating room for an axillary dissection. Three patients required reoperations for inadvertently missed multicentric disease. None had false negative margin evaluation with IFSA necessitating reexcision. Conclusion. The use of IFSA allows low rates of reoperation with BCT. Further research is needed to establish consistency in low reexcision rates for cost-effectiveness and optimum resource allocation.

  17. Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases.

    Matsumoto, Tomiya; Okuda, Shinya; Haku, Takamitsu; Maeda, Kazuya; Maeno, Takafumi; Yamashita, Tomoya; Yamasaki, Ryoji; Kuratsu, Shigeyuki; Iwasaki, Motoki


    Study Design Case report. Objective To present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case Report We present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. Conclusion Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex.

  18. Intervention for postpartum infections following caesarean section

    Hyldig, Nana; Bille, Camilla; Kruse, Marie


    treatment of post-CS infection requires hospital re-admission and re-operation for opening and debridement of the infected wounds under regional- or general anesthesia. The wound is normally re-sutured on the fourth day. NPWT is an alternative method of conservative wound management, which uses negative...

  19. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort

    Wilhelmsen, M.; Møller, M H; Rosenstock, S


    BACKGROUND: Surgery for perforated peptic ulcer (PPU) is associated with a risk of complications. The frequency and severity of reoperative surgery is poorly described. The aims of the present study were to characterize the frequency, procedure-associated risk and mortality associated...

  20. Protocol for translabial 3D-ultrasonography for diagnosing levator defects (TRUDIL): a multicentre cohort study for estimating the diagnostic accuracy of translabial 3D-ultrasonography of the pelvic floor as compared to MR imaging

    Notten, K.J.; Weemhoff, M.; Kluivers, K.B.; Schweitzer, K.J.; Mulder, F.; Stoker, J.; Beets-Tan, R.G.; Futterer, J.J.; Vliegen, R.F.; Evers, J.L.H.; Link, G.; Bergmans, M.G.; Kampschoer, P.H.; Gondrie, E.T.; Gestel, I. van; Dooren, I. van; Dirksen, C.; Smits, L.J.; Bossuyt, P.M.; Roovers, J.P.


    BACKGROUND: Pelvic organ prolapse (POP) is a condition affecting more than half of the women above age 40. The estimated lifetime risk of needing surgical management for POP is 11%. In patients undergoing POP surgery of the anterior vaginal wall, the re-operation rate is 30%. The recurrence risk is

  1. Massive reduction of tumour load and normalisation of hyperprolactinaemia after high dose cabergoline in metastasised prolactinoma causing thoracic syringomyelia.

    Uum, S.H.M. van; Alfen, N. van; Wesseling, P.; Lindert, E.J. van; Pieters, G.F.F.M.; Nooijen, P.T.G.A.; Hermus, A.R.M.M.


    In 1970 a 20 year old woman presented with a pituitary chromophobe adenoma for which she underwent transfrontal pituitary surgery. In 1978 she had to be reoperated on because of local tumour recurrence, resulting in hypopituitarism. Bromocriptine (5 mg/day) was given for 15 years, but the plasma pro

  2. [Ascending aorta replacement late after aortic valve replacement].

    Hayashi, Yasunari; Ito, Toshiaki; Maekawa, Atsuo; Sawaki, Sadanari; Fujii, Genyo; Hoshino, Satoshi; Tokoro, Masayoshi; Yanagisawa, Junji


    Replacement of the asceding aorta is indicated in patients undergoing aortic valve replacement( AVR), if the diameter of the ascending aorta is greater than 5.0 cm. If the diameter of the asceding aorta is from 4.0 to 5.0 cm, it was arguable whether replacement of the ascending aorta should be performed. Nine patients who underwent reoperative ascending aorta replacement after AVR were reviewed retrospectively. Reoperation on the asending aorta replacement was performed 11.8±7.2 years (range 1y5m~23y3m) after AVR. Mean patient age was 69.9±6.3 (range 60~81). In 2 cases, reoperations were performed early year after AVR. Although ascending aorta was dilated at the 1st operation, replacement wasn't performed for the age and minimally invasive cardiac surgery (MICS). In 3 cases, reoperations were performed more than 10 years later. On these cases, ascending aorta aneurysm and dissection occurred with no pain and were pointed out by computed tomography(CT) or ultrasonic cardiogram(UCG). We think that patients with dilatation of the ascending aorta should undergo AVR and aorta replacement at the 1st operation regardness of age. It is important that patients who underwent AVR should undergo a regular checkup on the ascending aorta.

  3. Simultaneous repair of pectus excavatum and pulmonary valve implantation years after complete repair of tetralogy of Fallot.

    Tuncer, Eylem; Vuran, Ali Can; Ozyuksel, Arda; Yeginsu, Ali; Ceyran, Hakan


    Although pectus excavatum is a common congenital abnormality of the chest wall, its coexistence with congenital heart defects is rarely encountered. In this report, we present a young adult who was re-operated for pulmonary valve regurgitation and pectus excavatum years after complete repair of tetralogy of Fallot. The surgical challenge and pitfalls are discussed along with a brief review of the literature.

  4. [Adjusted cupula in the treatment of massive osteonecrosis of the upper part of the femur in adolescent children].

    Lefort, G; Bouche-Pillon, M A; Lefebvre, F; Daoud, S


    Six important necrosis of the apophysis of the femur were treated by arthroplasty with adjusted cup. This operation always made these hips painless, 5 times, the mobility was greatly improved. This a normal social life was quickly recovered. However, the distant future remains uncertain. With the exception of one immediate failure, one hip had to be reoperated, 8 years after the total arthroplasty.

  5. Mitral valve repair and redo repair for mitral regurgitation in a heart transplant recipient

    Bouma, Wobbe; Brugemann, Johan; Wijdh-den Hamer, Inez J.; Klinkenberg, Theo J.; Koene, Bart M.; Kuijpers, Michiel; Erasmus, Michiel E.; van der Horst, Iwan C. C.; Mariani, Massimo A.


    A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation du


    Fanta, S M


    There were examined 134 patients, in whom in the clinic in 2005-2014 yrs a coronary shunting operation was performed. In patients with the angina pectoris recurrence a reoperation is indicated. The data of repeated coronaroventriculography and shuntography were analyzed. Efficacy of the surgical and interventional methods application in the patients was proved.

  7. Repeat surgery after failed midurethral slings

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler


    MUS from 1998 through 2007. The outcome was repeat surgery with any subsequent procedure code for urinary incontinence within a 5-year period of the first procedure. RESULTS: A total of 5,820 women (mean age 55.4 years, ± 12.1) were registered with a synthetic MUS, and 354 (6 %) underwent reoperation...

  8. Impact of patient-prosthesis mismatch after transcatheter aortic valve-in-valve implantation in degenerated bioprostheses

    Seiffert, Moritz; Conradi, Lenard; Baldus, Stephan


    Transcatheter valve-in-valve implantation is evolving as an alternative to reoperative valve replacement in high-risk patients with degenerated bioprostheses. Nevertheless, hemodynamic performance is limited by the previously implanted xenograft. We report our experience with patient-prosthesis...

  9. Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery: Copenhagen Arterial Revascularization Randomized Patency and Outcome trial

    Damgaard, S.; Lund, J.T.; Lilleor, N.B.;


    .9 in the conventional group (P = .004). Three months' follow-up for the arterial versus conventional groups showed the following: deaths: 1 (0.6%) versus 0; stroke: 3 (1.9%) versus 3 (1.8%); myocardial infarction: 6 (3.7%) versus 4 (2.4%); sternal wound reoperation: 4 (2.5%) versus 0 (P = .054); arm and leg wound...

  10. A fiber-optic retractor for harvesting the internal mammary artery.

    Angelini, G D; Azzu, A A


    A retractor for exposure and dissection of the internal mammary artery incorporating a fiber-optic transillumination system is presented. The device, which can be converted to a standard sternal retractor, has also proved valuable in improving illumination during procedures on the mitral valve and in facilitating dissection of fibrous adhesions from the anterior surface of the heart at reoperation.

  11. Groin hernia repair in young males: mesh or sutured repair?

    Bisgaard, T; Bay-Nielsen, M; Kehlet, H


    Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair....

  12. The Danish Hysterectomy and Hysteroscopy Database

    Topsøe, Märta Fink; Ibfelt, Else Helene; Settnes, Annette


    AIM OF THE DATABASE: The steering committee of the Danish Hysterectomy and Hysteroscopy Database (DHHD) has defined the objective of the database: the aim is firstly to reduce complications, readmissions, reoperations; secondly to specify the need for hospitalization after hysterectomy; thirdly...

  13. Image-guided endoscopic transnasal removal of recurrent pituitary adenomas.

    Lasio, Giovanni; Ferroli, Paolo; Felisati, Giovanni; Broggi, Giovanni


    To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. During a 45-month period, 19 endoscopic endonasal transsphenoidal reoperations were performed for recurrent pituitary adenomas. In 11 of 19 patients, the procedure was performed with the aid of an optically guided system. Clinical records were reviewed retrospectively, with attention to the following: comparison of baseline clinical data, the duration of surgery, and the postoperative course and complications of both image-guided and non-image-guided endoscopic reoperations. In addition, to test the reliability of the neuronavigation system, we made measurements of intraoperative accuracy in five additional transnasal endoscopic procedures in "virgin" noses and sphenoidal sinuses. In both groups studied, we found no difference with regard to either morbidity or mortality, which were null. The mean setup time was 13 minutes shorter in non-image-guided procedures (P = 0.021), and the operative time was 36 minutes shorter in image-guided procedures (P = 0.038). No other statistically significant differences were found between the two groups. In all cases, we found that the system performed without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of the intraoperative accuracy in the axial, coronal, and sagittal planes indicated a mean intraoperatively verified system error of 1.6 +/- 0.6 mm. Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and probably safer.

  14. A comparative study of trabeculectomy and the new clear-cornea filtering procedure, intrastromal diathermal keratostomy (IDK)

    Bach-Holm, Daniella; Storr-Paulsen, Allan; Norregaard, Jens Christian


    -established primary open-angle glaucoma referred for filtering operation. We compared the change in intraocular pressure (IOP), number of anti-glaucomatous medication, complications and reoperations after 1 year. Seventy-four eyes were operated with trabeculectomy, and 25 with IDK. Complete success was defined as IOP...

  15. Macular morphology and visual acuity after macular hole surgery with or without internal limiting membrane peeling

    Christensen, U.C.; Kroyer, K.; Sander, B.


    Aim: To examine postoperative macular morphology and visual outcome after 12 months in relation to internal limiting membrane (ILM) peeling versus no peeling, indocyanine green (ICG) staining and re-operation in eyes that achieved macular hole closure after surgery. Methods: Seventy-four eyes wit...

  16. Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: A systematic review and cost-effectiveness analysis

    P. Whiting (Penny); M.J. Al (Maiwenn); M. Westwood (Marie); I. Corro Ramos (Isaac); S. Ryder; N. Armstrong (Nigel); K. Misso (Kate); J. Ross (Janine); J.L. Severens (Hans); J. Kleijnen (Jos)


    textabstractBackground: Patients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM® Delta, TEM International GmbH,

  17. Pneumaturia signaling a fistula between the rectum anastomosis and seminal vesicle as a complication after transanal endorectal pull-through operation for Hirschsprung's disease. A method of repair

    Christina Granéli


    Full Text Available A 2-year-old boy underwent an uneventful transanal endorectal pull-through for Hirschsprung's disease. Postoperatively he suffered from pneumaturia which prompted surgical evaluation. He was found to have a rectum to seminal vesicle fistula. He was re-operated closing the fistula through an anterior transperineal approach with a successful operative outcome.

  18. [Long-term results of closed mitral commissurotomy--comparative study of closed mitral commissurotomy (CMC), open mitral commissurotomy (OMC) and mitral valve replacement (MVR)].

    Suzuki, S; Kondo, J; Imoto, K; Kajiwara, H; Tobe, M; Sakamoto, A; Isoda, S; Yamazaki, I; Noishiki, Y; Matsumoto, A


    As the technique of open heart surgery has improved, CMC has been abandoned in favor of OMC and MVR. We evaluated and compared the results of CMC, OMC and MVR. METHOD. Between 1965 and 1978, 141 patients with mitral stenosis (MS) underwent CMC, and late follow-up obtained in 117 (83%) of them (CMC group). Between 1980 and 1989, 72 patients and 37 patients underwent OMC (OMC group) and MVR (MVR group), respectively. Cumulative follow-up periods were 1982, 632 and 200 patient-years in the CMC, OMC and MVR groups, respectively. RESULTS. (1) Survival rate; In the CMC group there were 2 operative deaths due to severe mitral regurgitation (MR). There were 17 late deaths, due to reoperations in 4 patients, cerebral infarction in 4 patients, congestive heart failure in 3 patients, myocardial infarction in 2 patients and unknown causes in 4 patients. The survival rate was 95%, 91% and 86% at 5, 10 and 15 years, respectively, in the CMC group. In the OMC and MVR groups there was no death. (2) The event free rate was 89%, 79% and 58% at 5, 10 and 15 years, respectively, in the CMC group, 97% and 97% at 5 and 10 years in the OMC group, and 95% and 90% at 4 and 5 years in the MVR group. (3) Reoperations; In the CMC group of 40 patients (34%) required reoperations in an average of 10.4 years after the initial operation, due to re-MS in 22 patients, MR in 10 patients and MRS in the 8 patients. Reoperative findings consisted of clefts in the mitral leaflets in 7 patients. There were pulmonary hypertension in 15 patients and tricuspid regurgitation in 22 patients. Fourteen patients underwent tricuspid anuloplasty and one patient underwent a tricuspid valve replacement. In the OMC group one patient required a reoperation due to MR; in the MVR group one patient required a reoperation due to a thrombosed valve. CONCLUSION. In the CMC group the survival rate and the event free rate were lower, and the rate of reoperation was higher than in the other two groups.

  19. Carotid thromboses in the early postoperative period after carotid endarterectomy.

    Pokrovskiĭ, A V; Kuntsevich, G I; Beloiartsev, D F; Timina, I E; Kolosov, R V


    The paper analyzes 10 cases of internal carotid artery (ICA) thrombosis, which occurred after 635 carotid endarterectomies (CEA), carried out from January 1997 to July 2004. CEA procedures included 346 (54.5%) open CEAs with PTFE patch angioplasty and 289 (45.5%) eversion CEAs. Patients with thromboses in the reconstructed area (n=10) had the profiles of comorbidities and cerebrovascular insufficiency grade similar to the total CEA group (p>0.1). Differences concerned the higher rate of atrial fibrillation cases (10%), diabetes mellitus (30%) and contralateral ICA occlusions (20%) in the group of thromboses (p>0.1). Among these 10 patients, 5 underwent eversion CEA (1.44% of the total eversion CEA group) and 5 - open CEA with patch angioplasty (1.73%). In 8 patients thromboses manifested as local neurological symptoms in the area supplied by the operated carotid artery. One patient demonstrated the progression of general cerebral symptomatology, while in the tenth patient thrombosis was accompanied with cerebral coma. Urgent ultrasonography in 7 patients failed to detect a blood flow in ICA, that proved the diagnosis of ICA thrombosis; in 3 patients ultrasonography showed a mural thrombosis. Nine patients underwent reoperation in emergency, while for the tenth patient an intervention was contraindicated due to the thrombosis of middle cerebral artery, unstable clinical state (cerebral coma) and progression of neurological symptomatology. PTFE arterial graft was implantedin 7 reoperated patients with ICA thrombosis, thrombectomy from ICA was carried out in 1 patient and in another one patient a thrombectomy from reconstructed segment with PTFE patch angioplasty of the arteriotomy defect was fulfilled. In 3 reoperated patients a complete resolution of neurological symptoms was evident 24 hours after intervention, in 2 patients neurological symptomatology regressed over 2-4 weeks. In another 3 reoperated patients local neurological symptoms persisted; 1 patient

  20. Restoring Environmental Flows by Modifying Dam Operations

    Gregory A. Thomas


    Full Text Available The construction of new dams has become one of the most controversial issues in global efforts to alleviate poverty, improve human health, and strengthen regional economies. Unfortunately, this controversy has overshadowed the tremendous opportunity that exists for modifying the operations of existing dams to recover many of the environmental and social benefits of healthy ecosystems that have been compromised by present modes of dam operation. The potential benefits of dam "re-operation" include recovery of fish, shellfish, and other wildlife populations valued both commercially and recreationally, including estuarine species; reactivation of the flood storage and water purification benefits that occur when floods are allowed to flow into floodplain forests and wetlands; regaining some semblance of the naturally dynamic balance between river erosion and sedimentation that shapes physical habitat complexity, and arresting problems associated with geomorphic imbalances; cultural and spiritual uses of rivers; and many other socially valued products and services. This paper describes an assessment framework that can be used to evaluate the benefits that might be restored through dam re-operation. Assessing the potential benefits of dam re-operation begins by characterizing the dam's effects on the river flow regime, and formulating hypotheses about the ecological and social benefits that might be restored by releasing water from the dam in a manner that more closely resembles natural flow patterns. These hypotheses can be tested by implementing a re-operation plan, tracking the response of the ecosystem, and continually refining dam operations through adaptive management. The paper highlights a number of land and water management strategies useful in implementing a dam re-operation plan, with reference to a variety of management contexts ranging from individual dams to cascades of dams along a river to regional energy grids. Because many of the

  1. Impact of systemic steroids on posttonsillectomy bleeding: analysis of 61 430 patients using a national inpatient database in Japan.

    Suzuki, Sayaka; Yasunaga, Hideo; Matsui, Hiroki; Horiguchi, Hiromasa; Fushimi, Kiyohide; Yamasoba, Tatsuya


    Although postoperative bleeding after tonsillectomy is rare, it is potentially life-threatening. The association between steroid administration and postoperative bleeding remains controversial. The findings of previous studies were limited by small sample sizes. To examine the impact of intravenous steroid administration on posttonsillectomy bleeding requiring reoperation in children and adults. Retrospective cohort study of 61 430 patients from 718 hospitals who underwent tonsillectomy between 2007 and 2013, using the Diagnosis Procedure Combination database in Japan. Intravenous steroid administration on the day of tonsillectomy. The main outcome measure was reoperation for hemostasis under general anesthesia. Patient characteristics (age, sex, comorbidities) and steroid use were examined. Patients were classified as children (age ≤15 years, n = 31 934) and adults (age >15 years, n = 29 496), and subclassified into those who received intravenous steroid therapy on the day of tonsillectomy (steroid group) and those who did not (control group). Multivariable logistic regression analysis was performed to analyze the association between steroid use and posttonsillectomy bleeding with adjustment for patient characteristics. The rate of reoperation was significantly higher in the steroid group than in the control group for children (1.2% vs 0.5%) (P after tonsillectomy. After adjusting for patient characteristics, we found a significant increase in the rate of reoperation in the steroid group in children (adjusted odds ratio [OR], 2.50 [95% CI, 1.47-4.23]) (P = .001) but not in adults (OR, 1.18 [95% CI, 0.85-1.64]) (P = .31). Intravenous steroid administration on the day of tonsillectomy in children was an independent risk factor for severe bleeding requiring reoperation.

  2. Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality.

    Ndayizeye, Leonard; Ngarambe, Christian; Smart, Blair; Riviello, Robert; Majyambere, Jean Paul; Rickard, Jennifer


    Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital. Copyright © 2016 Elsevier Inc. All rights reserved.


    Gao, Yashan; Zan, Tao; Li, Haizhou; Li, Qingfeng


    To study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. A total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and pre-expanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. The patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). Pre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.

  4. Infective Endocarditis With Paravalvular Extension: 35-Year Experience.

    Rouzé, Simon; Flécher, Erwan; Revest, Matthieu; Anselmi, Amedeo; Aymami, Marie; Roisné, Antoine; Guihaire, Julien; Verhoye, Jean Philippe


    We investigated our surgical strategy and clinical results in patients from active infective endocarditis (AIE) complicated by paravalvular involvement to determine the risk factors of early and late death and reoperation. From October 1979 to December 2014, 955 patients underwent operations for AIE; among them 207 had AIE with paravalvular extension. The patients were a mean age of 59.9 ± 15.4 years, and 162 (78%) were male. Of these patients, 137 (66%) had isolated aortic valve endocarditis, and 138 (67%) had native valve endocarditis. Follow-up was 99% complete. The operative mortality of the cohort was 16% (n = 34). Abnormal communication, mechanical valve implantation, and renal failure were independent predictors of 30-day death. Survival at 1, 5, 10, and 15 years was 90.3% ± 2.3%, 62.4% ± 3.7%, 49.3% ± 4.1%, and 37.9% ± 4.4%, respectively. Streptococcus endocarditis (all species), complex annular repair, and preoperative heart failure were independent predictors of long-term death. A reoperation was required in 29 patients (14%). Streptococcus pneumoniae endocarditis was the only independent predictor of early reoperation (within 30 days after the operation or during the same hospitalization). Freedom from reoperation at 1, 5, 10, and 15 years was 91.9% ± 2.2%, 89.6% ± 2.6%, 89.6% ± 2.6%, and 87.0% ± 3.5%, respectively. Independent predictors of late reoperation were urgent/emergency operation, prosthetic valve endocarditis, and complex annular repair. AIE complicated by paravalvular involvement remains a surgical challenge. Valve replacement (particularly using bioprosthesis) associated with ad hoc reconstruction seems to be a reliable option and showed very encouraging results in this context. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Durability of bioprostheses for the tricuspid valve in patients with congenital heart disease.

    Burri, Melchior; Vogt, Manfred O; Hörer, Jürgen; Cleuziou, Julie; Kasnar-Samprec, Jelena; Kühn, Andreas; Lange, Rüdiger; Schreiber, Christian


    Only little data exist on the durability of bioprostheses in the tricuspid position in patients with congenital heart disease (CHD). The aim of the study was to determine the reoperation rate and the valve function after primary implantation. Between 1990 and 2013, 51 patients with CHD underwent tricuspid valve (TV) replacement with a bioprosthesis. The median age at operation was 32 years (range: 8-69). The underlying morphology was Ebstein's anomaly in 62% of the patients. Implanted valves included 38 pericardial and 13 porcine valves. All available echocardiographic examinations (n = 714) and clinical data were retrospectively reviewed. Dysfunction was defined as an at least moderate regurgitation or a mean diastolic gradient ≥9 mmHg. Freedom from death, reoperation and prosthetic valve dysfunction was estimated using the Kaplan-Meier method. The 30-day mortality rate was 9%. The estimated survival rate was 86% at one and 80% at ten years. The freedom from reoperation at 1, 5 and 10 years was 100, 86 and 81%, and that from prosthesis dysfunction detected by echocardiography at 1, 5 and 10 years was 89, 66 and 58%, respectively. The main reason for dysfunction was insufficiency (89%). Valve implantation at an age below 16 years was associated with earlier reoperation and dysfunction (the 5-year freedom rate from reoperation/dysfunction was 70%/30% compared with 89%/78% in the rest of the patients, P = 0.016/0.0009). Serial echocardiography shows a high rate of dysfunction of TV bioprosthesis in patients with CHD, which already occurred a few years after implantation. In patients below 16 years of age, most prostheses are dysfunctional within 5 years. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Late results of mitral valve repair with glutaraldehyde-treated autologous pericardium.

    Shomura, Yu; Okada, Yukikatsu; Nasu, Michihiro; Koyama, Tadaaki; Yuzaki, Mitsuru; Murashita, Takashi; Fukunaga, Naoto; Konishi, Yasunobu


    Mitral valve repair is an established surgical procedure for treating severe organic mitral regurgitation. The mechanisms of mitral regurgitation due to infective endocarditis include rheumatic disease and congenital diseases such as a lack of leaflet tissue, and thus additional material is required to create a functional coaptation surface. We review our experience with 139 patients who underwent mitral valve repair with glutaraldehyde-treated autologous pericardium to treat organic mitral regurgitation between March 1992 and November 2011. Mitral valve disease mainly consisted of infective endocarditis in 51 patients (active, n = 32; healed, n = 19) and rheumatic disease in 47. This procedure was also applied to 12 patients who required reoperation after mitral valve repair for degenerative, congenital, or rheumatic mitral regurgitation. The mean follow-up was 4.5 ± 4.3 years (maximum 19.1). Actuarial survival at 10 years was 84% ± 5%. Eleven reoperations proceeded at a mean of 68 months after surgery. The causes of reoperation were rheumatic disease progression (n = 4), infection (n = 3), patch dehiscence (n = 2), progressive fibrosis of the remaining mitral valve tissue after infective endocarditis (n = 1), and patch tear (n = 1). Mitral valves were replaced in 8 patients and re-repaired in 3 patients. The autologous pericardium was not calcified at the time of reoperation. The rate of freedom from reoperation was 82% ± 7% at 10 years. Mitral valves that might otherwise require replacement can be durably and predictably repaired using glutaraldehyde-treated autologous pericardium. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Risk profiles and outcomes of total laparoscopic hysterectomy compared with laparoscopically assisted vaginal hysterectomy.

    Hanwright, Philip J; Mioton, Lauren M; Thomassee, May S; Bilimoria, Karl Y; Van Arsdale, John; Brill, Elizabeth; Kim, John Y S


    With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes. A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; Plaparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07-1.42). Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity. II.

  8. Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions.

    Dias, Cláudia Camila; Rodrigues, Pedro Pereira; Coelho, Rosa; Santos, Paula Moura; Fernandes, Samuel; Lago, Paula; Caetano, Cidalina; Rodrigues, Ângela; Portela, Francisco; Oliveira, Ana; Ministro, Paula; Cancela, Eugénia; Vieira, Ana Isabel; Barosa, Rita; Cotter, José; Carvalho, Pedro; Cremers, Isabelle; Trabulo, Daniel; Caldeira, Paulo; Antunes, Artur; Rosa, Isadora; Moleiro, Joana; Peixe, Paula; Herculano, Rita; Gonçalves, Raquel; Gonçalves, Bruno; Sousa, Helena Tavares; Contente, Luís; Morna, Henrique; Lopes, Susana; Magro, Fernando


    The establishment of prognostic models for Crohn's disease [CD] is highly desirable, as they have the potential to guide physicians in the decision-making process concerning therapeutic choices, thus improving patients' health and quality of life. Our aim was to derive models for disabling CD and reoperation based solely on clinical/demographic data. A multicentric and retrospectively enrolled cohort of CD patients, subject to early surgery or immunosuppression, was analysed in order to build Bayesian network models and risk matrices. The final results were validated internally and with a multicentric and prospectively enrolled cohort. The derivation cohort included a total of 489 CD patients [64% with disabling disease and 18% who needed reoperation], while the validation cohort included 129 CD patients with similar outcome proportions. The Bayesian models achieved an area under the curve of 78% for disabling disease and 86% for reoperation. Age at diagnosis, perianal disease, disease aggressiveness and early therapeutic decisions were found to be significant factors, and were used to construct user-friendly matrices depicting the probability of each outcome in patients with various combinations of these factors. The matrices exhibit good performance for the most important criteria: disabling disease positive post-test odds = 8.00 [2.72-23.44] and reoperation negative post-test odds = 0.02 [0.00-0.11]. Clinical and demographical risk factors for disabling CD and reoperation were determined and their impact was quantified by means of risk matrices, which are applicable as bedside clinical tools that can help physicians during therapeutic decisions in early disease management.

  9. Does Preputial Reconstruction Increase Complication Rate Of Hypospadias Repair? 20-Year Systematic Review And Meta-analysis

    Marco eCastagnetti


    Full Text Available Introduction: We performed a systematic review of the literature on preputial reconstruction (PR during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely fistula formation and overall reoperation rate of the repair.Material and Methods: A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword hypospadias. Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected. A meta-analysis of studies comparing PR vs. circumcision was performed for the outcomes hypospadias fistula formation and reoperation rate.Results: Twenty studies were identified. Nineteen reported the outcome of PR in 2115 patients. Overall, 95% (2016/2115 of patients undergoing PR had distal hypospadias. The cumulative rate of PR complications was 7.7% (163/2115 patients, including 5.7% (121/2115 patients preputial dehiscences and 1.5% (35/2117 reported patients secondary phimoses needing circumcision. A meta-analysis of 7 studies comparing patients undergoing PR vs. circumcision, showed no increased risk of urethral fistula formation associated with PR, Odds Ratio (Mantel-Haenszel, Fixed effect, 95% CI, 1.25 (0.80-1.97. Likewise, two studies comparing the overall reoperation rate did not show an increased risk of reoperation associated with PR, Odds Ratio (Mantel-Haenszel, Random effect, 95% CI, 1.27 (0.45-3.58. Conclusions: Preputial reconstruction carries an 8% risk of specific complications (dehiscence of reconstructed prepuce or secondary phimosis needing circumcision, but does not seem to increase the risk of urethroplasty complications, and the overall reoperation rate of hypospadias repair.

  10. Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis.

    Dea, Nicolas; Fisher, Charles G; Batke, Juliet; Strelzow, Jason; Mendelsohn, Daniel; Paquette, Scott J; Kwon, Brian K; Boyd, Michael D; Dvorak, Marcel F S; Street, John T


    Pedicle screws are routinely used in contemporary spinal surgery. Screw misplacement may be asymptomatic but is also correlated with potential adverse events. Computer-assisted surgery (CAS) has been associated with improved screw placement accuracy rates. However, this technology has substantial acquisition and maintenance costs. Despite its increasing usage, no rigorous full economic evaluation comparing this technology to current standard of care has been reported. Medical costs are exploding in an unsustainable way. Health economic theory requires that medical equipment costs be compared with expected benefits. To answer this question for computer-assisted spinal surgery, we present an economic evaluation looking specifically at symptomatic misplaced screws leading to reoperation secondary to neurologic deficits or biomechanical concerns. The study design was an observational case-control study from prospectively collected data of consecutive patients treated with the aid of CAS (treatment group) compared with a matched historical cohort of patients treated with conventional fluoroscopy (control group). The patient sample consisted of consecutive patients treated surgically at a quaternary academic center. The primary effectiveness measure studied was the number of reoperations for misplaced screws within 1 year of the index surgery. Secondary outcome measures included were total adverse event rate and postoperative computed tomography usage for pedicle screw examination. A patient-level data cost-effectiveness analysis from the hospital perspective was conducted to determine the value of a navigation system coupled with intraoperative 3-D imaging (O-arm Imaging and the StealthStation S7 Navigation Systems, Medtronic, Louisville, CO, USA) in adult spinal surgery. The capital costs for both alternatives were reported as equivalent annual costs based on the annuitization of capital expenditures method using a 3% discount rate and a 7-year amortization period

  11. Laparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis

    Thornell, Anders; Angenete, Eva; Bisgaard, Thue


    BACKGROUND: Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. OBJECTIVE: To compare laparoscopic...... lavage with open colon resection and colostomy (Hartmann procedure) for perforated diverticulitis with purulent peritonitis. DESIGN: Randomized, controlled, multicenter, open-label trial. (ISRCTN registry number: ISRCTN82208287). SETTING: 9 hospitals in Sweden and Denmark. PATIENTS: Patients who have...... confirmed Hinchey grade III perforated diverticulitis with purulent peritonitis at diagnostic laparoscopy. INTERVENTION: Randomization between laparoscopic lavage and the Hartmann procedure. MEASUREMENTS: Primary outcome was the percentage of patients having 1 or more reoperations within 12 months. Key...

  12. Early results and future challenges of the Danish Fracture Database

    Gromov, K.; Brix, Michael; Kallemose, T.


    (currently 15,000). 85% of all procedures were performed on adult fractures and 15% on paediatric fractures. Proximal femur (33%), distal radius (15%) and malleolar fractures (12%) were the three most common primary adult fractures. Pain and discomfort from orthopaedic hardware, infection and failure......INTRODUCTION: The Danish Fracture Database (DFDB) was established in 2011 to establish nationwide prospective quality assessment of all fracture-related surgery. In this paper, we describe the DFDB's setup, present preliminary data from the first annual report and discuss its future potential...... are registered. Indication for reoperation is also recorded. The reoperation rate and the one-year mortality are the primary indicators of quality. RESULTS: Approximately 10,000 fracture-related surgical procedures were registered in the database at the time of presentation of the first annual DFDB report...

  13. Combined use of choledochoscope and duodenoscope in treatment of bile peritonitis after removal of T-tube

    Guo-Qiang Zhang; Yu-Hui Zhang; Chao-Min Shen; Jin-Rong Liang


    BACKGROUND:Biliary leakage after removal of a T-tube has signiifcant morbidity and mortality. Its etiology is multifactorial. The treatment and outcome of this complication vary. In the present study we evaluated the procedures and efifcacy of combined use of choledochoscope and duodenoscope in the treatment of bile peritonitis after T-tube removal. METHODS: The procedures and results of 11 cases of biliary leakage after removal of T-tube who had been treated from January 1998 to June 2004 by combined use of choledochoscope and duodenoscope were analyzed retrospectively. RESULT:After the treatment, 9 patients were cured, and 2 were reoperated on and cured. CONCLUSIONS:Biliary leakage after removal of T-tube can be cured successfully by combined use of choledochoscope and duodenoscope. Importantly, the method is simple, effective and safe, and mostly reoperation can be avoided.

  14. Treatment of displaced neck fractures of the femur with total hip arthroplasty.

    Rudelli, Sergio; Viriato, Sergio P; Meireles, Tadeu L O; Frederico, Tiago N


    We report our experience in unstable fractures of the femoral neck in a consecutive series of patients who underwent total hip arthroplasty. Over a period of 12 years, 88 patients were treated with a cemented total hip arthroplasty; 3 patients were lost to follow-up, leaving 86 fractures (85 patients) for retrospective analysis. Seven patients had dislocations, all but 1 of which were treated successfully without reoperation. Four patients required reoperation in the same hip undergoing arthroplasty. There was a graded increase in mortality rates across the continuum of risk groups at the time of surgery. The low incidence (4.6%) of a second procedure on the hip repaired initially, as well as low mortality rates, makes this treatment strategy quite satisfactory.

  15. Risk of femoral hernia after inguinal herniorrhaphy

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H


    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  16. Bioresorbable adhesion barrier for reducing the severity of postoperative cardiac adhesions: Focus on REPEL-CV®

    Martin Haensig


    Full Text Available Martin Haensig, Friedrich Wilhelm Mohr, Ardawan Julian RastanDepartment of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, GermanyAbstract: Treatment of a number of congenital heart defects often necessitates staged surgical intervention. In addition, substantial improvements in postoperative cardiac care and more liberal use of biological valve substitutes have resulted in many adult patients surviving to become potential candidates for reoperations to repair or replace valves or to undergo additional revascularization procedures. In all these scenarios, surgeons are confronted with cardiac adhesions, leading to an increased surgical risk. Thus, bioresorbable adhesion barriers had become of increasing interest because they are easy to use, and safe and effective. This review focuses on the mechanisms by which REPEL-CV® prevents adhesive processes, as well as the development, design, and materials used, and also summarizes efficacy studies, clinical data, safety, and current role in therapy.Keywords: adhesion prevention, bioresorbable copolymer, cardiac reoperation

  17. Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction

    Bonde, Christian; Khorasani, Hoda; Højvig, Jens


    because of the well-known side effects of NSAID treatment (bleeding/gastrointestinal ulcers). However, COX-2 inhibitors have been suggested to increase flap failure rates. We report our experience in using COX-2 inhibitors as part of our post-operative MOSA after ABR using free flaps. MATERIALS......BACKGROUND: A key component of modern analgesics is the use of multimodal opioid-sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors are superior to NSAIDs...... focus on reoperations due to bleeding/haematomas and flap thrombosis/failure. Comparisons between the COX-2 inhibitor and NSAID were made. RESULTS: Median age, ischaemia time, blood loss and operating time were similar in the two periods. Significantly, more patients were re-operated because of post...

  18. [A case of pancreatic and duodenal fistula after total gastrectomy successfully treated with coagulation factor XIII].

    Nishino, Hitoe; Kojima, Kazuhiro; Oshima, Hirokazu; Nakagawa, Koji; Fumura, Masao; Kikuchi, Norio


    Pancreatic fistula( PF) is a challenging postoperative complication. We report a case of PF following gastrectomy successfully treated using intravenous coagulation factor XIII( FXIII).A 78-year-old man with early gastric cancer underwent total gastrectomy with Roux-en-Y reconstruction. PF developed postoperatively, following which, leakage from the duodenal stump was observed. Percutaneous drainage and re-operative surgery were performed. A somatostatin analogue, antibiotic drugs, and gabexate mesilate were administrated along with nutritional support. The pancreatic and duodenal fistula had been producing duodenal juice for over 30 days since the re-operative surgery. As suspected, reduced FXIII activity was confirmed in the patient. After administering FXIII for 5 days, the amount of duodenal juice from the fistula markedly reduced, and the fistula closed immediately afterwards. The results of our study suggest that administration of FXIII could be a reasonable and effective treatment for patients with pancreatic or/and enterocutaneous fistula who are resistant to standard treatments.

  19. Fibrin sealant for mesh fixation in laparoscopic groin hernia repair does not increase long-term recurrence

    Fenger, Andreas Qwist; Helvind, Neel Maria; Pommergaard, Hans-Christian;


    ) laparoscopic groin hernia repair using either fibrin sealant or tacks for mesh fixation. METHODS: This study used data from the Danish Hernia Database to create the following cohort: All patients operated laparoscopically for primary groin hernia with a TAPP procedure using fibrin sealant for mesh fixation....... These patients were matched 1:2 with patients, where the mesh was fixated using tacks. A validated questionnaire was sent to all included patients to determine recurrence, which was defined as reoperation or clinical diagnosis of recurrence by a physician. Follow-up was from index operation to either reoperation...... were found, of which 30 (5.8%) were in the fibrin sealant group and 84 (8.3%) in the tacks group (p = 0.084). The Cox regression analysis found no difference in recurrence with the use of tacks compared to fibrin sealant (hazard ratio 0.8) [95% CI (0.5-1.2)]. CONCLUSION: We found no significant...

  20. Association of previous Cesarean delivery with surgical complications after a hysterectomy later in life

    Lindquist, Sofie A. I.; Shah, Neel; Overgaard, Charlotte


    Importance: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. Objective: To investigate whether previous cesarean delivery increases the risk...... of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. Design, Setting, and Participants: This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993......, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Exposure: Cesarean delivery. Main Outcomes and Measures: Reoperation, perioperative and postoperative complications, and blood...

  1. Adaptability of language-related brain network in a low-grade glioma patient

    Olivera Sveljo; Katarina Koprivsek; Milos Lucic


    Because functional magnetic resonance imaging can be used for dynamic observation of functional cortical changes after brain injuries, we followed up functional magnetic resonance imaging manifestationsof a language-related brain network in a low -grade glioma patient. Disease progressionand therapy during a 3-year period were followed up at different time points: before and after reoperation,after radiation therapy, and 1 year after irradiation. During the whole 3-year follow -up period,the patient exhibited no neurological deficits while functional magnetic resonance imaging revealeddifferent topologies of the language-related brain network. During disease progression and after irradiation,the language-related brain network was extended or completely transferred to the nondominant(right) hemisphere. In addition, after reoperation and 1 year after irradiation, languageareas were primarily found in the language dominant (left) hemisphere. Our results suggest a highlevel of adaptability of the language-related cortical network of the bilateral hemispheres in thislow -grade glioma patient.

  2. Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis-a meta-analysis

    Angenete, Eva; Bock, David; Rosenberg, Jacob;


    PURPOSE: Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mort......PURPOSE: Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity......, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis. METHODS: PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched. Published randomized controlled trials and prospective and retrospective cohorts...... compared to colon resection, with overall comparable morbidity and mortality. Furthermore, Hartmann's resection was more costly than laparoscopic lavage. We therefore consider laparoscopic lavage a valid alternative to surgery with resection for perforated purulent diverticulitis....

  3. Surgery for lumbar disc herniation: Analysis of 500 consecutive patients treated in an interdisciplinary spine centre.

    Schmid, S L; Wechsler, C; Farshad, M; Antoniadis, A; Ulrich, N H; Min, K; Woernle, C M


    Surgical removal of a symptomatic herniated lumbar disc is performed either with or without the support of a microscope. Up to the time of writing, the literature has reported similar clinical outcomes for the two procedures. Five hundred consecutive patients, operated upon for primary single-level lumbar disc herniation in our University Spine Center between 2003-2011, with (n=275), or without (n=225), the aid of a microscope were included. Data were retrospectively analyzed, comparing the primary endpoint of clinical outcome and the secondary endpoints of complications, surgical time and length of hospitalization. Clinical outcomes and reoperation rates were comparable in both groups. Surgical time was significantly shorter with a mean time of 47minutes without use of the microscope compared to the mean time of 87minutes (plumbar disc herniation is associated with similar clinical outcomes and reoperation rates. Open sequestrectomy is associated with shorter operation times. Microdiscectomy is associated with shorter hospitalization stays.

  4. Deep SSI after mesh-mediated groin hernia repair: management and outcome in an Emergency Surgery Department.

    Salamone, G; Licari, L; Augello, G; Campanella, S; Falco, N; Tutino, R; Cocorullo, G; Gullo, R; Raspanti, C; De Marco, P; Porrello, C; Profita, G; Gulotta, G


    Mesh-mediated groin hernia repair is considered the goldstandard procedure. It has low recurrence rate. Rarely a deep Surgical Site Infection (SSI) is seen when a synthetic prosthesis is used. We describe a rare case of bilateral deep SSI after mesh-mediated groin hernia repair. Diagnosis was performed through the physical examination and radiological exams. Microbiological samples identified a methicillin-resistant Staphylococcus aureus responsible of the infection. Target therapy was performed and re-operation performed in order to remove the infected prosthesis and to apply a biological one to create the fibrous scaffold. During follow-up time, right side recurrence was observed. Tru-cut biopsy of fascia was obtained in order to identify the responsible of the recurrence. Combination of antibiotic therapy and surgical reoperation seems to be the correct way to approach the deep SSI after mesh-mediated groin hernia repair. The use of biological mesh after synthetic removal seems to improve the final outcome.

  5. Sliding inguinal hernia is a risk factor for recurrence

    Andresen, Kristoffer; Bisgaard, Thue; Rosenberg, Jacob


    PURPOSE: A sliding inguinal hernia is defined as a hernia where part of the hernial sac wall is formed by an organ, e.g., the colon or bladder. Thus, repair of a sliding inguinal hernia may have higher risk of complications and recurrence compared with non-sliding inguinal hernia. The aim...... of this study was to investigate the incidence and reoperation rates following sliding inguinal hernia repair. METHODS: This study was based on data from the Danish Hernia Database covering the period between January 1, 1998 and February 22, 2012. Data were collected prospectively and nationwide. RESULTS......: In total, 70,091 primary hernia repairs were included for analysis. The occurrence of sliding inguinal hernias of the total group of included hernia repairs was 9.4 % among males and 2.9 % among females (p inguinal hernias had a higher cumulated reoperation rate...

  6. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    Andersen, M. J.; Gromov, K.; Brix, M.


    INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Muller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...... by interns were performed under supervision, whereas 32% of operations by junior residents were unsupervised. Supervision was absent in 14-16% and 22-33% of the three most frequent primary procedures and reoperations when performed by interns and junior residents, respectively. The proportion of unsupervised...

  7. A new algorithm for hip fracture surgery

    Palm, Henrik; Krasheninnikoff, Michael; Holck, Kim


    Background and purpose Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results. Methods 2,000 consecutive patients over 50...... years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient...... by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced. Interpretation It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised...

  8. Locking plate osteosynthesis of clavicle fractures

    Fridberg, Marie; Ban, Ilija; Issa, Zaid


    PURPOSE: Locking plate osteosynthesis has become the preferred method for operative treatment of clavicle fractures. The method offers stable fixation, and would theoretically be associated with a low rate of fracture-related complications and reoperations. However, this remains to be explored...... in a large cohort, and our purpose was to assess the overall rates of complications and reoperations following locking plate osteosynthesis of mid-shaft clavicle fractures. METHODS: We identified all locking plate osteosynthesis of mid-shaft clavicle fractures operated upon in our department from January...... 2008 to November 2010 (n = 114). Nine patients did not attend the follow-up at our institution. The study group of 105 fractures (104 patients, 86 males) had a median age of 36 years (14-75 years). Follow-up ranged from 0.5 to 3.5 years. No patients were allowed to load the upper extremity for six...

  9. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    Andersen, Morten Jon; Gromov, Kirill; Brix, Michael


    INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Müller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...

  10. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

    Andersen, M. J.; Gromov, K.; Brix, M.


    INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Muller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...

  11. [Image-guided endoscopic transsphenoidal removal of pituitary adenoma].

    Zhang, Qui-Hang; Liu, Hai-Sheng; Yang, Da-Zhang; Cheng, Jing-Yu


    To assess the role of neuronavigation in assisting endoscopic transsphenoidal surgery for pituitary adenomas. Ten endoscopic endonasal transsphenoidal reoperations for pituitary adenomas were selected. Clinical records were reviewed retrospectively. Five of 10 patients had gigantic adenoma, 3 microadenoma, 2 large adenoma. The mean setup time was 5 minutes, and the operative time was 50 minutes in image-guided procedures. In all cases, the system worked well without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of intraoperative accuracy in the axial, coronal, and.sagittal planes indicated a mean verified system error of 1.5 mm. for pituitary adenomas. After operation, the symptoms relieved in all patients. Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and safer.

  12. Risk of femoral hernia after inguinal herniorrhaphy

    Mikkelsen, T; Bay-Nielsen, M; Kehlet, H


    BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July...... 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database....... The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia...

  13. Adverse Event Recording and Reporting in Clinical Trials Comparing Lumbar Disk Replacement with Lumbar Fusion: A Systematic Review

    HIRATZKA, JAYME; Rastegar, Farbod; Contag, Alec G.; Norvell, Daniel C.; Anderson, Paul A.; Hart, Robert A


    Study Design Systematic review. Objectives (1) To compare the quality of adverse event (AE) methodology and reporting among randomized trials comparing lumbar fusion with lumbar total disk replacement (TDR) using established AE reporting systems; (2) to compare the AEs and reoperations of lumbar spinal fusion with those from lumbar TDR; (3) to make recommendations on how to report AEs in randomized controlled trials (RCTs) so that surgeons and patients have more-detailed and comprehensive inf...

  14. Technologies for Hemostasis and Stabilization of the Acute Traumatic Wound


    cells [22]. We recently reportedtheproductionofrecombinanthumanFI (rhFI) made at high concentrations in the milk of dairy cows [23]. Re...operation Iraqi Freedom and operation Enduring Freedom. J Trauma 64: 295–299. 5. Gerhardt R, Mabry R, De Lorenzo R, Butler F (2012) Fundamentals of...bandage toxicity (subject growth, serum chemistry , histology). Results: Pre-injury weight, VS, and laboratory testing did not differ among groups

  15. Treatment of delayed rupture of the left ventricle after mitral valve replacement

    Gomes Walter J.


    Full Text Available Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.

  16. A Prospective Study on the Outcome of Degenerative Lumbar Spinal Stenosis Treated With Open Laminotomy

    Martin Wong Chung-Ting


    Result: There were significant improvement of mean Japanese Orthopaedic Association lumbar score, Oswestry Disability Index(ODI, and visual analogue scale (VAS. Male had significantly better result in ODI and VAS. There was no significant difference regarding to older age (>65 or the presence of preexisting degenerative spondylolisthesis. One patient was found to have increased lumbar instability after operation. The overall reoperation rate was 6.9%.

  17. Needlescopic video-assisted thoracic surgery for reversal of thoracic sympathectomy.

    Wong, Randolph H L; Ng, Calvin S H; Wong, Jasper K W; Tsang, Susanna


    Thoracic sympathectomy is a commonly performed surgical procedure for the treatment of palmar hyperhidrosis. However, one major complication of such a procedure is compensatory truncal hyperhidrosis. We describe an extreme case of compensatory truncal hyperhidrosis and anhidrosis over the head and neck region which led to a heatstroke. Bilateral reoperative needlescopic video-assisted thoracic surgery was performed for the reversal of thoracic sympathectomy with an interposition intercostal nerve graft. The patient's truncal hyperhidrosis resolved gradually over 1 month following the reversal procedure.

  18. Interventional Radiology Procedures after Pancreatic Resections for Pancreatic and Periampullary Diseases

    Riccardo Casadei


    Full Text Available Context The use of interventional radiology has increased as the first-line management of complications after pancreatic resections. Methods Patients in whom interventional radiology was performed were compared with those in whom interventional radiology was not performed as regards type of pancreatic resection, diagnosis, postoperative mortality and morbidity, postoperative pancreatic fistula postpancreatectomy haemorrhage, bile leakage, reoperation rate and length of hospital stay. Our aim was to evaluate the usefulness of interventional radiology in the treatment of complications after pancreatic resection. Results One hundred and eighty-two (62.8% out of 290 patients experienced postoperative complications. Interventional radiology procedures were performed in 37 cases (20.3%: percutaneous drainage in 28, transhepatic biliary drainage in 8 and arterial embolisation in 3 cases. Technical success was obtained in all casesand clinical success in 75.7%. Reoperation was avoided in 86.5%. In patients with major complications, clinically relevant postoperative pancreatic fistula and bile leaks as well as those with late postpancreatectomy haemorrhage (P=0.030 and patients with postpancreatectomy haemorrhage grade C (P=0.029, interventional radiology was used (P0.001, P0.001 ad P=0.009, respectively significantly more frequently than in the remaining patients. The reoperation and mortality rates were similar in the two groups (P=0.885 and P=0.100,respectively while patients treated with interventional radiology procedures had a significant longer length of hospital stay than those in the non-iterventional radiology group (37.5 ± 23.4 vs. 18.7 ± 11.7 days; P<0.001. Conclusions Interventional radiology procedures were useful, especially for patients with postoperative pancreatic fistulas and bile leaks in whom reoperation was very often avoided.

  19. Osteochondral destruction in pigmented villonodular synovitis during the clinical course.

    Nishida, Yoshihiro; Tsukushi, Satoshi; Nakashima, Hiroatsu; Sugiura, Hideshi; Yamada, Yoshihisa; Urakawa, Hiroshi; Arai, Eisuke; Ishiguro, Naoki


    In pigmented villonodular synovitis (PVNS), some cases recur and progress to osteochondral destruction. The aim of our study was to clarify the occurrence of osteochondral destruction according to the location of PVNS during the clinical course. Seventy-two patients with PVNS (43 female, 29 male) with a mean age of 40 years (range 3-87 yrs) had been referred to our institutions. Factors influencing the occurrence of osteochondral destruction were investigated. Mean followup was 60 months (range 12-190 mo). Adjacent bone change occurred in 24 (42%) of 57 patients, who were evaluated at the time of the first consultation. Eight (89%) of 9 patients with hip lesions initially had bone lesions, significantly more frequently than those with other lesions (p = 0.038). Duration of symptoms was significantly correlated with the occurrence of bone lesions in diffuse knee lesions (p = 0.005). During followup, patients with location in the knee had a significantly higher incidence of osteoarthritic change (73%) compared to those with foot and ankle involvement (p = 0.027). Re-operation was more frequently required for knee lesions due to the high recurrence rate (32%). Patients who required re-operation had significantly more marked osteoarthritic change in knees (p = 0.001) during followup than those who did not. For PVNS arising in knees, repeated recurrences followed by re-operation resulted in the progression of osteoarthritic change. PVNS arising in hips, feet, and ankles developed bone lesions initially, probably due to the limited volume of these joints. The indications for re-operation for recurrent knee lesions require careful consideration regarding progression of osteoarthritic change.

  20. Aorta-atrial fistula, a rare complication of prosthetic valve endocarditis.

    Dewilde, W; Kurvers, M; Jaarsma, W


    A 51-year-old male with a history of a mechanical Carbomedics aortic and mitral valve replacement in 2003 and several re-operations because of endocarditis of the mitral valve in 2007 presented with heart failure 68 days after operation. Echocardiography confirmed the presence of a fistulous connection between the aorta and the left atrium. Because of the multiple surgical interventions and high operative risk, an initial conservative medical treatment was initiated and the clinical course was uneventful to this date.

  1. Transcatheter Closures for Fistula Tract and Paravalvular Leak after Mitral Valve Replacement and Tricuspid Annuloplasty


    Paravalvular leaks (PVLs) often occur after surgical valve replacement. Surgical reoperation has been the gold standard of therapy for PVLs, but it carries a higher operative risk and an increased incidence of re-leaks compared to the initial surgery. In high surgical risk patients with appropriate geometries, transcatheter closure of PVLs could be an alternative to redo-surgery. Here, we report a case of successful staged transcatheter closures of a fistula tract between the aorta and right ...

  2. Long-term outcomes in patients after epilepsy surgery failure.

    Ryzí, Michal; Brázdil, Milan; Novák, Zdeněk; Hemza, Jan; Chrastina, Jan; Ošlejšková, Hana; Rektor, Ivan; Kuba, Robert


    The primary aim of this study was to analyze the long-term outcomes of patients who were classified as Engel IV one year after resective epilepsy surgery. The secondary objectives were to evaluate the effectiveness of different treatment options and to examine the reasons that the patients did not undergo resective reoperation. Our study was designed as a retrospective open-label investigation of the long-term outcomes of 34 patients (12% of all surgically treated patients) who were classified as Engel IV one year after epilepsy surgery. At the last follow-up visit (average of 7.6 ± 4.2 years after surgery), 12 of the 34 examined patients (35.3%) were still classified as Engel IV; 22 of the 34 patients (64.7%) were improved (Engel I-III). Of the 34 patients, 8 (23.5%) achieved an excellent outcome, classified as Engel I, 3 patients (8.8%) were classified as Engel II, and 11 patients (32.4%) as Engel III. The seizure outcome in the patients classified as Engel I was achieved by resective reoperation in 4; by a change in antiepileptic medication in 3 patients; and by vagus nerve stimulation (VNS) in 1 patient. The seizure outcome of Engel II was achieved by a change in antiepileptic medication in all 3 patients. Of the 34 patients, a total of 6 (17.6%) underwent resective reoperation only. The major reasons for this were the absence of a plausible hypothesis for invasive re-evaluation, the risk of postoperative deficit, and multifocal epilepsy in the rest of patients. Although the reoperation rate was relatively low in our series, we can achieve better or even excellent seizure outcomes using other procedures in patients for whom resective surgery initially failed. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. The effect of mesh removal and selective neurectomy on persistent postherniotomy pain

    Aasvang, Eske K; Kehlet, Henrik


    SUMMARY BACKGROUND DATA AND OBJECTIVE: Persistent pain affects everyday activities in 5% to 8% of patients after groin hernia repair. Because previous reports on the effect of neurectomy and/or mesh removal suffer from methodological problems we performed a detailed prospective trial of the effec...... neurophysiologic assessment is recommended to identify patients who may or may not benefit from reoperation and to allocate patients to specific surgical and/or medical intervention....

  4. Comparison between late-presenting and isolated neonatal congenital diaphragmatic hernias

    Christos Plataras


    Full Text Available Purpose: Late-presenting posterolateral congenital diaphragmatic hernias (CDH are anatomically similar to isolated neonatal CDH but are diagnosed and treated after the first month of life. We aim to characterise the clinical manifestations and short-term postoperative course of this entity and compare it with isolated CDH of the neonatal period. Materials and Methods: In the 30-year period from 1980 to 2010, 116 children with CDH were treated at the Aghia Sophia Children′s Hospital, Athens, Greece. Twenty-three (19% of these children were late-presenting cases, being diagnosed between the ages of 1 month and 4 years. Ninety-three were neonatal cases, of whom 22 (24% were excluded due to severe associated anomalies, leaving 71 cases of isolated neonatal CDH. We compared these two groups of patients with regard to preoperative symptoms, postoperative hospital stay, time to complete feeding, overall complication rate, and reoperation rate. Results: Isolated neonatal cases presented more often with acute respiratory symptoms (n=25; P= 0.016 and failure to thrive (n= 38; P= 0.03. Late-presenting cases presented more often with chronic respiratory symptoms (n=14;P= 0.0044 or gastrointestinal symptoms (n=12; P= 0.006. Thirty-five cases with minor or serious complications were reported in the neonatal group, whereas only five complications were observed in the late-presenting group (P= 0.028. We did not record any recurrences or reoperations in the late-presenting group, but we had two recurrences and three reoperations in the neonatal group. Time to full feeds and postoperative hospital stay was shorter in the late-presenting group. Conclusions: Our data demonstrate differences between the two groups in preoperative symptoms and short-term postoperative complications and short-term outcome. Late-presenting cases of CDH had a greater number of chronic symptoms preoperatively, more favorable postoperative outcomes, and less recurrences and reoperations.

  5. Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation

    Kim Hoon; Ryu Woo; Woo Sang; Son Gil; Lee Eun; Lee Jae; Bae Jeoung


    Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of...

  6. Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room.

    Flint, Alexander C; Chan, Sheila L; Rao, Vivek A; Efron, Allen D; Kalani, Maziyar A; Sheridan, William F


    OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.

  7. Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality?

    Abt, Nicholas B; Reh, Douglas D; Eisele, David W; Francis, Howard W; Gourin, Christine G


    Patients may perceive resident procedural participation as detrimental to their outcome. Our objective is to investigate whether otolaryngology-head and neck surgery (OHNS) housestaff participation is associated with surgical morbidity and mortality. Case-control study. OHNS patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program 2006 to 2013 databases. We compared the incidence of 30-day postoperative morbidity, mortality, readmissions, and reoperations in patients operated on by resident surgeons with attending supervision (AR) with patients operated on by an attending surgeon alone (AO) using cross-tabulations and multivariable regression. There were 27,018 cases with primary surgeon data available, with 9,511 AR cases and 17,507 AO cases. Overall, 3.62% of patients experienced at least one postoperative complication. The AR cohort had a higher complication rate of 5.73% than the AO cohort at 2.48% (P < .001). After controlling for all other variables, there was no significant difference in morbidity (odds ratio [OR] = 1.05 [0.89 to 1.24]), mortality (OR = 0.91 [0.49 to 1.70]), readmission (OR = 1.29 [0.92 to 1.81]), or reoperation (OR = 1.28 [0.91 to 1.80]) for AR compared to AO cases. There was no difference between postgraduate year levels for adjusted 30-day morbidity or mortality. There is an increased incidence of morbidity, mortality, readmission, and reoperation in OHNS surgical cases with resident participation, which appears related to increased comorbidity with AR patients. After controlling for other variables, resident participation was not associated with an increase in 30-day morbidity, mortality, readmission, or reoperation odds. These data suggest that OHNS resident participation in surgical cases is not associated with poorer short-term outcomes. 3b Laryngoscope, 126:2263-2269, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Pacing and Sensing of Human Heart for over 31 Years with the Same Apparatus (Generator and Lead

    Evangelos Papasteriadis


    Full Text Available Several patients receive a permanent pacemaker in a relatively young age, with multiple subsequent reoperations for pacemaker replacement. Pulse generator replacement is an invasive procedure, associated with the risk of various complications, mainly infection and skin erosion. A case of an extremely long-lasting pacemaker with a totally uneventful longevity period over 31 years is presented. The explanation for this quite rare pacemaker longevity (possibly unique is analyzed and discussed.

  9. Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection.

    Clayton, John L; Bazakas, Andrea; Lee, Clara N; Hultman, C Scott; Halvorson, Eric G


    There has been a trend toward limiting perioperative prophylactic antibiotics, based on research not conducted in plastic surgery patients. The authors' university hospital instituted antibiotic prescribing guidelines based on the Surgical Care Improvement Project. An increased rate of surgical-site infections was noted in breast reconstruction patients. The authors sought to determine whether the change in antibiotic prophylaxis regimen affected rates of surgical-site infections. A retrospective study compared patients undergoing breast reconstruction who received preoperative and postoperative prophylactic antibiotics with a group who received only a single dose of preoperative antibiotic. Type of reconstruction and known risk factors for implant infection were noted. Two hundred fifty patients were included: 116 in the pre-Surgical Care Improvement Project group and 134 in the Surgical Care Improvement Project group. The overall rate of surgical-site infections increased from 18.1 percent to 34.3 percent (p = 0.004). Infections requiring reoperation increased from 4.3 percent to 16.4 percent (p = 0.002). Multivariate logistic regression demonstrated that patients in the Surgical Care Improvement group were 4.74 times more likely to develop a surgical-site infection requiring reoperation (95 percent CI, 1.69 to 13.80). Obesity, history of radiation therapy, and reconstruction with tissue expanders were associated with increased rates of surgical-site infection requiring reoperation. Withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of surgical-site infection, reoperation, and thus reconstructive failure. The optimal duration of postoperative prophylactic antibiotic use is the subject of future study.

  10. Surgical outcomes after epiretinal membrane peeling combined with cataract surgery.

    Yiu, Glenn; Marra, Kyle V; Wagley, Sushant; Krishnan, Sheela; Sandhu, Harpal; Kovacs, Kyle; Kuperwaser, Mark; Arroyo, Jorge G


    To compare functional and anatomical outcomes after idiopathic epiretinal membrane (ERM) peeling combined with phacoemulsification and intraocular lens implantation versus ERM peeling alone. A retrospective, non-randomised comparative case series study was conducted of 81 eyes from 79 patients who underwent ERM peeling at the Beth Israel Deaconess Medical Center between 2001 and 2010. Eyes that underwent combined surgery for ERM and cataracts (group 1) were compared with those that had ERM peeling alone (group 2) with respect to best-corrected visual acuity at 6 months and 1 year after surgery, postoperative central macular thickness (CMT) as measured on optical coherence tomography, and rates of complications, including elevated intraocular pressure (IOP), ERM recurrence and need for reoperation. Mean logMAR visual acuity improved significantly in both groups at 6 months (p<0.001) and 1 year (p<0.001) after surgery. There was no statistical difference between the two groups in visual acuity improvement at 6 months (p=0.108) or 1 year (p=0.094). Mean CMT of both groups also significantly decreased after surgery (p=0.002), with no statistical difference in CMT reduction between the two groups, but a trend toward less CMT reduction in group 1 (p=0.061). The rates of complications, including IOP elevation, ERM recurrence and frequency of reoperation, were similar in the two groups, with non-statistical trends toward greater ERM recurrence (p=0.084) and need for reoperation (p=0.096) in those that had combined surgery. Combined surgery for ERMs and cataracts may potentially be as effective as membrane peeling alone with respect to visual and anatomical outcomes. Further studies are necessary to determine if there may be greater ERM recurrence or need for reoperation after combined surgery.

  11. Long-term outcomes of tear-oriented ascending/hemiarch replacements for acute type A aortic dissection.

    Aizawa, Kei; Kawahito, Koji; Misawa, Yoshio


    Extended arch repair for acute type A aortic dissection remains controversial. Our strategy for acute type A aortic dissection was primary entry resection and tear-oriented ascending/hemiarch replacement for patients with the intimal tear in the ascending aorta or is not found in the ascending/aortic arch. Extended total/partial arch replacement was performed for patients with the tear located in the aortic arch. Here, we investigated the validity of our strategy from the viewpoints of long-term survival and reoperation. Between 2003 and 2014, 267 acute type A aortic dissection patients (mean age; 65.2 ± 12.9 years, 134 men and 133 women) underwent emergent surgical repair. Ascending/hemiarch replacements were performed in 225 patients (ascending/hemiarch group) and total/partial arch replacements in 42 patients (arch group). Early and late outcomes of both groups were compared. The hospital mortality rates in the ascending/hemiarch and the arch groups were 4.4 and 9.5 %, respectively (p = 0.25). For ascending/hemiarch and arch groups, the actuarial survival rates were 80.7 vs. 84.3 % after 5 years, and 66.4 vs. 74.6 %, respectively, after 10 years (p = 0.94). For ascending/hemiarch and arch groups, reoperation-free survival rates were 72.1 vs. 77.1 % after 5 years, and 62.0 vs. 67.1 %, respectively, after 10 years (p = 0.85). We observed no significant differences in the actuarial survival or reoperation-free survival rates between the groups. These findings suggest that tear-oriented ascending/hemiarch replacement for acute type A aortic dissection does not increase the risk of long-term mortality or reoperation.

  12. Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

    Edivaldo Massazo Utiyama

    Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

  13. Intra-aortic filtration is effective in collecting hazardous materials.

    Mestres, Carlos-A; Bernabeu, Eduardo; Fernández, Claudio; Colli, Andrea; Josa, Miguel


    Neurological complications after cardiac operations are mostly due to particle embolization. This case illustrates the embolic potential of any material. A 77-year-old lady underwent re-operation for homograft aortic regurgitation and mitral valve replacement. Intra-aortic filtration was used. After cardiopulmonary bypass the filter was found to have captured a pledget from a suture used to secure the mitral replacement device.


    P. A. Vavilov


    Full Text Available In our department from December 1998 to 2009 have been performed 1028 operations with use of prosthesises «MedEng-2»: aortic valve replacement (AVR – 494, mitral valve replacement (MVR – 351 and double valves mitral and aortic replacement (DVR – 183. Remote results are tracked at 76% (719 patients. The 10-years survival rate has made 4532 patient-years of them 3146 pats.-years (86,4% for AVR, 2530 (82,4% for MVR and 836 (82,9% for DVR. Mechanical dysfunctions of artificial valves were not. Freedom from a thrombosis, endocarditis and reoperations at AVR has made 98,7; 97,6; 97,1% accordingly. From embolism complications – 97,5%. For MVR freedom from thrombosis – 96,9%, endocarditis – 97,7%, from reoperations and embolism complications of 99,1 and 91,2%. Freedom from throm- bosis and endocarditis at DVR 100 and 97,4% accordingly. From embolism complications and reoperations – 97,5%. The analysis of 10-years results of replacements prosthetics valves «MedEng-2» has shown its good haemody- namic qualities and satisfactory results both in the nearest, and in the remote terms after operation. 

  15. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland

    Sahanne, Sari; Tuuminen, Raimo; Haukka, Jari; Loukovaara, Sirpa


    Background Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB) with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV). Methods This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50) and PPV (n=269). Changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded at 30 days and reoperation rates within 180 days postoperatively. Results Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test); however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006). Changes in BCVA did not differ between the surgical procedures. Conclusion PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD. PMID:28331284

  16. The recurrent carpal tunnel syndrome.

    Kern, B C; Brock, M; Rudolph, K H; Logemann, H


    Sixteen out of 720 patients with carpal tunnel syndrome who had undergone surgery since 1979 were reoperated for a "recurrence" (2.2%). Twelve of these patients had been originally operated on in our department. Thus, our own recurrence rate is 1.7%. Three patients deteriorated following surgery, 6 had an unsatisfactory improvement, and in 7 the symptoms recurred after initial improvement. Eight of the reoperated patients had a predisposing disease (terminal renal insufficiency, insulin-dependent diabetes mellitus, acromegaly). In 10 of the 16 cases the initial operation had been carried out by surgeons in the first three years of training. Reoperation revealed incomplete splitting of the transverse carpal ligament in 10 cases, compression of the median nerve by the scar in 4, injury of the muscular branch in 1, and an anatomical variant as cause of incomplete decompression in 1 patient. "Recurrences" after carpal tunnel surgery are predominantly due to inadequacies of the first procedure. A remarkable number of patients (50%) has predisposing diseases. Interfascicular or epineural neurolysis and complete exposure and neurolysis of the median nerve and its branches is necessary only in cases of recurrence. Their omission at the first surgery does not result in an increased recurrence rate. Our observations indicate that the number of operations for recurrent carpal tunnel syndrome can probably be reduced when the first operation is performed with care and experience. Patients with carpal tunnel syndrome secondary to a systemic disease are particularly at risk.

  17. Intraoperative nuclear guidance in benign hyperparathyroidism and parathyroid cancer

    Bonjer, H.J. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Surgery; Bruining, H.A. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Surgery; Pols, H.A.P. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Internal Medicine 3; Herder, W.W. de [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Internal Medicine 3; Eijck, C.H.J. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Surgery; Breeman, W.A.P. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Nuclear Medicine; Krenning, E.P. [Univ. Hospital Dijkzigt, Rotterdam (Netherlands). Dept. of Nuclear Medicine


    The success of parathyroid surgery is determined by the identification and removal of all hyperactive parathyroid tissue. Ectopic location of parathyroid tumours and fibrosis due to previous operations can cause failure of parathyroidectomy. Parathyroid tumours accumulate and retain 2-methoxyisobutylisonitrile (MIBI) labelled with technetium-99m. This study assesses the value of intra-operative localization of parathyroid tumours using a hand-held gamma detector in patients with hyperparathyroidism and parathyroid cancer. Twenty patients undergoing their first operations for hyperparathyroidism, 15 patients undergoing reoperations for either persistent or recurrent hyperparathyroidism and two patients with parathyroid cancer were studied. Radioactivity in the neck and the mediastinum was recorded by a gamma detector after administration of 370 MBq {sup 99m}Tc-MIBI. Surgical findings and postoperative serum levels of calcium were documented. The sensitivity of the gamma detector in identifying parathyroid tumours was 90.5% in first parathyroidectomies, 88.9% in reoperations for either persistent or recurrent hyperparathyroidism and 100% in parathyroid cancer. One false-positive result was due to a thyroid nodule. Hypercalcaemia ceased in all but one patient postoperatively. It is concluded that employment of the gamma detector is to be advocated in first parathyroidectomies when a parathyroid tumour cannot be discovered, in reoperations for either persistent or recurrent hyperparathyroidism and in surgery for parathyroid cancer. (orig.)

  18. Is valve repair preferable to valve replacement in ischaemic mitral regurgitation? A systematic review and meta-analysis.

    Salmasi, Mohammad Yousuf; Acharya, Metesh; Humayun, Nada; Baskaran, Dinnish; Hubbard, Stephanie; Vohra, Hunaid


    Ischaemic mitral regurgitation (MR) is associated with poor survival. The favoured surgical option remains debatable. Our aim was to perform a meta-analysis to compare the outcomes of mitral valve repair (MVRp) with replacement (MVR). A literature search was conducted in PubMed, Medline and Ovid using the terms 'ischaemic mitral regurgitation', 'repair' and 'replacement'. The primary outcome measure was 30-day survival. The secondary outcome measures were MR recurrence and reoperation. Out of 310 articles, 18 fulfilled the inclusion criteria. A total of 3978 patients were included: 2563 (64%) MVRp cases and 1415 (36%) MVR cases. Operative techniques included annuloplasty for MVRp and subvalvular apparatus-sparing MVR techniques. Thirty-day mortality was lower after MVRp compared with MVR [OR 0.42; (95% CI 0.33-0.54; P = 0.0001)]. There was no difference in long-term survival ranging 1-5 years (HR 0.85, 95% CI 0.65-1.12). Recurrence of MR was significantly higher in the MVRp group (OR 4.26, 95% CI 2.52-7.22), as was the rate of reoperation (OR 2.03, 95% CI 1.49-2.77). Although MVR for ischaemic MR has a higher 30-day mortality rate compared with MVRp, MVRp is associated with the higher rate of MR recurrence and the need for reoperation. MVR remains an attractive option for ischaemic MR.

  19. [Long-term effect of polystan monocusp ventricular outflow patch after right ventricular outflow tract reconstruction].

    Sugita, T; Matsumoto, M; Ogino, H; Nishizawa, J; Matsuyama, K; Yoshimura, S; Yoshioka, T; Tokuda, Y; Matsumura, M; Suda, K; Ueda, Y


    Forty-eight patients who underwent right ventricular outflow tract reconstruction with Monocusp Ventricular Outflow Patch (MVOP) fifty-five times and survived surgery, were reviewed in this study. Mean age at surgery was 6.4 years-old and mean follow-up interval was 75.2 months. There was no late death, however reoperation was performed 7 times. Freedom from reoperation rate was 97.2% and 80.7% after 5 and 10 years after surgery, respectively. The main cause for reoperation were right ventricular outflow obstruction RVOTO (5 cases). All of the RVOTO occurred at the distal end of the anastomosis. However, there was no RVOTO in patients who underwent RVOTR with MVOP during the past ten years. So, we considered the cause of RVOTO a technical problem. Pulmonary regurgitation was one to two degree early after surgery, and had worsened by almost two or three degrees more than 5 years after surgery. Moreover, five of six patients who underwent cardiac catheterization more than 10 years after surgery had three degrees of pulmonary regurgitation as well as a large CTR. In conclusion, according to long-term results, especially more than 10 years post operatively, pulmonary regurgitation was the most important problem.

  20. A case of extensive skull base tumor (ameloblastoma); Przypadek rozleglego guza podstawy czaszki (ameloblastoma)

    Kukwa, A.; Krajewski, R.; Sujkowska, U. [Klinika Otolaryngologiczna, Oddzial Stomatologii, Akademia Medyczna, Warsaw (Poland)


    The authors present a case of ameloblastoma originating from rt. maxilla and extensively invading skull base. First symptoms appeared 10 years earlier and 8 years before present hospitalization the tumor was removed from maxilla. Pathology showed malignant ameloblastoma. The patient presented with giant tumor occupying whole maxilla, growing into nasal cavity and nasopharynx, invading sphenoid bone, medial parts of pyramids and reaching foramen magnum posteriorly, causing difficulties in swallowing and obstruction of the upper airway. Reoperation using lateral rhinotomy approach was undertaken and the tumor was grossly totally removed from maxillary region and subtotally from the skull base. After four months there was huge recurrence in area of the mandible, peripharyngeal space and subtemporal fossa. The tumor was again removed. Pathology showed polycystic ameloblastoma in specimens from both reoperations. After another 4 months the patient developed signs of upper cervical spinal cord compression and died. In spite of benign histological appearance the extent of tumor infiltration and rapid recurrence after reoperation caused unsatisfactory outcome. (author)

  1. Simultaneous pancreas-kidney transplantation in a single center:10-year retrospective analysis

    ZHENG Jian-ming; SONG Wen-li; TU Jin-peng; FENG Gang; MO Chun-bai; SHEN Zhong-yang


    Background Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment option for diabetic patients with advanced chronic renal failure. The current study aimed to analyze the surgical indications, treatments and prognosis of SPKT.Methods We retrospectively analyzed 40 cases of SPKT performed between December 1999 and January 2010 in our center, including the survival rate, complications and the reasons of reoperation.Results Of all the 40 SPKT cases, the one-year survival rates of the recipients, kidney and pancreas transplant graft were 97.6%, 97.6% and 92.7%, while 97.6%, 91.1%, 92.7% at 3 years and 83.6%, 78.0%, 79.4% at 5 years, respectively.After SPKT, 10 patients need reoperation because of surgical complications (14 operations). The reoperation rate was 25%, including 2 patients (4 operations) with hematuria, 4 patients with abdominal hemorrhage, 2 patients (3 operations)with abdominal infection, 1 patient with pancreatic venous thrombosis, 1 patient with anastomotic leakage, and 1 patient with fistula.Conclusion Although SPKT provides a successful and effective treatment for diabetics with end-stage renal disease,how to reduce the complications of this treatment still need further effort.

  2. Acute internal carotid artery occlusion after carotid endarterectomy

    Masatoshi Yunoki


    Full Text Available We report two cases of acute carotid artery (CA occlusion following carotid endarterectomy (CEA. Case 1: a 58-year-old man was admitted with transient right-sided hemiparesis. Magnetic resonance imaging (MRI and MR angiography (MRA revealed cerebral infarction in the left cerebral hemisphere and left CA stenosis. Ten days after admission, he underwent CEA. 24 h after surgery, he developed right hemiplegia. MRI and MRA demonstrated a slightly enlarged infarction and left internal carotid artery (ICA occlusion. Emergency reoperation was performed and complete recanalization achieved. The patient made a clinically significant recovery. Case 2: a 65 year-old man underwent a right-sided CEA for an asymptomatic 80% CA stenosis. 48 h after surgery, his family noticed he was slightly disorientated. MRI and MRA revealed multiple infarctions and right ICA occlusion. He was treated with antiplatelet therapy without reoperation because sufficient cross-flow from the left ICA through the anterior communicating artery was demonstrated by angiography, and his neurological symptoms were mild. His symptoms gradually alleviated and he was discharged 14 days after surgery. With ICA occlusion after CEA, immediate re-operation is mandatory with severe neurological symptoms, whereas individualized judgement is needed when the symptoms are mild.

  3. Introducing the SKIN score: a validated scoring system to assess severity of mastectomy skin flap necrosis.

    Lemaine, Valerie; Hoskin, Tanya L; Farley, David R; Grant, Clive S; Boughey, Judy C; Torstenson, Tiffany A; Jacobson, Steven R; Jakub, James W; Degnim, Amy C


    With increasing use of immediate breast reconstruction (IBR), mastectomy skin flap necrosis (MSFN) is a clinical problem that deserves further study. We propose a validated scoring system to discriminate MSFN severity and standardize its assessment. Women who underwent skin-sparing (SSM) or nipple-sparing mastectomy (NSM) and IBR from November 2009 to October 2010 were studied retrospectively. A workgroup of breast and plastic surgeons scored postoperative photographs using the skin ischemia necrosis (SKIN) score to assess depth and surface area of MSFN. We evaluated correlation of the SKIN score with reoperation for MSFN and its reproducibility in an external sample of surgeons. We identified 106 subjects (175 operated breasts: 103 SSM, 72 NSM) who had ≥1 postoperative photograph within 60 days. SKIN scores correlated strongly with need for reoperation for MSFN, with an AUC of 0.96 for SSM and 0.89 for NSM. External scores agreed well with the gold standard scores for the breast mound photographs with weighted kappa values of 0.82 (depth), 0.56 (surface area), and 0.79 (composite score). The agreement was similar for the nipple-areolar complex photographs: 0.75 (depth), 0.63 (surface area), and 0.79 (composite score). A simple scoring system to assess the severity of MSFN is proposed, incorporating both depth and surface area of MSFN. The SKIN score correlates strongly with the need for reoperation to manage MSFN and is reproducible among breast and plastic surgeons.

  4. [Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: systematic review and meta-analysis of randomised controlled trials].

    Alcalá-Cerra, Gabriel; Moscote-Salazar, Luis Rafael; Paternina-Caicedo, Ángel; Gutiérrez-Paternina, Juan José; Niño-Hernández, Lucía M; Sabogal-Barrios, Rubén


    Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis. All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals. A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses. There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  5. Risk factors for mortality in postoperative peritonitis in critically ill patients

    Launey, Yoann; Duteurtre, Benjamin; Larmet, Raphaëlle; Nesseler, Nicolas; Tawa, Audrey; Mallédant, Yannick; Seguin, Philippe


    AIM To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP). METHODS This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments. Adequate source control was defined based on a midline laparotomy, infection source control and intraoperative peritoneal lavage. The number of reoperations needed was also recorded. RESULTS A total of 201 patients were included. The overall mortality rate was 31%. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score (OR = 1.03; 95%CI: 1.02-1.05, P number of reoperations (OR = 2.45; 95%CI: 1.16-5.17, P = 0.015). Surgery was considered as optimal in 69% of the cases, but without any significant effect on mortality. CONCLUSION The results from the large cohort in this study emphasize the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality.

  6. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences.

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian; Bisgaard, Thue; Rosenberg, Jacob


    The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p hernia recurrences exclusively existed after anterior open primary operation.

  7. Total laparoscopic hysterectomy: our 5-year experience (1998-2002).

    Bonilla, David J; Mains, Lindsay; Rice, Janet; Crawford, Benjamin


    To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m(2)), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances.

  8. Total Laparoscopic Hysterectomy: Our 5-Year Experience (1998–2002)

    Bonilla, David J.; Mains, Lindsay; Rice, Janet; Crawford, Benjamin


    Purpose: To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. Methods: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Results: Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m2), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Conclusions: Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances. PMID:21603347

  9. Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

    van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J


    To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

  10. Surgical management of liver hydatidosis: a multicentre series of 1412 patients.

    Secchi, Mario A; Pettinari, Ricardo; Mercapide, Carlos; Bracco, Ricardo; Castilla, Carlos; Cassone, Eduardo; Sisco, Pablo; Andriani, Oscar; Rossi, Leonardo; Grondona, Jorge; Quadrelli, Lisandro; Cabral, Raúl; Rodríguez León, Nicolás; Ledesma, Carlos


    The management of hydatid liver disease (HLD) includes various nonsurgical and surgical treatment options. The purpose of the present longitudinal study was to report the changes in surgical management and the consequent outcome of HLD patients in 10 referral surgical centres in Argentina from 1975 to 2007. The study result analysis was divided into two study periods (1975-1990 and 1991-2007). A total of 1412 patients underwent radical (Group 1: 396 patients), conservative (Group 2: 748 patients) or combined (Group 3: 536 interventions in 268 patients) surgical procedures. The overall mortality and complication rate (Clavien I-IV) was 1.8 and 39% respectively. The complication rate was significantly lower in Group 1 (26%) compared with Group 2 (45%) and Group 3 (42%) There was a significant decrease in mortality (2.3 vs. 1%), complication (42 vs. 34%) and early reoperation (12 vs. 6%) rates between the first study part (918 patients) and the second study part (494 patients). During a median follow-up of 7 years, there was a significant decrease in the first part of this study in the late reoperation rate (8.4-3%) and in disease recurrence (9-1.6%). This large national observational multicentre series shows a significant improvement in surgical management of HLD in Argentina, with a decrease in mortality, morbidity, early and late reoperation and recurrence rates. A recent trend was observed in favour of an earlier diagnosis, less complicated clinical presentation and recent use of minimally invasive approaches.

  11. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Chia-Jen Wu


    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

  12. [Complications in reconstructive procedures on arteries in the lower extremities].

    Radak, D; Rosato, E; Cyba-Altunbay, S


    During a year (1987/88) a study was performed at he Clinic of Thoracal and Vascular Surgery, supervised by Prof. dr J. Vollmar. Analysis of all cases with complications after reconstruction of the lower limbs arteries necessitating reoperation was performed. There were 56 patients in all. They were retrospectively analysed for establishing risk factors, clinical stage (by Fonstine), and time lapse from the surgery to the occurrence of complications. There were 12(21,4%), 23 (41,1%) and 21 (37,5%) of immediate, early and late complications, respectively. The following causes of complications following reconstruction of the lower limbs arteries were recorded: graft trombosis (41,1%), pseudoaneurism of anastomosis (17,8%), progressive arteriosclerosis (12,7%), proximally or distally to the operated segment. The following reoperations were applied: graft prolongation due to distal occlusion (35,7%), desobstruction of the graft and patch plasty (21,2%), partial or total replacement of the graft (17,9%), correction of the supplying vascular tree (7,1%). More than one reoperation were performed in 22 cases (39,2%) and amputation of the limb was necessitated in 4 (7,1%) cases.

  13. Repeated mitral valve replacement in a patient with extensive annular calcification

    Kitamura Tadashi


    Full Text Available Abstract Background Mitral valve replacement in the presence of severe annular calcification is a technical challenge. Case report A 47-year-old lady who had undergone mitral and aortic valve replacement for rheumatic disease 27 years before presented with dyspnea. At reoperation, extensive mitral annular calcification was hindering the disc motion of the Starr-Edwards mitral prosthesis. The old prosthesis was removed and a St Jude Medical mechanical valve was implanted after thorough annular debridement. Postoperatively the patient developed paravalvular leak and hemolytic anemia, subsequently undergoing reoperation three days later. The mitral valve was replaced with an Edwards MIRA valve, with a bulkier sewing cuff, after more aggressive annular debridement. Although initially there was no paravalvular leak, it recurred five days later. The patient also developed a small cerebral hemorrhage. As the paravalvular leak and hemolytic anemia gradually worsened, the patient underwent reoperation 14 days later. A Carpentier-Edwards bioprosthetic valve with equine pericardial patches, one to cover the debrided calcified annulus, another as a collar around the prosthesis, was used to eliminate paravalvular leak. At 7 years postoperatively the patient is doing well without any evidence of paravalvular leak or structural valve deterioration. Conclusion Mitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification.

  14. Recurrent Volvulus of an Ileal Pouch Requiring Repeat Pouchopexy: A Lesson Learnt

    Pär Myrelid


    Full Text Available Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition. Case Report. A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms. Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single row pouchopexy might be insufficient for preventing retwisting. Several rows seem to be needed.


    S. A. Kovalev


    Full Text Available Aim. To evaluate in-hospital and long-term results of surgical treatment of patients with infective endocarditis of the tricuspid valve, to compare the effectiveness of valve repair and valve replacement techniques, and to identify risk factors of mortality and reoperations. Materials and methods. 31 surgical patients with tricuspid valve infective endocarditis were evaluated. Patients were divided into 2 groups. In Group 1 (n = 14 repairs of the tricuspid valve were performed, in Group 2 (n = 17 patients had undergone tricuspid valve replacements. Epidemiological, clinical, microbiological and echocardiographic data were studied. Methods of comparative analysis, the Kaplan–Meier method, and Cox risk models were applied. Results. The most common complication of in-hospital stay was atrioventricular block (17.7% of cases in Group 2. In Group 1, this type of complication was not found. Hospital mortality was 7.14% in Group 1, and 0% in Group 2. Long-term results have shown the significant reduction of heart failure in general cohort and in both groups. In Group 1 the severity of heart failure in the long term was less than in Group 2. No significant differences in the severity of tricuspid regurgitation were found between the groups. In 7-year follow up no cases of death were registered in Group 1. Cumulative survival rate in Group 2 within 60 months was 67.3 ± 16.2%. No reoperations were performed in patients from Group 1. In Group 2, the freedom from reoperation within 60 months was 70.9 ± 15.3%. Combined intervention was found as predictor of postoperative mortality. Prosthetic valve endocarditis was identified as risk factor for reoperation. Conclusion. Valve repair and valve replacement techniques of surgical treatment of tricuspid valve endocarditis can provide satisfactory hospital and long-term results. Tricuspid valve repair techniques allowed reducing the incidence of postoperative atrioventricular block. In the long-term, patients

  16. 11-year experience with laparoscopic adjustable gastric banding for morbid obesity--what happened to the first 123 patients?

    Tolonen, Pekka; Victorzon, Mikael; Mäkelä, Jyrki


    Few long-term studies regarding the outcome of laparoscopic adjustable gastric banding for morbid obesity have so far been published. We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years (mean 86 months) of follow-up. Data have been collected prospectively among 280 patients operated since March 1996. Until March 2002 (minimum 5-year follow-up), 123 patients have been operated laparoscopically with the Swedish band. We report major late complications, reoperations, excess weight losses (EWL) and failure rates among these patients, with a mean (range) follow-up time of 86 months (60-132). EWL 50% was considered a success. Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21-44). Mean (range) preoperative weight was 130 kg (92-191). Mean (range) preoperative body mass index was 49.28 kg/m2 (35.01-66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years. Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.

  17. Minimally invasive approach for redo mitral valve surgery.

    Botta, Luca; Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi


    Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these

  18. An outcomes analysis of 2142 breast reduction procedures.

    Manahan, Michele Ann; Buretta, Kate J; Chang, David; Mithani, Suhail K; Mallalieu, Jesse; Shermak, Michele A


    Breast reduction alleviates macromastia symptoms and facilitates symmetrical breast reconstruction after cancer treatment. We investigated a large series of consecutive breast reductions to study important factors that impact outcomes. An institutional review board-approved, retrospective review of all breast reductions from 1999 to 2009 in a single institution was performed using the medical record for demographics, medical history, physical examination, intraoperative data, and postoperative complications. Multivariate statistical analysis was performed using Stata 1.0. P ≤ 0.05 defined significance. Seventeen surgeons performed 2152 consecutive breast reductions on 1148 patients using inferior pedicle/Wise pattern (56.4%), medial pedicle/Wise pattern (16.8%), superior pedicle/nipple graft/Wise pattern (15.1%), superior pedicle/vertical pattern (11.6%), and liposuction (0.1%) techniques. Complications included discernible scars (14.5%), nonsurgical wounds (13.5%), fat necrosis (8.2%), infection (7.3%), wounds requiring negative pressure wound therapy or reoperation (1.4%), and seroma (1.2%). Reoperation rates were 6.7% for scars, 1.4% for fat necrosis, and 1% for wounds.Body mass index greater than or equal to 35 kg/m increased risk of infections [odds ratio (OR), 2.3, P = 0.000], seromas (OR, 2.9, P = 0.03), fat necrosis (OR, 2.0, P = 0.002), and minor wounds (OR, 1.7, P = 0.001). Cardiac disease increased reoperation for scar (OR, 3.0, P = 0.04) and fat necrosis (OR, 5.3, P = 0.03). Tobacco use increased infection rate (OR, 2.1, P = 0.008). Secondary surgery increased seromas (OR, 12.0, P = 0.001). Previous hysterectomy/oophorectomy increased risk of wound reoperations (OR, 3.4, P = 0.02), and exogenous hormone supplementation trended toward decreasing infections (OR, 0.5, P = 0.08). χ analysis revealed 7.8% infection risk without exogenous hormone versus 3.8% risk with hormone supplementation (P = 0.02). Morbid obesity, tobacco, cardiac history, and

  19. Clinical effect of endoscope-assisted surgery on recurrent facial spasm(report of 19 cases)%复发性面肌痉挛神经内镜下再手术治疗的症状转归

    蓝胜勇; 肖泉; 徐鹏


    目的 总结复发性面肌痉挛单纯神经内镜下再手术治疗的效果.方法 对19例曾行显微镜下微血管减压术治疗有效6个月以上又复发的病人,神经内镜下再行面神经手术减压术.结果 15例术后症状即消失;3例术后痉挛症状减轻,其中2例两周后消失,1例2个月后消失;1例术后症状无改善.17例获得随访,时间6~24个月,平均14个月,无复发病例.结论 神经内镜下再手术是治疗复发性面肌痉挛的安全、有效的方法.%Objective To explore the clinical effect of endoscope-assisted surgery on recurrent facial spasm.Methods The facial spasm recurred 6 months after the microvascular decompression under the operating microscope in 19 patients,of whom,17 received endoscope-assisted microvascular decompression through retrosigmoid keyhole approach once again and 2 received endoscope-assisted neurolysis.The three dimensional time of flight magnetic resonance angiography was performed in all the patients before the reoperation.Results The blood vessels responsible for the facial spasm were intraoperatively found in 17 patients.The facial nerves adhesions to the scar around them were found in 2 patients.The spasmodic symptom disappeared in 15 patients,was relieved in 3 and was unchanged in 1 immediately after the reoperation.The spasmodic symptom disappeared 2 weeks after the reoperation in 2 and 1 month after the reoperation in 1 of 3 patients in whom the symptom was relieved immediately after the reoperation.Seventeen patients were followed up from 6 to 24 months(mean,14 months)and the outcomes showed that no patient had a relapse.Conclusion The endoscope-assisted surgery is a safe and effective method to treat the recurrent facial spasm.

  20. Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy

    Jones, Douglas W.; Goodney, Philip P.; Conrad, Mark F.; Nolan, Brian W.; Rzucidlo, Eva M.; Powell, Richard J.; Cronenwett, Jack L.; Stone, David H.


    Objective Controversy persists regarding the perioperative management of clopidogrel among patients undergoing carotid endarterectomy (CEA). This study examined the effect of preoperative dual antiplatelet therapy (aspirin and clopidogrel) on in-hospital CEA outcomes. Methods Patients undergoing CEA in the Vascular Quality Initiative were analyzed (2003–2014). Patients on clopidogrel and aspirin (dual therapy) were compared with patients taking aspirin alone preoperatively. Study outcomes included reoperation for bleeding and thrombotic complications defined as transient ischemic attack (TIA), stroke, or myocardial infarction. Secondary outcomes were in-hospital death and composite stroke/death. Univariate and multivariable analyses assessed differences in demographics and operative factors. Propensity score-matched cohorts were derived to control for subgroup heterogeneity. Results Of 28,683 CEAs, 21,624 patients (75%) were on aspirin and 7059 (25%) were on dual therapy. Patients on dual therapy were more likely to have multiple comorbidities, including coronary artery disease (P therapy were also more likely to have a drain placed (P therapy was independently associated with increased reoperation for bleeding (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.20–2.42; P = .003) but was protective against TIA or stroke (OR, 0.61; 95% CI, 0.43–0.87; P = .007), stroke (OR, 0.63; 95% CI, 0.41–0.97; P = .03), and stroke/death (OR, 0.66; 95% CI, 0.44–0.98; P = .04). Propensity score matching yielded two groups of 4548 patients and showed that patients on dual therapy were more likely to require reoperation for bleeding (1.3% vs 0.7%; P = .004) but less likely to suffer TIA or stroke (0.9% vs 1.6%; P = .002), stroke (0.6% vs 1.0%; P = .04), or stroke/death (0.7% vs 1.2%; P = .03). Within the propensity score-matched groups, patients on dual therapy had increased rates of reoperation for bleeding regardless of carotid symptom status. However, asymptomatic

  1. Postoperative start compared to preoperative start of low-molecular-weight heparin increases mortality in patients with femoral neck fractures

    Leer-Salvesen, Sunniva; Dybvik, Eva; Dahl, Ola E; Gjertsen, Jan-Erik; EngesæTer, Lars B


    Background and purpose — Controversies exist regarding thromboprophylaxis in orthopedic surgery. Using data in the nationwide Norwegian Hip Fracture Register (NHFR) with postoperative death and reoperation in the first 6 months after surgery as endpoints in the analyses, we determined whether the thromboprophylaxis in patients who undergo hemiarthroplasty for femoral neck fracture should start preoperatively or postoperatively. Patients and methods — After each operation for hip fracture in Norway, the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age, ASA score, gender, type of implant, length of surgery, and year of surgery. Results — During the period 2005–2014, 25,019 hemiarthroplasties as treatment for femoral neck fractures were reported to the registry. Antithrombotic medication was given to 99% of the patients. Low-molecular-weight heparin predominated with dalteparin in 57% of the operations and enoxaparin in 41%. Only operations with these 2 drugs and with known information on preoperative or postoperative start of the prophylaxis were included in the analyses (n = 20,241). Compared to preoperative start of thromboprophylaxis, postoperative start of thromboprophylaxis gave a higher risk of death (risk ratio (RR) = 1.13, 95% CI: 1.06–1.21; p < 0.001) and a higher risk of reoperation for any reason (RR =1.19, 95% CI: 1.01–1.40; p = 0.04), whereas we found no effect on reported intraoperative bleeding complication or on the risk of postoperative reoperation due to hematoma. The results did not depend on whether the initial dose of prophylaxis was the full dosage or half of the standard dosage. Interpretation — Postoperative start of thromboprophylaxis increased the mortality and risk of reoperation compared to preoperative start in femoral neck fracture patients operated with hemiprosthesis. The risks of bleeding and of reoperation due to

  2. Management of venous stenosis in living donor liver transplant recipients

    Jie Yang; Ming-Qing Xu; Lu-Nan Yan; Wu-Sheng Lu; Xiao Li; Zheng-Rong Shi; Bo Li; Tian-Fu Wen; Wen-Tao Wang; Jia-Ying Yang


    AIM: To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation (LDLT).METHODS: From February 1999 to May 2009, 1 intraoperative hepatic vein (HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients. Postoperative portal vein (PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT. Patients ranged in age from 9 to 56 years (median, 44 years). An air balloon was used to correct the intraoperative HV tension. Emergent surgical reoperation, transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3, 15, 50, 55, and 270 after LDLT, respectively. Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.RESULTS: The intraoperative HV tension was corrected with an air balloon. The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later. HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients. The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared, while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later. Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites, respectively. Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT, and this patient has survived for 9 mo without recurrent PV stenosis and ascites.CONCLUSION: Intraoperative balloon placement, emergent reoperation, proper

  3. Aortic valve reconstruction with use of pericardial leaflets in adults with bicuspid aortic valve disease: early and midterm outcomes.

    Song, Meong Gun; Yang, Hyun Suk; Choi, Jong Bum; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok


    In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.

  4. Safety of carboxymethylcellulose/polyethylene oxide for the prevention of adhesions in lumbar disc herniation – consecutive case series review

    Fransen Patrick


    Full Text Available Abstract Background Epidural fibrosis is regarded as a cause of failed back surgery syndrome (FBSS when excessive adhesional/fibrotic scar tissue causes compression, pain or discomfort by tethering of nerve tissue to the surrounding muscle or bone. Fibrosis inhibitors could therefore increase the success rate of spinal surgery and decrease the need for reoperations. In recent years, bio-resorbable gels or films for the prevention of peridural fibrosis and post-operative adhesions have been developed that look clinically promising. This included a 100% synthetic, sterile, absorbable gel combinations of carboxymethylcellulose (CMC and polyethylene oxide (PEO used to coat the dura to reduce scarring after discectomy which became available in Europe in 2002. However, given the burden of the problem and unfavorable experience with other types of adhesion-reduction agents, our unit decided to evaluate the safety of CMC/PEO in a large population of patients undergoing spinal microdiscectomy for herniation. Methods To determine the safety and assess efficacy of carboxymethylcellulose/polyethylene oxide (CMC/PEO gel as an anti-adhesion gel, a consecutive series of 396 patients undergoing lumbar discectomy performed by one surgeon had CMC/PEO gel administered at the end of surgery. The patients were followed up in accordance with standard clinical practice and records reviewed for side effects, such as skin reactions, general reactions or local fluid collections. Reoperations for recurrent herniation included an evaluation of fibrosis reduction. Results No product related complications were observed. Five patients needed reoperations for recurrent herniation. Significant but subjective reduction in fibrosis was observed in these patients. Conclusion The findings provide confidence that CMC/PEO gel is well tolerated as an agent to achieve reduction of fibrosis in lumbar disc surgery. Further formal prospective study is recommended in this area of unmet

  5. Eliminating patellofemoral complications in total knee arthroplasty: clinical and radiographic results of 121 consecutive cases using the Duracon system.

    Mont, M A; Yoon, T R; Krackow, K A; Hungerford, D S


    This study reports the minimum 5-year follow-up of our experience with the Duracon Total Knee Arthroplasty System. A total of 121 consecutive total knee replacements using the Duracon system (Howmedica, Rutherford, NJ) were performed in 104 patients. Three patients died before the 5-year follow-up and were excluded from the final evaluation. The remaining 118 knees (101 patients) were assessed at a mean follow-up of 65 months (range, 60-80 months). The knee diagnoses were osteoarthritis in 97 patients, rheumatoid arthritis in 2 patients, osteonecrosis in 1 patient, and pigmented villonodular synovitis in 1 patient. The mean age was 70 years (range, 28-85 years). There were no reoperations for aseptic loosening, and there have been no reoperations for patellofemoral problems. At final follow-up evaluation, 112 knees (96%) had good or excellent results, and 6 knees (4%) had poor clinical results or went on to revision. For the surviving knees, the preoperative Knee Society objective score improved from a mean of 52 points (range, 20-72 points) to a final follow-up mean of 94 points (range, 66-100 points). Five knees needed reoperations: 2 knees in 1 patient because of acute hematogenous infection at 12 months, 1 knee because of a supracondylar femur fracture, 1 because of a patellar tendon rupture, and 1 to increase polyethylene thickness because of instability. The lack of aseptic loosening at the minimum 5-year follow-up compares favorably with any cemented or cementless series of knee replacement. The almost complete absence of patellofemoral complications in this series also indicates that the design changes, with particular attention to the trochlea design and patellofemoral contact throughout full flexion, have achieved their intended purpose. The results are encouraging at midterm, awaiting true long-term (15-20 years) follow-up.

  6. Radiological and clinical outcome after operations in patients with congenital deficiencies of the wrist and hand

    Schmelzer-Schmied, Nicole; Jung, Martin [Department of Orthopedic Surgery, University of Heidelberg (Germany); Ludwig, Karl, E-mail: [Department of Diagnostic and Interventional Radiology, Klinikum Herford (Germany)


    Purpose: To evaluate the incidence, therapy results, complications and radiologic workup of operatively treated congenital disorders of the hand and wrist in a large university center during a 10-year period. Methods: The institutional database was retrospectively analysed for patients with congenital disorders of the hand and wrist treated operatively during a 10-year period (1998-2007). Disorders were classified according to Van Schoonhoven into 11 different entities. For each entity the incidence, the patients' age at the time of operation, the pre- and postoperative clinical and radiological workup and the frequency of complications and reoperations were evaluated. Results: A total of 278 patients was treated operatively for congenital disorders of the hand and wrist with syndactyly being present in 112, thumb hypoplasia in 15, polydactyly in 11, radial clubhand in 7, radioulnar synostosis in 6, clinodactyly in 6, thumb duplication in 6, brachydactyly in 4 and macrodactyly in 4 cases. Patients' age at the time of operation varied substantially between the different entities with a mean age between 0.9 and 6.2 years. There were 9 complications (3%, n = 278) - all of them infections. There were 28 reoperations (10%, n = 278), 13 of them (5%, n = 278) due to reoccurring webs in syndactyly. Conclusion: Congenital disorders of the hand and wrist include various rare diseases with syndactyly and thumb hypoplasia being the most frequent entities. As a rule, diagnosis is obtained clinically. Radiologic workup typically consists of plain radiography. Complications are rare, whereas reoperations are frequent, mostly due to reoccurring webs in syndactyly.

  7. Diagnostic validity of periapical radiography and CBCT for assessing periapical lesions that persist after endodontic surgery.

    Kruse, Casper; Spin-Neto, Rubens; Reibel, Jesper; Wenzel, Ann; Kirkevang, Lise-Lotte


    Traditionally, healing after surgical endodontic retreatment (SER); i.e. apicectomy with or without a retrograde filling, is assessed in periapical radiographs (PR). Recently, the use of Cone Beam CT (CBCT) has increased within endodontics. Generally, CBCT detects more periapical lesions than PR, but basic research on the true nature of these lesions is missing. The objective was to assess the diagnostic validity of PR and CBCT for determining inflammation in SER-cases that were re-operated (SER-R) due to unsuccessful healing, using histology of the periapical lesion as reference for inflammation. Records from 149 patients, receiving SER 2004-10, were screened. In total 108 patients (119 teeth) were recalled for clinical follow-up examination, PR and CBCT, of which 74 patients (83 teeth) participated. Three observers assessed PR and CBCT as "successful healing" or "unsuccessful healing" using Rud and Molven´s criteria. SER-R was offered to all non-healed teeth with expected favorable prognosis for subsequent functional retention. During SER-R, biopsy was performed and histopathology verified whether or not inflammation was present. All re-operated cases were assessed non-healed in CBCT while 11 of these were assessed successfully healed in PR. Nineteen biopsies were examined. Histopathologic diagnosis revealed 42% (teeth=8) without periapical inflammation, 16% (teeth=3) with mild inflammation, and 42% (teeth=8) with moderate to intense inflammation. A correct diagnosis was obtained in 58% with CBCT (true positives) and 63% with PR (true positives+true negatives). Of the re-operated teeth, 42% had no periapical inflammatory lesion, and hence no benefit from SER-R. Not all lesions observed in CBCT represented periapical inflammatory lesions.

  8. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis.

    Tao Li

    Full Text Available OBJECTIVE: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 70 years old. METHODS: We searched PUBMED, EMBASE, Cochrane Library, CNKI and VIP Database from inception to December 2012 for relevant randomized controlled trials (RCTs. Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR and weighted mean differences (WMD from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies. RESULTS: 7 RCTs involving 1,125 patients (1,125 hips were eligible for meta-analysis. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31-0.76; P = 0.002, lower residual pain (OR = 0.43, 95%CI, 0.29-0.64; P<0.0001, less implant-related complications (OR = 0.15, 95%CI, 0.09-0.26; P<0.00001 and longer operation time (WMD = 7.43 min, 95% CI, 5.37-9.49 min; P<0.00001. No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss. CONCLUSIONS: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

  9. Long-term outcomes of ethanol injection therapy for locally recurrent papillary thyroid cancer.

    Kim, Soo Young; Kim, Seok-Mo; Chang, Hojin; Kim, Bup-Woo; Lim, Chi Young; Lee, Yong Sang; Chang, Hang-Seok; Park, Cheong Soo


    The standard treatment regimen for locally recurrent lesions is total thyroidectomy, or complete removal of the recurrent thyroid lesion within the thyroid bed. However, reoperation increases the risk of complications and patients have to undergo general anesthesia. Percutaneous ethanol injection therapy represents a far less invasive procedure without general anesthesia and with lower risk of complications. Thirty-four patients who received PEIT at Yonsei University Medical Center between October 2002 and August 2009 for recurrent cervical nodal metastases of differentiated papillary thyroid cancer were included in this retrospective study. During a minimum follow-up of 60 months, treatment outcomes were determined by measuring the lesion size prior to the first injection and 3 months after the last injection. A total of 46 recurrent lesions were detected in 34 patients. Five patients underwent surgery and PEIT was administered to the remaining 19 and 22 lesions in the central compartment and lateral neck lymph nodes, respectively. Size increases were observed in seven (17.1%) lesions, whereas no changes in size and decreases were detected in 10 (24.4%) and 24 (58.5%) lesions. Patients with increased lymph nodes were significantly older (65.3 ± 14.4 vs. 48.2 ± 16.3 years; p = 0.02) and had smaller sizes (9.3 ± 1.0 vs. 12.3 ± 6.4 mm; p = 0.012). Although reoperation remains the first-line treatment for recurrent thyroid cancer, PEIT may be considered as a treatment option in selected patients with lesions larger than 1 cm who are ineligible for surgery or have refused reoperation.

  10. Subcutaneous mastectomy in female-to-male transsexuals: a retrospective cohort-analysis of 202 patients.

    Cregten-Escobar, Patricia; Bouman, Mark Bram; Buncamper, Marlon E; Mullender, Margriet G


    Subcutaneous mastectomy is the first surgical procedure to be completed by female to male transsexuals after appropriate mental health and endocrine therapy. Objectives of subcutaneous mastectomy in this group are to masculinize the chest by the removal of breast tissue and skin excess, reduction and proper positioning of the nipple-areola complex, obliteration of the infra-mammary fold, and ideally with a minimal of chest wall scars. In this study, the largest series of subcutaneous mastectomies in female-to-male transsexuals to date is presented. Our aim was to determine relations between surgical technique, risk factors, complications, reoperations and secondary corrections in female-to-male transsexuals. We performed a retrospective survey study on 404 mastectomies in 202 female-to-male transsexuals during the period of 2000-2011. Primary outcomes for this study were complication rate, acute reoperations, secondary corrections, surgical time, and length of hospital stay in relation to the surgical technique used. The average age of these patients at time of the intervention was 31 years (±10) with an average BMI of 25 kg/m(2) (±4). The chosen technique depended strongly on breast volume, which, in turn, was strongly related to BMI and age. The number of acute reoperations and secondary corrections depended on the surgical technique. The total rate of acute complications was 5.0%. This percentage was highest in surgeries without skin resection (10.5%). To improve overall aesthetic results, the following secondary corrections were performed: nipple and/or areola corrections (8.9%), scar revisions (12.6%), and chest contouring (17.8%). This study shows a correlation between the surgical technique, complication rate, and length of hospital stay. In general, the larger the breast, the larger the scars that remain after the operation. On the other hand, the smaller the scars resulting from the operation, the higher the risk of hematoma. © 2012 International

  11. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland

    Sahanne S


    Full Text Available Sari Sahanne,1 Raimo Tuuminen,2 Jari Haukka,3 Sirpa Loukovaara4 1Department of Anesthesiology, Helsinki University Central Hospital, Helsinki, 2Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, 3Hjelt Institute, Faculty of Medicine, University of Helsinki, 4Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland Background: Rhegmatogenous retinal detachment (RRD is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV. Methods: This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50 and PPV (n=269. Changes in intraocular pressure (IOP and best-corrected visual acuity (BCVA were recorded at 30 days and reoperation rates within 180 days postoperatively. Results: Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test; however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006. Changes in BCVA did not differ between the surgical procedures. Conclusion: PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD. Keywords: rhegmatogenous retinal detachment, vitrectomy, scleral buckling

  12. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

    Du, Xing; Wu, Ji-Min; Hu, Zhi-Wei; Wang, Feng; Wang, Zhong-Gao; Zhang, Chao; Yan, Chao; Chen, Mei-Ping


    Abstract Background: Laparoscopic Nissen fundoplication (LNF) has been the gold standard for the surgical management of Gastro-esophageal reflux disease (GERD). Laparoscopic anterior 180° fundoplication (180° LAF) is reported to reduce the incidence of postoperative complications while obtaining similar control of reflux. The present meta-analysis was conducted to confirm the value of the 2 techniques. Methods: PubMed, Medline, Embase, Cochrane Library, Springerlink, and China National Knowledge Infrastructure Platform databases were searched for randomized controlled trials (RCTs) comparing LNF and 180° LAF. Data regarding the benefits and adverse results of 2 techniques were extracted and compared using a meta-analysis. Results: Six eligible RCTs comparing LNF (n = 266) and 180° LAF (n = 265) were identified. There were no significant differences between LNF and 180° LAF with regard to operating time, perioperative complications, length of hospital stay, patient satisfaction, willingness to undergo surgery again, quality of life, postoperative heartburn, proton pump inhibitor (PPI) use, postoperative DeMeester scores, postoperative lower esophageal sphincter (LES) pressure, postoperative gas-bloating, unable to belch, diarrhea, or overall reoperation. LNF was associated with a higher prevalence of postoperative dysphagia compared with 180° LAF, while 180° LAF was followed by more reoperation for recurrent reflux symptoms. Conclusion: LNF and 180° LAF are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° LAF can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD. PMID:28906412

  13. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease: A meta-analysis and systematic review.

    Du, Xing; Wu, Ji-Min; Hu, Zhi-Wei; Wang, Feng; Wang, Zhong-Gao; Zhang, Chao; Yan, Chao; Chen, Mei-Ping


    Laparoscopic Nissen fundoplication (LNF) has been the gold standard for the surgical management of Gastro-esophageal reflux disease (GERD). Laparoscopic anterior 180° fundoplication (180° LAF) is reported to reduce the incidence of postoperative complications while obtaining similar control of reflux. The present meta-analysis was conducted to confirm the value of the 2 techniques. PubMed, Medline, Embase, Cochrane Library, Springerlink, and China National Knowledge Infrastructure Platform databases were searched for randomized controlled trials (RCTs) comparing LNF and 180° LAF. Data regarding the benefits and adverse results of 2 techniques were extracted and compared using a meta-analysis. Six eligible RCTs comparing LNF (n = 266) and 180° LAF (n = 265) were identified. There were no significant differences between LNF and 180° LAF with regard to operating time, perioperative complications, length of hospital stay, patient satisfaction, willingness to undergo surgery again, quality of life, postoperative heartburn, proton pump inhibitor (PPI) use, postoperative DeMeester scores, postoperative lower esophageal sphincter (LES) pressure, postoperative gas-bloating, unable to belch, diarrhea, or overall reoperation. LNF was associated with a higher prevalence of postoperative dysphagia compared with 180° LAF, while 180° LAF was followed by more reoperation for recurrent reflux symptoms. LNF and 180° LAF are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° LAF can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD.

  14. The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury.

    Han, Hokyun; Koh, Eun Jung; Choi, Hyunho; Kim, Byong-Cheol; Yang, Seung Yeob; Cho, Keun-Tae


    Traditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI. We retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups. During the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups. Preinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.

  15. Safety of Outpatient Total Ankle Arthroplasty vs Traditional Inpatient Admission or Overnight Observation.

    Mulligan, Ryan P; Parekh, Selene G


    Total joint surgeons have successfully performed hip, knee, and shoulder arthroplasty procedures in the outpatient setting without compromising safety, satisfaction, or results. The purpose of this study was to evaluate outpatient total ankle arthroplasty (TAA) as compared with overnight or extended inpatient stay, with regard to 90-day medical and operative complications, reoperations, readmissions or emergency room visits, and pain control. The medical records of patients who underwent TAA with 1 fellowship-trained orthopedic foot and ankle surgeon were reviewed. Outcome measures included operative complications, adverse medical events, readmission or emergency room visit for any reason, or reoperation within 90 days following surgery; surgeon's office contact before first postoperative visit regarding pain or other issues; visual analog scale pain score at the first postoperative visit; and need for narcotic refill. Outcomes were assessed by admission status: outpatient, overnight observation, or inpatient admission. Standard statistical analysis was used, and P rate was seen among groups ( P = .01) but not rate of readmission or reoperation. Of 16 patients, 5 (31%) who were admitted for 2 or more nights following surgery had a complication, as opposed to 3 of 65 (5%) who were outpatient or admitted overnight ( P = .01). There were no differences in frequency of postoperative phone calls, narcotic refills, or visual analog scale pain scores at the first postoperative visit. There were no adverse medical events. With proper instruction, TAA was performed safely in the outpatient setting. As health care policy continues to evolve in the United States, safe and efficient practices will remain a priority. Level III, retrospective comparative study.

  16. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain

    Ara J Deukmedjian


    Full Text Available Background: Lumbar fusion is a proven treatment for chronic lower back pain (LBP in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD. Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD. Materials and Methods: Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS, patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS. Results: The average resolution of preoperative back pain per patient was 84% (n = 205 while the average resolution of preoperative leg pain was 90% (n = 190 while a mean follow-up period of 528 days (1.5 years. Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001, a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4. Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11 and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4. Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3; surgical site infection (n = 7; repair of cerebrospinal fluid leak (n = 1, and one patient death at home 3 days after discharge. Conclusion: Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.

  17. Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases

    Albayrak, Serdal; Ozturk, Sait; Durdag, Emre; Ayden, Ömer


    Background: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs) and to share our experiences. Materials and Methods: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1st, 3rd, 6th-month and 1st, 3rd, 5th and 7th-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. Results: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05). None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. Conclusion: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results. PMID:26933352

  18. Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases

    Serdal Albayrak


    Full Text Available Background: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs and to share our experiences. Materials and Methods: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1st, 3rd, 6th-month and 1st, 3rd, 5th and 7th-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. Results: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05. None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. Conclusion: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results.

  19. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis.

    de Oliveira, Sofia Andrade; Fonseca, Marcelo C M; Bortolini, Maria A T; Girão, Manoel J B C; Roque, Matheus T; Castro, Rodrigo A


    The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate. We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life. Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88-3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26-88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13-3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference -12.43 min; 95% CI -14.11 to -10.74 ; p uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.

  20. Gastropancreatic ligament: Description, incidence, and involvement during laparoscopic sleeve gastrectomy.

    Rebibo, Lionel; Darmon, Ilan; Peltier, Johann; Dhahri, Abdennaceur; Regimbeau, Jean-Marc


    During laparoscopic sleeve gastrectomy (LSG), adhesions between the stomach and the pancreas are sometimes found, forming a "gastropancreatic ligament" (GPL). However, the GPL has only been described once in the literature, in 1985. The objective of this study was to determine the incidence of the GPL during LSG, describe this structure and assess its effect on the surgical technique. All patients undergoing primary LSG in our institution (n = 240) and patients referred for gastric fistula (GF) after primary LSG (n = 18) between January 2015 and December 2015 were included. The primary endpoint was the incidence of a GPL during primary LSG. The secondary endpoints were the postoperative complication rate, the postoperative GF rate, and the presence of this ligament during reoperation for GF. Among the 240 patients, a GPL was visible in 49 cases (20.4%) and was described as thin in 34 of these (69.4%). Twelve postoperative complications (5%) were observed, including seven major (2.9%). The GF rate was 2% (n = 5), not requiring reoperation. The gastric stenosis rate was 0.4% (n = 1). The GPL had been previously sectioned in one of the five patients (20%) with postoperative GF. During the study period, 18 patients were referred for GF and 14 were reoperated. A non-sectioned GPL, not described in the operating report, was observed in four patients (28.5%). A GPL was identified in 20.4% of cases. Identification of a GPL could be important in the context of LSG, as section of the ligament allows tension-free stapling to be performed and can therefore possibly reduce the risk of postoperative complications, particularly GF. Clin. Anat. 30:336-341, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  1. [A meta-analysis of pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy].

    Li, Xiucheng; Dong, Ming; Sheng, Weiwei; Yue, Lishuang; Liu, Qingfeng; Dong, Qi


    To evaluate the pancreatic fistula affected by different type of pancreaticojejunostomy after pancreaticoduodenectomy. Electronic databases PubMed, EMBase, COCHRANE Library, Wanfang, and VIP etc were used to search for randomized controlled trials or non randomized prospective controlled trials reported before September 2013 on clinical effects of pancreaticojejunostomy after pancreaticoduodenectomy. The statistical analysis was done by Review Manager 5.0. A total of 8 trials were included in this meta-analysis. The effects of duct-to-mucosa pancreaticojejunostomy (dmPJ) and invaginating pancreaticojejunostomy (iPJ) on postoperative complication in five studies were compared, and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR = 0.77, 95% CI:0.35-1.69, P = 0.52), reoperation (M-H:OR = 1.38, 95% CI:0.64-2.95, P = 0.41) and mortality (M-H:OR = 1.15, 95% CI:0.42-3.13, P = 0.79) between dmPJ and iPJ. The effects of binding pancreaticojejunostomy (bPJ) and conventional pancreaticojejunostomy (cPJ) (including duct-to-mucosa pancreaticojejunostomy and invaginating pancreaticojejunostomy) on postoperative complication were compared, and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR = 0.57, 95% CI = 0.28-1.17, P = 0.13) , reoperation (M-H:OR = 1.18, 95% CI = 0.48-2.92, P = 0.72) and mortality (M-H:OR = 0.74, 95% CI = 0.27-1.99, P = 0.55) between bPJ and cPJ. There are no significant differences between dmPJ and iPJ in pancreatic fistula reoperation and mortality, and there are also no significant differences between bPJ and cPJ.

  2. ACL Injury, Return To Play And Reinjury In The Elite, Collegiate Athlete: An Analysis Of A Single, Division I NCAA Cohort

    Kamath, Ganesh V.; Murphy, Timothy; Creighton, Robert A.; Taft, Timothy N.; Spang, Jeffrey T.


    Objectives: Graft survivorship, reinjury rates, and career length are poorly understood after ACL reconstruction in the elite, NCAA Division-I athlete. The purpose of this study was to examine the outcomes of ACL reconstruction in a Division-I athlete cohort. Methods: Retrospective chart review was performed of all Division-I athletes at a single, public university from 2000 to 2009 until completion of eligibility. Athletes with a Pre-collegiate (PC) and Intra-collegiate (IC) ACL reconstruction were separated into two cohorts. Graft survivorship, reoperation rates, and career length information was collected. Results: 35 athletes were identified with a pre-collegiate (PC) ACL reconstruction; 60 with an intra-collegiate (IC) reconstruction. The PC group had a 17.1% injury rate to the original graft, with a 20.0% rate of contralateral ACL injury. For the IC group, the reinjury rates were 1.9% to the ACL graft, with a 9.2% rate of contralateral ACL injury after an IntraCollegiate ACL reconstruction. The PC group used 78% of their total eligibility (avg 3.11 yrs). Athletes in the IC group used an average of 77% of their remaining NCAA eligibility. 88.3% of the IC group played an additional non-redshirt year after their injury. Reoperation rate for the PC group was 51.4% and 20.3% for the IC group. Conclusion: Reoperation and reinjury rates are high after ACL reconstruction in the Division-I athlete. Pre-collegiate ACL reconstruction is associated with a very high rate of repeat ACL reinjury to the graft or opposite knee (37.1%). The majority of athletes are able to return to play after successful reconstruction.

  3. Femoral head fractures: hemiarthroplasty or total hip arthroplasty?

    Ullmark, Gösta


    Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%.For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads. Surprisingly, the bipolar head had an increased reoperation risk for dislocation, infection and for periprosthetic fracture.Total hip arthroplasty (THA) after fracture has a four-fold raised risk for dislocation compared with THA after osteoarthritis. A larger head on the same neck (head to neck ratio) results in a theoretically larger range of movement and hence less risk for dislocation. The dual mobility bearing has, theoretically, the largest range of movement and good clinical results.Functional results are better for THA compared with HA. Arthroplasty for fracture has much better results compared with arthroplasty after a failed internal fixation; the risk for reoperation is more than doubled for the latter.A Swedish hip arthroplasty register study found a 20-fold higher risk for periprosthetic fracture when comparing uncemented HA with matt cemented HA. Also a polished cemented stem had 13½-fold higher risks compared with a matt.The mortality during the first day after surgery is higher for cemented compared with uncemented arthroplasties, but lower after one week, one month and one year. Analysing the time points together resulted in no difference.A matt cemented THA with a maximum head size, maybe dual mobility, has the best results, and is also for the low-demanding elderly.

  4. Non-infectious Pseudoaneurysm of Ascending Aorta Following Redo-Aortic Valve Replacement

    Nozari Younes


    Full Text Available A 46 year old man had been undergone Aortic valve replacement (AVR due to mechanical aortic valve endocarditis two month ago. He was referred to Imam Khomeini hospital because of dyspnea since two weeks ago. Echocardiography showed the false aneurysm, with an area of flow beyond the lumen of the aorta. This patient underwent reoperation, the previously implanted aortic valve was removed, meticulous debridement was performed in aortic valve annulus and adjacent part of the ascending aorta, and aortic valve and root replacement were performed.

  5. Structural valve deterioration of a mitral Carpentier-Edwards pericardial bioprosthesis in an 87-year-old woman 16 years after its implantation

    Haruki Takashi


    Full Text Available Abstract The second-generation pericardial valve, the Carpentier-Edwards perimount bioprosthetic (CEP valve, shows dramatically improved durability as compared to the first-generation pericardial valve, and excellent performance has been obtained, in both the aortic and mitral positions. Especially in elderly patients with an implanted CEP valve, reoperation due to structural valve deterioration (SVD is rarely required. Here, we report the case of an 87-year-old woman with an explanted CEP valve in the mitral position due to SVD, 16 years after its implantation.

  6. Inadequate preoperative colonic evaluation for synchronous colorectal cancer

    Achiam, M P; Burgdorf, S K; Wilhelmsen, M


    BACKGROUND AND AIMS: Synchronous cancers (SC) are well known (2-11%) in patients with colorectal carcinoma (CRC). One study has shown that intraoperative palpation can miss up to 69% of the SC while other studies have shown altered planned surgical procedure due to preoperatively diagnosed......-operation and one patient had pulmonary embolism as a complication to re-operation. CONCLUSIONS: The results show that many patients (78%) never underwent FPCE, but also that many of these patients never had a full postoperative colonic evaluation. SC being overlooked can lead to increased morbidity...... and the possibility of advanced staging of the cancer which is also exemplified in this study....

  7. Breast reconstruction using a latissimus dorsi flap after mastectomy

    Højvig, Jens B; Bonde, Christian Torsten


    , in contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... of 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor...


    Koneru, Baburao; Zajko, Albert B.; Sher, Linda; Marsh, J. Wallis; Tzakis, Andreas G.; Iwatsuki, Shunzaburo; Starzl, Thomas E.


    A tension mucocele was created in three hepatic homografts by ligating a low-lying cystic duct during transplant cholecystectomy and by incorporating its outflow end into the anastomosis of the common hepatic duct to the recipient common duct or Roux limb of jejunum. The consequent complication of obstruction of the biliary tract that necessitated reoperation and excision of the mucocele in all three patients can be avoided by the simple expedient of completely removing the cystic duct when feasible or providing egress to the secretion of the cystic duct as described. PMID:2652346

  9. Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist

    Raquel de Melo Santos Vilas Boas


    Full Text Available AbstractSoft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

  10. [A simple point score for definition of the risk of postoperative complications].

    Grundmann, R; Papoulis, C


    During a 5-year-period we recorded prospectively 5,823 patients who had undergone general surgery and documented the postoperative complications as wound infection, pneumonia, reoperations and death. A score including all these complications was developed to evaluate the risk of an operation more exactly than using the wound infection rate alone. This method seems to provide a continuous monitoring and the comparison of the complication risks of certain operations within a quality assurance program. For gastric and colon surgery we found a correlation between postoperative antibiotic use and score, but not between score and postoperative hospitalization time.

  11. Outcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.

    Saurav, Alok; Alla, Venkata Mahesh; Kaushik, Manu; Hunter, Claire C; Mooss, Aryan V


    Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively

  12. Decision and management algorithms to address patient and food and drug administration concerns regarding breast augmentation and implants.

    Adams, William P; Bengston, Bradley P; Glicksman, Caroline A; Gryskiewicz, Joe M; Jewell, Mark L; McGrath, Mary H; Reisman, Neal R; Teitelbaum, Steven A; Tebbetts, John B; Tebbetts, Terrye


    During the U.S. Food and Drug Administration's advisory panel hearings to evaluate the premarket approval for conventional silicone gel implants on October 14 and 15, 2003, panel members and patient advocate representatives focused on four specific areas of concern: reoperation rates in primary breast augmentation; levels, depth, and methods of patient education and informed consent; modes, frequency, and management of silicone gel implant device failures, including management of "silent" ruptures; and methods of monitoring and managing symptoms or symptom complexes that may or may not be associated with connective tissue disease or other undefined symptom complexes. These concerns, with a reported 20 percent reoperation rate for primary augmentation within just 3 years, and a lack of concise, definitive management protocols addressing these areas of concern may have contributed to the Food and Drug Administration's rejection of the premarket approval, despite the panel's recommendation for approval. This article presents decision and management algorithms that have been used successfully for 7 years in a busy breast augmentation practice (Tebbetts and Tebbetts). The algorithms have been further expanded and refined by a group of surgeons with diverse experiences and expertise to address the following clinical situations that coincide with concerns expressed by patients and the Food and Drug Administration: implant size exchange, grade III to IV capsular contracture, infection, stretch deformities (implant bottoming or displacement), silent rupture of gel implants, and undefined symptom complexes (connective tissue disease or other). In one practice (Tebbetts and Tebbetts) that uses the TEPID system (tissue characteristics of the envelope, parenchyma, and implant and the dimensions and fill distribution dynamics of the implant), implant selection is based on quantified patient tissue characteristics, pocket selection is based on quantified soft-tissue coverage, and

  13. Rekonvalescens efter operation for hoftenaer fraktur

    Palm, Henrik; Foss, Nicolai Bang; Kristensen, Morten Tange


    In Denmark, 10,000 patients with hip fractures are annually admitted to hospital. These patients are generally old with a high degree of comorbidities. Current treatment strategies for peri- and postoperative treatment are presented in relation to patient reconvalescence. Overall expected...... hospitalization is 5-25 days with 1-3 months of analgesic treatment and physiotherapy. The 30-day mortality is 10% and the reoperation rate is 10-20%. The use of specialized centres and accelerated clinical programmes in Denmark is recommended....

  14. A novel design of posterior leaflet butterfly resection for mitral valve repair.

    Asai, Tohru; Kinoshita, Takeshi; Nishimura, Osamu; Kambara, Atsushi; Suzuki, Tomoaki; Matsubayashi, Keiji


    A new design for posterior leaflet resection, "butterfly resection," is proposed. It is a combination of two triangular resections in the prolapsing posterior leaflet segment. This method minimizes resection in the target segment, and it prevents systolic anterior motion by reducing the height of the posterior leaflet according to the amount of excess tissue. We have used this technique for 60.4% (29 of 48) of posterior leaflet prolapse cases with zero hospital mortality and no morbidity. Postbypass transesophageal echocardiography identified no more than mild regurgitation and no sign of systolic anterior motion. During 13.1 ± 6.8 months of follow-up, patients neither died nor needed reoperation.

  15. Delayed breast implant reconstruction

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne


    the period 1999 to 2006; 239 one-stage procedures and 353 two-stage procedures. The postoperative course through November 2009 was evaluated by cumulative incidence adjusting for competing risks for the selected outcomes; hematoma, infection, seroma, implant rupture, severe capsular contracture (modified.......7% for severe capsular contracture, 32.3% for displacement/asymmetry of the implant and 38.6% for reoperation. When comparing one- and two-stage procedures, we observed significantly higher risk estimates for infection, seroma and extrusion of the implant following two-stage procedures, whereas the risk...

  16. Bariatric surgery: an updated systematic review and meta-analysis, 2003–2012

    Chang, Su-Hsin; Stoll, Carolyn R.T.; Song, Jihyun; Varela, J. Esteban; Eagon, Christopher J.; Colditz, Graham A.


    Importance The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003. Objective Up-to-date, comprehensive data and appropriate meta-analytic techniques were used to examine effectiveness and risks of bariatric surgery. Data Sources Literature searches of Medline, Embase, Scopus, Current Contents, Cochrane Library, and between 2003 and 2012 were performed. Study Selection Exclusion criteria included publication of abstracts only, case reports, letters, comments, or reviews; animal studies; languages other than English; duplicate studies; no surgical intervention; and no population of interest. Inclusion criteria were at least one outcome of interest resulting from the studied surgery was reported – comorbidities, mortality, complications, reoperations, or weight loss. Of the 25,060 initially identified articles, 24,023 studies met the exclusion criteria, and 259 met the inclusion criteria. Data Extraction A review protocol was followed throughout. Three reviewers independently reviewed studies, abstracted data, and resolved disagreements by consensus. Studies were evaluated for quality. Results A total of 164 studies were included (37 randomized controlled trials (RCTs) and 127 observational studies). Analyses included 161,756 patients with mean age 45 years and body mass index (BMI) 46 kg/m2. We conducted random-effects and fixed-effect meta-analyses and meta-regression. In RCTs, ≤30 days mortality rate was 0.08% [95%CI, 0.01%–0.24%]; >30 days mortality rate was 0.31% [95%CI, 0.01%–0.75%]. BMI loss at the post-surgery five years was 12–17 kg/m2. The complication rate was 17% [95%CI, 11%–23%], and the reoperation rate was 7% [95%CI, 3%–12%]. Gastric bypass (GB) was more effective in weight loss but associated with more complications. Adjustable gastric banding (AGB) had lower mortality and complication

  17. [Online infection recording within the scope of total quality management].

    Ehlebracht, M; Birth, M; Hilbert, M; Weiser, H F


    The continuous and exact recording of infections is a condition sine qua non for total quality management. Therefore, at the Diakoniekrankenhaus Rotenburg (Wümme) a program which offers the possibility of online recording of data was integrated into the hospital intranet. The recording is done with network clients. The recording of data is supported by a series of plausibility controls. The advantage consists in immediate evaluation of up to date and extensive statistics of infections. By integration into the existing system, relevant influences and consequences such as the prolongation of hospitalisation, use of material, and frequency of reoperation can by recognized and immediately considered with high validity.

  18. Simple operative management of ingrown toenail using bipolar diathermy.

    Farrelly, P J; Minford, J; Jones, M O


    Ingrowing toenails (IGTN) cause significant discomfort for children and adults alike. Where conservative treatment fails, a surgical approach is usually adopted. Many surgical procedures have been described with varying complexity and outcome. We report a novel, simple technique which involves wedge excision of the ingrowing nail, and bipolar diathermy of the nail bed. Three-hundred and fifty-three procedures were carried out on 302 patients during the study period. Our re-operation rate for recurrence is 9.9%, which compares favourably with other techniques, and which lends itself to utilisation for minor surgery lists in primary care.

  19. [Total temporomandibular joint prostheses].

    Zwetyenga, N; Amroun, S; Wajszczak, B-L; Moris, V


    The temporomandibular joint (TMJ) is probably the most complex human joint. As in all joints, its prosthetic replacement may be indicated in selected cases. Significant advances have been made in the design of TMJ prostheses during the last three decades and the indications have been clarified. The aim of our work was to make an update on the current total TMJ total joint replacement. Indications, contraindications, prosthetic components, advantages, disadvantages, reasons for failure or reoperation, virtual planning and surgical protocol have been exposed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Dizziness due to intravestibular protrusion of prosthesis after stapedectomy

    Suheil Artul


    Full Text Available We present a case of 37 year-old female with severe dizziness for the past six months whose past medical history revealed stapedectomy due to otosclerosis two years prior to visiting our hospital. Coronal high resolution computed tomography reconstruction showed the protrusion of a metallic device “peosthesis”, which had been used to replace the stape bone, to the vestibule of inner ear. The patient was re-operated for revision and replacing the prosthesis with good clinical outcome. 

  1. Late Chronic Tamponade after Intraoperative Right Ventricular Rupture Repair with Mediastinal Fat.

    Gualis, Javier; Castaño, Mario; Rodríguez, Miguel Angel; García, Cristina


    Advanced age and female sex are known risk factors for ventricular wall rupture during open-heart procedures. We present the case of an 83-year-old female patient with an intraoperative traumatic right ventricular free wall rupture during an aortic valve replacement procedure. Pledgetted interrupted sutures reinforced with large pieces of mediastinal fat were used for rupture repair. After 6 months, the patient was readmitted with the diagnosis of a retrosternal mediastinal mass and clinical signs of cardiac tamponade that required reoperation.

  2. [The evolution of otitis media with effusion treated by transtympanic drainage].

    Lacosta, J L; Zabaleta, M; Erdozain, I


    One hundred sixty children with effusive otitis media who did not improve with medical treatment were reviewed. The evolution and complications observed in 294 ears treated by myringotomy and ventilation tubes (grommets) over a three-year period were analyzed. Otorrhea occurred during grommet placement in 11.6%. The disease remitted in 84%. Recurrences occurred in 15.3%: 4.8% had different degrees of tympanic atelectasia and 0.7% had perforation. Three per cent of the children were reoperated for bilateral recurrence of otitis. Younger children and those whose had delayed surgery had a worse outcome. Insertion of ear grommets improved hearing.

  3. Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

    Mehtap Bozkurt


    Full Text Available Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI. The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery.

  4. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report.

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko


    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition.

  5. Colonic Perforation Caused by Methicillin-Resistant Staphylococcus aureus Enteritis After Total Gastrectomy: A Case Report

    Furukawa, Kenei; Tsutsumi, Jun; Takayama, Sumio; Mashiko, Hiroshi; Shiba, Hiroaki; Yanaga, Katsuhiko


    A 68-year-old man underwent total gastrectomy and splenectomy for adenocarcinoma and low anterior resection for carcinoma in tubulo-villous adenoma of the rectum. Broad-spectrum antibiotics were administered for postoperative pancreatic fistula. Methicillin-resistant Staphylococcus aureus enteritis occurred on the 50th postoperative day and cecal perforation followed. The patient underwent construction of cecostomy with peritoneal drainage, and vancomycin was administered orally and per cecostomy for 2 weeks. The patient recovered well and was discharged at 35 days after re-operation in good general condition. PMID:25785319

  6. Postsurgical intrapericardial adhesions: mechanisms of formation and prevention.

    Cannata, Aldo; Petrella, Duccio; Russo, Claudio Francesco; Bruschi, Giuseppe; Fratto, Pasquale; Gambacorta, Marcello; Martinelli, Luigi


    Postsurgical intrapericardial adhesions are still considered an unavoidable consequence of cardiothoracic operations. They increase the technical difficulty and the risk of reoperations. The pathogenesis of postsurgical adhesions is a multistep process, and the main key players are (1) loss of mesothelial cells, (2) accumulation of fibrin in areas devoid of mesothelial cells, (3) loss of normal pericardial fibrinolysis, and (4) local inflammation. Today, very promising methods to reduce adhesions are available for clinical use. This report reviews the process of formation of adhesions and the methods to prevent them, classified according to the mechanism of action.

  7. Statistic analysis in treatment of complications of vertebral-spinal trauma (by MSE data

    Pedachenko Ye.H.


    Full Text Available The analysis of treatment of 130 patients with the complicated spinal trauma by the data of medical-social expertise was conducted. In the majority of patients (64%, because of the complicated spinal trauma the conservative methods of treatment were applied. In more than half (51% of patients treated con¬servatively, there was the unremoved compression of spinal cord or its radices, 24% patients were operated in the sharp period of the complicated spinal trauma, 4% of them were re-operated over course of time. Due to unremoved compression 12% were operated in the period of rehabilitation.

  8. Limb Amputation after Multiple Treatments of Tenosynovial Giant Cell Tumour: Series of 4 Dutch Cases

    Monique J. L. Mastboom


    Full Text Available In Tenosynovial Giant Cell Tumours (TGCT, previously named Pigmented Villonodular Synovitis (PVNS, a distinction is made between a single nodule (localized-type and multiple nodules (diffuse-type. Diffuse-type is considered locally aggressive. Onset and extermination of this orphan disease remain unclear. Surgical resection is the most commonly performed treatment. Unfortunately, recurrences often occur (up to 92%, necessitating reoperations and adjuvant treatments. Once all treatments fail or if severe complications occur, limb amputation may become unavoidable. We describe four cases of above-knee amputation after TGCT diagnosis.

  9. Cardiovascular surgery in the elderly: an update

    Song WAN; Ahmed A. ARIFI; Calvin S. H. NG; Anthony P. C. YIM


    The aging of the population and improvements in outcomes after cardiovascular surgery have resulted in a worldwide growing demand of complex surgical intervention for elderly patients. We briefly review the up-to-date English-language literature with particular focus on cardiovascular surgery in elderly patients. With earlier referral, careful preoperative evaluation, strategic planning, and the continuing efforts in optimizing surgical techniques, operative mortality and morbidity following primary or reoperative coronary artery bypass grafting and valvular interventions are expected to fall in this high-risk patient subset. Importantly,accumulating evidence indicates that elderly patients may benefit from improved functional status and quality of life after cardiovascular surgical therapy

  10. [Poor results in 183 threaded acetabular cups at a mean 7 years follow-up].

    Lecestre, P; Poilbout, P; Dambreville, A; Vial, D


    We reviewed 183 threaded rings at a mean 7 years follow-up. Poor résults are frequent: 34 % had been revised and 50 % have radiographic migration, essentially with proximal migration of the cup. Generally, we reoperated with other cememtless implants. The type of threaded cup does not matter (spheric or conic). Only the duration of follow up seems significant. We think that biomecanical strains, rather than physiology, explain these numerous migrations. We have therefore abandoned threaded cups in favour of porous-coated impacted cups.

  11. Transcatheter closures for fistula tract and paravalvular leak after mitral valve replacement and tricuspid annuloplasty.

    Om, Sang Yong; Park, Gyung Min; Kim, Jin Yong; Yoon, Yong Hoon; Lee, Sinwon; Kim, Young-Hak; Song, Jae-Kwan


    Paravalvular leaks (PVLs) often occur after surgical valve replacement. Surgical reoperation has been the gold standard of therapy for PVLs, but it carries a higher operative risk and an increased incidence of re-leaks compared to the initial surgery. In high surgical risk patients with appropriate geometries, transcatheter closure of PVLs could be an alternative to redo-surgery. Here, we report a case of successful staged transcatheter closures of a fistula tract between the aorta and right atrium, and mitral PVLs after mitral valve replacement and tricuspid annuloplasty.

  12. Ten years patency of left internal mammary artery trunk dissection graft after coronary artery bypass procedure

    CHENG Yu-tong; YU Jian-bo; SUN Tao; QUE Bin; WANG Su; LI Zhi-zhong


    @@ The left internal mammary artery (LIMA) had become the conduit of choice for myocardial revascularization, since it has been proved that 10 years patency rates of LIMA grafts are more than 90%. 1,2 The arterial graft trunk dissection is a rare event, affecting the procedure effects and related to reoperation.3 According to Kim and coworker's study,4 the arterial graft trunkdelayed dissection manifested by early post-operative angiography only occurred in 6 of 1111 of the off-pump coronary artery bypass grafts. So up to now, the consequence of dissections without severe hemodynamicabnormality is beyond our knowledge.

  13. Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications.

    Silecchia, G; Rizzello, M; Casella, G; Fioriti, M; Soricelli, E; Basso, N


    The aim of this study is to retrospectively analyze the incidence of complications after two-stage laparoscopic biliopancreatic diversion with duodenal switch (Lap BPD-DS) in high-risk super-obese patients and explore the possible predictive factors of specific complications after laparoscopic sleeve gastrectomy (SG). High-risk patients--body mass index (BMI) > 50 kg/m(2) with at least two major comorbidities: type 2 diabetes, obstructive sleep apnea syndrome (OSAS), hypertension--undergoing two-stage laparoscopic BPD-DS were retrospectively analysed. The SG pouch volume was 100-150 ml; in the second stage, the common channel and the alimentary loop were 100 cm and 150 cm, respectively. Eighty-seven patients (50 female, 57.5%) underwent SG (two open). The mean age was 41.8 +/- 10.22 years with BMI of 55.2 +/- 6.69 kg/m(2). Four patients had Prader-Willy syndrome. Fourteen (16.46%) patients (6 female, 42.8%) had postoperative complications such as bleeding, fistula, pulmonary embolism, transitory acute renal failure, and abdominal abscess. One patient died at postoperative day 5 of pulmonary embolism. One patient was reoperated for hemoperitoneum by laparoscopy. The risk of complications after SG was lower in patients where reinforcement of the suture line was used (0.492), while it was higher in men (1.780). Neither difference was statistically significant [p = not significant (NS)]. After 9-24 months, 27 patients (BMI 43 +/- 8 kg/m(2)) underwent a second stage of BPD-DS (two open). Major postoperative complications were registered in eight patients (29.6%): three bleeding, four duodeno-ileal stenosis and one rhabdomyolysis. Two cases of internal hernia required laparoscopic reoperation. The reoperation rate was 1/85 (1.2%) after SG and 2/27 (7.4%) after second stage. Complications after SG greatly decrease after the learning curve period and can be successfully managed without need of reoperation. Suture-line reinforcement, at least selectively in the middle

  14. [Cystectomy in Denmark 2000-2005

    Johansen, L.S.; Christensen, T.H.; Bendixen, A.;


    in the period January 1, 2000-December 31, 2005 were assessed. RESULTS: There were 995 cystectomies with a median postoperative hospital stay of 18.9 days (including readmissions) and hospital mortality of 3.7%. The operations were performed in seven departments without difference in outcome between departments....... Morbidity was observed in 58%, 16.8% of which were re-operated for wound or urinary diversion complications. CONCLUSION: It is concluded that cystectomy should be performed in only five departments in Denmark, and the results suggest that an intensified multicenter collaboration should be initiated...

  15. Cystektomi i Danmark 2000-2005

    Johansen, L.S.; Christensen, T.H.; Bendixen, A.;


    in the period January 1, 2000-December 31, 2005 were assessed. RESULTS: There were 995 cystectomies with a median postoperative hospital stay of 18.9 days (including readmissions) and hospital mortality of 3.7%. The operations were performed in seven departments without difference in outcome between departments....... Morbidity was observed in 58%, 16.8% of which were re-operated for wound or urinary diversion complications. CONCLUSION: It is concluded that cystectomy should be performed in only five departments in Denmark, and the results suggest that an intensified multicenter collaboration should be initiated...

  16. Adverse events of sacral neuromodulation for fecal incontinence reported to the federal drug administration

    Klaus Bielefeldt


    AIM:To investigate the nature and severity of AE related to sacral neurostimulation(SNS).METHODS:Based on Pubmed and Embase searches,we identified published trials and case series of SNS for fecal incontinence(FI)and extracted data on adverse events,requiring an active intervention.Those problems were operationally defined as infection,device removal explant or need for lead and/or generator replacement.In addition,we analyzed the Manufacturer and User Device Experience registry of the Federal Drug Administration for the months of August-October of2015.Events were included if the report specifically mentioned gastrointestinal(GI),bowel and FI as indication and if the narrative did not focus on bladder symptoms.The classification,reporter,the date of the recorded complaint,time between initial implant and report,the type of AE,steps taken and outcome were extracted from the report.In cases of device removal or replacement,we looked for confirmatory comments by healthcare providers or the manufacturer.RESULTS:Published studies reported adverse events and reoperation rates for 1954 patients,followed for 27(1-117)mo.Reoperation rates were 18.6%(14.2-23.9)with device explants accounting for 10.0%(7.8-12.7)of secondary surgeries;rates of device replacement or explant or pocket site and electrode revisions increased with longer follow up.During the period examined,the FDA received 1684 reports of AE related to SNS with FI or GI listed as indication.A total of 652 reports met the inclusion criteria,with 52.7%specifically listing FI.Lack or loss of benefit(48.9%),pain or dysesthesia(27.8%)and complication at the generator implantation site(8.7%)were most commonly listed.Complaints led to secondary surgeries in 29.7%of the AE.Reoperations were performed to explant(38.2%)or replace(46.5%)the device or a lead,or revise the generator pocket(14.6%).Conservative management changes mostly involved changes in stimulation parameters(44.5%),which successfully addressed concerns in 35

  17. The clinical features, diagnosis and management of recurrent thymoma.

    Luo, Taobo; Zhao, Hongguang; Zhou, Xinming


    Thymoma is a disease with malignant potential, which has a recurrence rate after complete resection ranging from 5 to 50 %. Multiple studies on the risk factors, treatment or prognosis have been reported. Many of them are controversial, however. In this review, we summarized some accepted risk factors, means of diagnosis and different treatments of recurrent thymoma. The risk factors of recurrent thymoma haven't been well-studied, and its management remains controversial. We reviewed the literatures and found some key points which should be noticed during the surgery of initial thymoma. Although reoperation should be taken into account preferentially, multimodal treatments are also available. The prognosis are also been discussed.

  18. Consecutive percutaneous valve-in-valve replacement late after Ross procedure: A novel approach in an adult with congenital heart disease.

    Wiktor, Dominik M; Kay, Joseph D; Kim, Michael S


    The emergence of transcatheter valve technology over the last decade has made significant impact on the treatment of patients with valvular heart disease. There has been increasing experience with both native and valve-in-valve indications with promising results. We present the case of a young woman with congenital heart disease who underwent the Ross procedure for bicuspid aortic valve endocarditis with subsequent reoperation and surgical aortic valve replacement for neo-aortic root dilation who experienced worsening symptoms related to both pulmonary and aortic valve dysfunction. She was successfully treated with percutaneous pulmonary and aortic valve replacement with excellent early term technical results and marked improvement in symptoms.

  19. Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

    Lindquist, Sofie A I; Shah, Neel; Overgaard, Charlotte; Torp-Pedersen, Christian; Glavind, Karin; Larsen, Thomas; Plough, Avery; Galvin, Grace; Knudsen, Aage


    In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Cesarean delivery. Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having

  20. Asendan Desendan Aortic Bypass: Atan Kalpte Mediyan Sternotomi Yoluyla Onarim

    Muhammet Akyuz


    Full Text Available We report the case of a 9-month-old patient presenting for redo aortic arch surgery because of recoarctation. In present case, ascending-to-descending aortic bypass via median sternotomy was performed without cardiopulmonary bypass with good result. In spite of the fact that the different surgical and intervention treatment options of aortic coarctation are quite satisfactory, a certain group of patients need reoperation because of recoarctation. The recoarctation repair of the aorta with the extra-anatomic aortic bypass is considered a low-risk procedure with high success rate.

  1. Bile Duct Leaks from the Intrahepatic Biliary Tree: A Review of Its Etiology, Incidence, and Management

    Sorabh Kapoor


    Full Text Available Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.

  2. Radiological results of treatment using an extensive anterolateral approach for developmental dysplasia of the hip: minimum 5-year follow-up.

    Sugawara, Ryo; Watanabe, Hideaki; Hagiwara, Kayo; Inoue, Hirokazu; Takeshita, Katsushi; Kikkawa, Ichiro


    To investigate the radiological results using the extensive anterolateral approach in patients with developmental dysplasia of the hip. A total of 16 hips with developmental dysplasia of the hip treated by the extensive anterolateral approach were retrospectively reviewed after a minimum follow-up of 5 years. For evaluation, we considered the Severin classification and postoperative complications. At the final follow-up (mean 75.6 months), 14 hips (87.5%) were satisfactory in the Severin classification. Reoperation was performed in only one hip (6.3%) because of redislocation. No femoral head necrosis was observed. Our results were more favorable than those using conventional surgical methods.

  3. Porous Titanium Granules and Blood for Bone Regeneration around Dental Implants: Report of Four Cases and Review of the Literature

    Andreas Thor


    Full Text Available A regenerative procedure treating a local osseous defect around titanium dental implant using porous titanium granules is described in four patients. Porous titanium granules represent, for maxillofacial surgery, a new alternative in augmenting osseous defects. Its earliest application was in the field of orthopedics for stabilization of tibia plateau fractures and for reoperations in prosthetic fixation of femoral stems. There is emerging scientific evidence regarding titanium for its potential use in the maxillofacial area and porous titanium granules are now commercially available. The scientific background for the osteoconductive use of porous titanium granules is elucidated in this paper and the supporting literature is reviewed.

  4. Spinal Surgery Complications and Failures in Patients with Parkinsons Disease.

    Sapkas, George S; Mavrogenis, Andreas F; Papastathis, Elias; Tsiavos, Kostas; Igoumenou, Vasilios; Megaloikonomos, Panayiotis D; Galanopoulos, Ioannis; Soultanis, Konstantinos; Papadopoulos, Elias C; Papagelopoulos, Panayiotis J


    Parkinson's disease is a degenerative disorder of the central nervous system affecting the substantia nigra in the midbrain. It accounts for 1.5% of the population in Europe over 60 years of age. Recent advances in the medical treatment of Parkinson's disease have improved the quality of life and life expectancy of the patients. However, it remains a debilitating disease. Spinal disorders are frequent in these patients, and as the population ages, more patients with Parkinson's disease are expected to require spinal surgery. Spinal surgery in patients with Parkinson's disease has been associated with an exceptionally high rate of complications; failures and reoperations are common, and patient outcomes are dismal.

  5. Case Report of a Left Atrial Myxoma Associated with Carney%u2019s Syndrome

    Anil Ozen


    Full Text Available Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney%u2019s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney%u2019s syndrome.

  6. Reintervenciones en Cirugía General

    Jesús Valdés Jiménez


    Full Text Available Se estudiaron 76 enfermos reintervenidos entre 1996 y 1999, en el Hospital Universitario «Comandante Manuel Fajardo». El 52,3 % correspondió al sexo femenino, y el 50 % se hallaba en décadas superiores a la séptima. El 75 % de los casos lo constituían pacientes operados inicialmente de urgencia, con predominio de la oclusión intestinal mecánica y las neoplasias del tubo digestivo. El 98,7 % de las reintervenciones se realizó antes del sexto día de la intervención inicial. Las causas fundamentales de las reintervenciones fueron: peritonitis residual por procesos supurativos o perforaciones (22,3 %, dehiscencias de la sutura gastrointestinal (18,5 % y hemorragias intraabdominales (17,1 %. Los factores de riesgo destacables fueron la edad (mayores de 61 años, la intervención quirúrgica de urgencia y los antecedentes personales de enfermedad (cáncer, diabetes, mala nutrición. La mortalidad quirúrgica de los pacientes reintervenidos fue del 20,6 % que contrasta con el 0,2 % del total de intervenciones de los 4 años estudiados76 patients reoperated on between 1996 and 1999 at "Comandante Manuel Fajardo" Teaching Hospital were studied. 52.3 % were females and 50 % were over 70. 75 % of the cases were urgently operated on for the first time, with predominance of mechanical intestinal occlusion and digestive tube neoplasias. 98.7 % of the reoperations were performed after the sixth day of the initial operation. The main causes of the reoperations were: residual peritonitis due to supurative processes or perforations (22.3 %, deshicence of the gastrointestinal suture (18.5 % and intraabdominal hemorrhages (17.1 %. The remarkable risk factors were: age (over 61, urgent operation and personal history of diseases (cancer, diabetes, malnutrition. The surgical mortality of the patients that were reoperated on was 20.6 % compared with 0.2 % of the total of operations performed during the 4 years under study

  7. The effect of pre-operative optimization on post-operative outcome in Crohn's disease resections

    El-Hussuna, Alaa; Iesalnieks, Igors; Horesh, Nir


    on the post-operative outcome in CD. METHOD: This is a multicentre retrospective cohort study. The primary outcome was 30-day post-operative complications. Secondary outcomes were intra-abdominal septic complications, surgical site infection (SSI), re-operation, length of post-operative stay in a hospital......BACKGROUND: The timing of surgical intervention in Crohn's disease (CD) may depend on pre-operative optimization (PO) which includes different interventions to decrease the risk for unfavourable post-operative outcome. The objective of this study was to investigate the effect of multi-model PO...

  8. Do all hemolytic anemias that occur after mitral valve repair require surgical treatment?

    Gungunes, Askin; Akpinar, Ibrahim; Dogan, Mehmet; Baser, Kazim; Yildirim, Ismail Safa; Haznedaroglu, Ibrahim C


    We report on a 29-year-old woman with severe hemolytic anemia following mitral valve annuloplasty. Although hemolysis due to mechanical prosthetic mitral valve is well recognized, hemolytic anemia associated with mitral valve repair is an uncommon condition. Reoperation may be considered if the patient has serious and persistent anemia. Although valve replacement is suggested to be a unique intervention, it may not be the solution every time because of mechanical effects. Various mechanisms of hemolysis related to mitral valve repair were suggested, but sufficient and precise data is not available. In this case, we tried to emphasize whether all hemolytic anemias that occur after mitral valve repair require surgical treatment.

  9. Prolapso jejunal em gastroenteroanastomose Jejunal prolapse in gastroenteroanastomosis

    Gerson Junqueira Júnior


    Full Text Available The autors report a case of jejunal mucosa prolapse after gastroenteroanastomosis, a rare postoperative complication. In the late postcholecistectomy period the patient had persistent vomit. Upper digestive endoscopy (UDE showed obstruction of the second portion of duodenum, and a gastrojejunal anastomosis was performed. Soon after that, the patient had persistent vomit and upper digestive endoscopy (UDE showed invagination of the jejunal mucosa. She was reoperated, a Roux Y gastrectomy was performed and the patient had a good evolution. The treatment for this complication is basically surgical, which intends to realieve the obstructive symptomatology.

  10. [Resection margins in conservative breast cancer surgery].

    Medina Fernández, Francisco Javier; Ayllón Terán, María Dolores; Lombardo Galera, María Sagrario; Rioja Torres, Pilar; Bascuñana Estudillo, Guillermo; Rufián Peña, Sebastián


    Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  11. [Prevention of the anastomosis dehiscence following low anterior rectal resections].

    Hut'an, M; Lukác, I; Poticný, V


    Authors analyse 106 patients that were operated in their department by Dixon's method, in retrospective study. They analyse indications for operations, lesions distance in rectum, endosonographic and CT findings. Basic principles of the operation technique are adequate blood flow, sufficient colon mobilization and tightness of the anastomosis being supplemented with transanal pertubation. Out of early complications anastomosis dehiscence appeared in 6 patients (e.g. 5.6%) out of which 4 were treated conservatively and 2 were being reoperated on (by axial ileostomia and drainage). In discussion different opinions on preoperative preparation, neoadjuvant therapy, presacral drainage, transanal pertubation and other decompressive techniques are anticipated.

  12. Reflections on the 24 years durability of an isolate tricuspid bovine pericardium IMC/Braile bioprosthesis Reflexões sobre a durabilidade de 24 anos de uma bioprótese IMC/Braile de pericárdio bovino em posição tricúspide isolada

    Solange Bassetto


    Full Text Available We were challenged by the experience of one patient reoperation for a bioprosthetic bovine pericardium degenerative stenosis, 24 years after implantation. This bioprosthesis was implanted due to tricuspid valve bacterial staphylococcal endocarditis after septic abortion.Vivenciamos a experiência de reoperar uma paciente por estenose degenerativa de uma prótese biológica de pericárdio bovino, após 24 anos de implante. Essa prótese degenerada havia sido implantada devido à destruição da valva tricúspide por endocardite bacteriana estafilocócica após aborto séptico.

  13. Genotype predicting phenotype in familial adenomatous polyposis: a practical application to the choice of surgery

    Nieuwenhuis, Marry H; Bülow, Steffen; Björk, Jan


    PURPOSE: Genetic information may help preoperatively select patients with familial adenomatous polyposis for either colectomy with ileorectal anastomosis or proctocolectomy with ileal pouch-anal anastomosis. Although complicated, the latter procedure has a low long-term risk of rectal cancer...... the risk of secondary proctectomy after primary colectomy in familial adenomatous polyposis. Patients with severe genotypes have a high risk of reoperation after primary colectomy and will benefit from primary proctocolectomy with ileal pouch-anal anastomosis. The risk of rectal cancer after primary...

  14. The recurrent Morton neuroma: what now?

    Richardson, David R; Dean, Erin M


    Interdigital neuromas are a common cause of forefoot pain, and approximately 80% of patients require surgical excision for symptom relief. Although 50% to 85% of patients obtain relief after primary excision, symptoms may recur because of an incorrect diagnosis, inadequate resection, or adherence of pressure on a nerve stump neuroma. The symptom relief rate after reoperation is similar to that after primary excision. A plantar longitudinal incision provides optimal exposure, and transposition of the nerve stump into bone or muscle and avoids traction or pressure on the nerve ending that can result in a painful stump neuroma. Preoperative counseling is essential to align patient expectations with potential outcomes.

  15. Early Correction of Common Atrioventricular Septal Defects: A Single-Center 20-Year Experience.

    Vida, Vladimiro L; Tessari, Chiara; Castaldi, Biagio; Padalino, Massimo A; Milanesi, Ornella; Gregori, Dario; Stellin, Giovanni


    Over the past 20 years our policy has been to electively repair common atrioventricular canal defects (CAVCD) in patients between 8 and 12 weeks of age. We sought to evaluate the results of our past 20-year experience. From January 1992 to April 2014, 159 consecutive patients underwent CAVCD repair (133 patients had complete CAVCD and 26 patients had a transitional form of CAVCD). Surgical repair was accomplished with a double-patch (n = 137 [86%]) or a modified single patch (n = 22 [14%]) technique. Median age at operation was 96 days (interquartile range [IQR], 73-128 days); 90 patients were younger than 3 months of age. There were 3 operative (1.9%) and 12 late (7.7%) deaths. Median follow-up time after repair was 8.2 years (IQR, 3.6-15 years). Twenty patients (13%) required reoperation-16 (10%) for left atrioventricular valve (LAVV) regurgitation. Reoperation on the LAVV was more frequent in patients with a dysplastic LAVV preoperatively (p = 0.01; odds ratio [OR], 4.2; 95% confidence interval [CI], 1.33-13.5) and in patients who underwent closure for an absent/incomplete cleft at the time of repair (p = 0.01; OR, 5.4; 95% CI, 1.4-21). Late LAVV performance (regurgitation greater than or equal to moderate or the need for reoperation), including late deaths and patients who underwent reoperation, was significantly worse in patients older than 3 months at repair (10 of 83 patients [12%] versus 20 of 73 patients [27%]; hazard ratio [HR], 2.71; 95% CI, 1.19-6.19) and in patients with LAVV dysplasia (19 of 68 patients [28%] versus 11 of 88 patients [12%]; HR, 3; 95% CI, 1.53-8.51). Individualized early repair of CAVCD is safe and beneficial, with good early and long-term results. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery.

    Mahesh, Balakrishnan; Wells, Francis; Nashef, Samer; Nair, Sukumaran


    Functional tricuspid regurgitation (FTR) is frequently present in patients undergoing aortic, and particularly mitral valve, surgery. Untreated FTR may lead to right heart failure. Reoperative cardiac surgery for late FTR is associated with high morbidity and mortality. Therefore, severe FTR has emerged as a Class I indication for concomitant tricuspid valve surgery in patients undergoing left valve surgery. Concomitant tricuspid valve surgery during left heart valve surgery to address moderate and mild FTR is controversial. This review addresses this issue and proposes an algorithm for the treatment of FTR in patients undergoing left heart valve surgery.

  17. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction.

    Duggal, Claire S; Madni, Tarik; Losken, Albert


    Intraoperative angiography is a useful tool for predicting both tissue perfusion during postmastectomy breast reconstruction and mastectomy flap and free flap survival. The authors determine whether the routine use of laser-assisted indocyanine green (ICG) fluorescence angiography (SPY Imaging; LifeCell Corp, Branchburg, New Jersey) in breast reconstruction decreases the incidence of complications and whether this new technology is cost-effective. A retrospective review was conducted for 184 consecutive patients who underwent breast reconstruction using intraoperative ICG angiography from April 2009 to December 2011 at Emory University (Atlanta, Georgia). The incidence of complications (including mastectomy skin necrosis, flap necrosis, fat necrosis, unexpected reoperations, infections, and dehiscence) among these patients was compared with data for 184 consecutive patients who underwent breast reconstruction at Emory University from October 2007 to April 2009, prior to the introduction of ICG angiography. Patient data recorded included age, body mass index, smoking status, and history of preoperative radiation as well as the timing and type of reconstruction, along with complications. The cost of unexpected reoperations for perfusion-related complications and associated hospital stays was calculated. The 184 patients who underwent procedures using ICG angiography imaging had a lower incidence of mastectomy skin necrosis (13% vs 23.4%; P = .010) and unexpected reoperations for perfusion-related complications (5.9% vs 14.1%, P = .009). The 184 patients who underwent procedures without ICG angiography had a higher mean degree of severity of mastectomy skin necrosis (2.22 vs 1.83 on a scale of 1-3; P = .065). There were no significant differences in the degree of flap necrosis, nipple necrosis, fat necrosis, dehiscence, infection, implant exposure, flap loss, seroma, hematoma, or the number of overall complications between the 2 groups. The use of ICG angiography

  18. Patient-related predictors of implant failure after primary total hip replacement in the initial, short- and long-terms. A nationwide Danish follow-up study including 36,984 patients

    Johnsen, S.P.; Sørensen, H.T.; Lucht, Ulf


    We examined the association between patient-related factors and the risk of initial, short- and long-term implant failure after primary total hip replacement. We used data from the Danish Hip Arthroplasty Registry between 1 January 1995 and 31 December 2002, which gave us a total of 36 984 patients....... Separate analyses were carried out for three follow-up periods: 0 to 30 days, 31 days to six months (short term), and six months to 8.6 years after primary total hip replacement (long term). The outcome measure was defined as time to failure, which included re-operation with open surgery for any reason...

  19. Intra-aortic balloon clamp for safe resternotomy in a patient with a giant aneurysm of sinuses of Valsalva.

    Zembala, Michal Oscar; Filipiak, Krzysztof; Niklewski, Tomasz; Przybylski, Roman


    Despite advances in surgical techniques and postoperative medical management, the mortality rates for cardiac reoperations remain high. The risk is most commonly associated with failed resternotomy complicated by fatal injury to the myocardium or its structures. This short case report documents the first use of an endoluminal balloon occlusive device in order to prevent aneurysmal sack damage and coronary vessel injury in a patient with a giant aortic aneurysm after failed aortic surgery. The safe aortic occlusion allowed for closed-chest cardioplegia delivery and subsequent aortic unloading, thus facilitating a difficult but uneventful resternotomy.

  20. Danish experience with paediatric epilepsy surgery

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find


    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... in Denmark and 50 abroad. In all, 14 children needed reoperation. The median follow-up period was four years. At the latest follow-up, Engel class I (indicating no disabling seizures) was found in 67% of the patients. Cortical dysplasia, mesial temporal sclerosis and tumour were the most common MRI findings...

  1. Restorative proctocolectomy with an ileoanal pouch. Postoperative course and long-term functional results

    Walker, L.R.; Bulow, S.


    results. MATERIALS AND METHODS: A prospective cohort analysis and a questionnaire in 178 consecutive patients operated since 1987 in Hvidovre Hospital. RESULTS: Postoperative complications were seen in 38 patients (21%), but only few were serious: anastomotic leakage in 2 (1%), pelvic abscess in 4 (2......%) and complications after ileostomy closure in 2 (1%). The late complications comprised reoperation for intestinal bowel obstruction in 10 (6%), pouch fistula in 6 (3%), pouchitis in 22 (12%), and anastomotic stricture in 8 (5%). Three patients (2%) had the pouch removed. After a median observation period of 7 years...

  2. The implementation of a standardized approach to laparoscopic rectal surgery

    Aslak, Katrine Kanstrup; Bulut, Orhan


    performed: low anterior resection (n = 26), low anterior resection with loop-ileostomy (n = 39), Hartmann's operation (n = 14), and abdominoperineal resection (n = 21). The median length of hospital stay was 7 days; 9 patients were readmitted There were 9 cases of conversion to open surgery. The overall...... complication rate was 35%, including 6 cases (90/%) of anastomotic leakages requiring reoperation. The 30-day mortality was 5%. The median number of harvested lymph nodes was 15 (range, 2 to 48). There were 6 cases of positive circumferential resection margins. The median follow-up was 9 (range, 1 to 27...

  3. Anatomic Tumor Location Influences the Success of Contemporary Limb-Sparing Surgery and Radiation Among Adults With Soft Tissue Sarcomas of the Extremities

    Korah, Mariam P., E-mail: [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Deyrup, Andrea T. [Department of Pathology, Emory University, Atlanta, GA (United States); Monson, David K.; Oskouei, Shervin V. [Department of Orthopedics, Emory University, Atlanta, GA (United States); Weiss, Sharon W. [Department of Pathology, Emory University, Atlanta, GA (United States); Landry, Jerome; Godette, Karen D. [Department of Radiation Oncology, Emory University, Atlanta, GA (United States)


    Purpose: To examine the influence of anatomic location in the upper extremity (UE) vs. lower extremity (LE) on the presentation and outcomes of adult soft tissue sarcomas (STS). Methods and Materials: From 2001 to 2008, 118 patients underwent limb-sparing surgery (LSS) and external beam radiotherapy (RT) with curative intent for nonrecurrent extremity STS. RT was delivered preoperatively in 96 and postoperatively in 22 patients. Lesions arose in the UE in 28 and in the LE in 90 patients. Patients with UE lesions had smaller tumors (4.5 vs. 9.0 cm, p < 0.01), were more likely to undergo a prior excision (43 vs. 22%, p = 0.03), to have close or positive margins after resection (71 vs. 49%, p = 0.04), and to undergo postoperative RT (32 vs. 14%, p = 0.04). Results: Five-year actuarial local recurrence-free and distant metastasis-free survival rates for the entire group were 85 and 74%, with no difference observed between the UE and LE cohorts. Five-year actuarial probability of wound reoperation rates were 4 vs. 29% (p < 0.01) in the UE and LE respectively. Thigh lesions accounted for 84% of the required wound reoperations. The distribution of tumors within the anterior, medial, and posterior thigh compartments was 51%, 26%, and 23%. Subset analysis by compartment showed no difference in the probability of wound reoperation between the anterior and medial/posterior compartments (29 vs. 30%, p = 0.68). Neurolysis was performed during resection in (15%, 5%, and 67%, p < 0.01) of tumors in the anterior, medial, and posterior compartments. Conclusions: Tumors in the UE and LE differ significantly with respect to size and management details. The anatomy of the UE poses technical impediments to an R0 resection. Thigh tumors are associated with higher wound reoperation rates. Tumor resection in the posterior thigh compartment is more likely to result in nerve injury. A better understanding of the inherent differences between tumors in various extremity sites will assist in

  4. Cardiac Rehabilitation After Heart Valve Surgery

    Pollmann, Agathe Gerwina Elena; Frederiksen, Marianne; Prescott, Eva


    PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity...... ((Equation is included in full-text article.)O2peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders...

  5. Prophylactic salpingectomy in women undergoing hysterectomy for benign gynaecological disease - a new Danish recommendation

    Sloth, Sigurd Beier; Gimbel, Helga; Jørgensen, Annemette

    , 282, 158) met the inclusion criteria. The quality of evidence for all critical and important outcomes was rated very low. For the critical outcomes evidence from one OS showed fewer reoperations (RR 0.33 95% CI 0.1 to 1.06) and operations on salpinx (RR 0.15 95% CI 0.01 to 2.46) after hysterectomy...... with concomitant bilateral salpingectomy compared to women undergoing hysterectomy without bilateral salpingectomy. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline panel gave a weak recommendation for concomitant bilateral salpingectomy...

  6. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D


    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.

  7. The learning curve in revision cholesteatoma surgery.

    Stankovic, Milan


    To review the results of revision surgery for cholesteatoma. Retrospective review of patient's records. Tertiary referral center. A retrospective study of patients operated for acquired middle ear cholesteatoma during the period 1990-2002 was performed. A total of 758 patients were divided into two groups according to surgical experience, and followed during short-term and long-term period. The cholesteatoma was divided according to location, age of patients, status of auditory ossicles, and bilaterality of disease. The patients were treated with single canal wall up or wall down, according to the propagation of disease and condition of middle ear. The indications for the reoperations were: recurrent or residual cholesteatoma, resuppuration, and AB gap more than 20 dB. Type of surgical therapy, localization of cholesteatoma, age of patients, revisions, bilaterality of disease, damage of auditory ossicles and learning curve were analyzed. The number of revision operations was reduced in the second period (from totally 24.3% to 16.4%). Closed technique gave a significantly lower rate of failure. For attic cholesteatoma, adults, bilateral disease, and ossicular damage the rate of revisions was significantly lower with surgical experience. Surgical experience was important for reduction of reoperation rate for attic and sinus cholesteatoma, adults, bilateral cholesteatoma, and when closed technique is used. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review


    Background While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Methods Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. Results 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). Conclusions 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other. PMID:24161014

  9. Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

    Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung


    This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. [Reconstruction of the pulmonary outflow tract without external conduit].

    Yoshimura, N; Yamaguchi, M; Oka, S; Ootaki, Y; Yoshida, M; Hayashi, T; Shinkawa, T; Tei, T; Kuroe, K; Kido, S; Tsukuda, K; Oshima, Y


    Between October 1987 and December 2000, 50 patients underwent reconstruction of the pulmonary outflow tract without external conduit. The primary malformation was tetralogy of Fallot with pulmonary atresia in 37, double outlet of right ventricle in 4, corrected transposition of the great arteries in 4, transposition of the great arteries with ventricular septal defect and pulmonary stenosis in 4, and double outlet of left ventricle in 2. Mean age at operation was 7.2 years, and mean body weight was 18.3 kg. To reconstruct posterior wall of the pulmonary outflow tract, interposition of autologous pericardium was performed in 24, direct anastomosis between pulmonary trunk and ventriculotomy in 13, longitudinal incision from ventriculotomy through pulmonary trunk in 12, and interposition of left atrial appendage in 1. Anterior wall was reconstructed with monocusp valved outflow patch (MVOP). There was one hospital death and no late death. At 10 years, the freedom from reoperation for pulmonary outflow tract obstruction was 100%, and freedom from reoperation for any cause was 86.6%. Transcatheter stenting for peripheral pulmonary stenosis was performed in 6 patients 2 to 10 months after operation.

  11. Microscopic versus open approach to craniosynostosis: a long-term outcomes comparison.

    Teichgraeber, John F; Baumgartner, James E; Viviano, Stephen L; Gateno, Jaime; Xia, James J


    The purpose of this retrospective study was to evaluate the long-term outcomes of using the microscopic minimally invasive approach for the treatment of nonsyndromic craniosynostosis. During the last 10 years, 180 consecutive patients with nonsyndromic craniosynostosis were treated: 67 patients were treated with microscopic minimally invasive approach, and 113 were treated with the open approach. In the microscopic group, there was 1 intraoperative complication (1.5%). There were 10 postoperative complications (14.9%), of which 9 required major reoperations and 1 required a minor procedure. The major complications occurred in 7 unicoronal patients (58.3%) and 2 metopic patients (25.0%). In the open-approach group, there were 8 complications (7.1%), 2 patients required major reoperations and 6 required minor procedures. Chi-squared test showed that there was no statistically significant difference in the overall complication rate between the microscopic and open approaches. However, in the unicoronal patients, the complication rate was significantly higher in the microscopic group (P microscopic approach is our treatment of choice in nonsyndromic patients with sagittal and lambdoidal craniosynostosis. We no longer use the microscopic approach in patients with unicoronal or metopic craniosynostosis because of the high complication rate.

  12. Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas.

    Esquenazi, Yoshua; Essayed, Walid I; Singh, Harminder; Mauer, Elizabeth; Ahmed, Mudassir; Christos, Paul J; Schwartz, Theodore H


    Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches. A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications. Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group. This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma

    Francesco A. Polistina


    Full Text Available Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree.

  14. Preliminary soft-tissue distraction versus checkrein ligament release after fasciectomy in the treatment of dupuytren proximal interphalangeal joint contractures.

    Craft, Randall O; Smith, Anthony A; Coakley, Brandon; Casey, William J; Rebecca, Alanna M; Duncan, Scott F M


    Checkrein ligament release for treatment of proximal interphalangeal joint Dupuytren contractures does not address the shortened arteries or deficient skin. The Digit Widget uses soft-tissue distraction to overcome these issues. This study compares checkrein ligament release after fasciectomy versus preliminary soft-tissue distraction, followed by operative release, for treatment of proximal interphalangeal joint Dupuytren contractures. The authors compared operative and postoperative characteristics of patients treated with either fasciectomy plus checkrein ligament release or Digit Widget distraction between 2001 and 2008. Seventeen patients (20 digits) underwent ligament release (mean contracture, 55.9 degrees); six of these 20 were reoperations. Thirteen patients (17 digits) underwent distraction (mean contracture, 67.6 degrees); 10 of 17 were reoperations. The 20 digits treated with fasciectomy plus ligament release had an average extension improvement of 31.4 degrees (range, -4 to 70 degrees). Digits treated with distraction had an average extension improvement of 53.4 degrees (range, 30 to 75 degrees) (pDupuytren fasciectomy plus checkrein ligament release. Therapeutic, III.

  15. Postoperative peritonitis without an underlying digestive fistula after complete cytoreductive surgery plus HIPEC

    Charles Honoré


    Full Text Available Background/Aim: Peritoneal carcinomatosis (PC is a pernicious event associated with a dismal prognosis. Complete cytoreductive surgery (CCRS combined with hyperthermic intraperitoneal chemotherapy (HIPEC is able to yield an important survival benefit but at the price of a risky procedure inducing potentially severe complications. Postoperative peritonitis after abdominal surgery occurs mostly when the digestive lumen and the peritoneum communicate but in rare situation, no underlying digestive fistula can be found. The aim of this study was to report this situation after CCRS plus HIPEC, which has not been described yet and for which the treatment is not yet well defined. Patients and Methods: Between 1994 and 2012, 607 patients underwent CCRS plus HIPEC in our tertiary care center and were retrospectively analyzed. Results: Among 52 patients (9% reoperated for postoperative peritonitis, no digestive fistula was found in seven (1%. All had a malignant peritoneal pseudomyxoma with an extensive disease (median Peritoneal Cancer Index: 27. The median interval between surgery and reoperation was 8 days [range: 3-25]. Postoperative mortality was 14%. Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%. The infection was monobacterial in 71%, with multidrug resistant germs in 78%. Conclusions: Postoperative peritonitis without underlying fistula after CCRS plus HIPEC is a rare entity probably related to bacterial translocation, which occurs in patients with extensive peritoneal disease requiring aggressive surgeries. The principles of treatment do not differ from that of other types of postoperative peritonitis.

  16. Is intra-abdominal drainage necessary after pancreaticoduodenectomy?

    Heslin, M J; Harrison, L E; Brooks, A D; Hochwald, S N; Coit, D G; Brennan, M F


    Closed suction drains after pancreaticoduodenectomy are theoretically used to drain potential collections and anastomotic leaks. It is unknown whether such drains are effective, harmful, or affect the outcome after this operation. Eighty-nine consecutive patients underwent pancreaticoduodenectomy for presumed periampullary malignancy and were retrospectively reviewed. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of the operation. We analyzed patient, nutritional, laboratory, and operating room factors with end points being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Postoperative interventions were defined as CT-guided drainage and reoperation. Analysis was by Student's t test and chi-square test. Two of eight surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to demographic, nutritional, and operative factors. Time under anesthesia was significantly shorter in the group without drains (P = 0.0001). There was no statistical difference in the rate of fistula, abscess, CT drainage, or length of hospital stay. Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, or reoperation or the necessity for CT-guided intervention after pancreaticoduodenectomy. Routine use of drains after pancreaticoduodenectomy may not be necessary and should be subjected to a randomized trial.

  17. Novel Biliary Reconstruction Techniques During Liver Transplantation

    Carmody, Ian C.; Romano, John; Bohorquez, Humberto; Bugeaud, Emily; Bruce, David S.; Cohen, Ari J.; Seal, John; Reichman, Trevor W.; Loss, George E.


    Background: Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant. Methods: A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years. Results: No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications. Conclusion: Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts.

  18. Subtemporal transtentorial approach for recurrent trigeminal neuralgia after microvascular decompression via the lateral suboccipital approach: case report.

    Ogiwara, Toshihiro; Goto, Tetsuya; Kusano, Yoshikazu; Kuroiwa, Masafumi; Kiuchi, Takafumi; Kodama, Kunihiko; Takemae, Toshiki; Hongo, Kazuhiro


    Microvascular decompression (MVD) via lateral suboccipital craniotomy is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. In the present case report the authors describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach.

  19. A new method of subtotal thyroidectomy for Graves’ disease leaving a unilateral remnant based on the upper pole

    Liu, Yu; Liu, Bin; Liu, Rui-Lei; Jiang, Hua; Huang, Ze-Nan; Huang, Yong


    Abstract Background: The aim of this prospective randomized study was to evaluate the feasibility of subtotal thyroidectomy with leaving a unilateral remnant based on the upper pole. Methods: Patients who underwent the subtotal thyroidectomy and isthmusectomy leaving either a unilateral remnant based on the upper pole (Group I, 79 patients) or the bilateral dorsal thyroid tissue remained (Group II, 89 patients) were compared in operation time, blood loss, recurrence, and postoperative complications. Results: Among 168 patients analyzed, the operation time remained similar, but the blood loss, the reoperation time, and recurrence in Group I were much less than Group II. In addition, no postoperative hemorrhage occurred in Group I. Two patients (2.28%) in Group II underwent recurrent laryngeal nerve damages. Four patients (5.06%) in Group I and 3 patients (3.37%) in Group II experienced transient hypocalcemia. Recurrence only occurred in Group II. Conclusion: In terms of blood loss, reoperation time, postoperative complication, and the recurrence, subtotal thyroidectomy with recurrent laryngeal nerves identification and the unilateral superior pole remnant of the gland provides a better outcome than subtotal thyroidectomy with bilateral dorsal thyroid tissue remnant. PMID:28178132

  20. Pneumatic retinopexy. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group.

    Tornambe, P E; Hilton, G F


    Pneumatic retinopexy was compared with scleral buckling in a multicenter (7 centers), randomized, controlled, clinical trial with 198 patients. Admission criteria included detachments with retinal break(s) no greater than 1 clock hour in size, within the superior two thirds of the fundus, without significant proliferative vitreoretinopathy (PVR). All patients were followed for at least 6 months. Scleral buckling was compared with pneumatic retinopexy with regard to single-operation reattachment (82 versus 73%), reattachment with one operation and postoperative laser/cryotherapy (84 versus 81%), overall reattachment with reoperations (98 versus 99%), final visual acuity of 20/50 or better in eye with preoperative detachment of the macula for 2 weeks or less (56 versus 80%), PVR (5 versus 3%), and new retinal breaks (13 versus 23%). Complications, including reoperations, as measured by the "score" system, were similar. The anatomic results of the two operations were not significantly different (P greater than 0.05), but pneumatic retinopexy had less morbidity and better postoperative visual acuity (P = 0.01). Pneumatic retinopexy is recommended for cases meeting the admission criteria.

  1. Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

    Schmidt, C. Max; Choi, Jennifer; Powell, Emilie S.; Yiannoutsos, Constantin T.; Zyromski, Nicholas J.; Nakeeb, Attila; Pitt, Henry A.; Wiebke, Eric A.; Madura, James A.; Lillemoe, Keith D.


    Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality. PMID:19461951

  2. Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

    C. Max Schmidt


    Full Text Available Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD. We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%. Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98% closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.

  3. The routine use of post-operative drains in thyroid surgery: an outdated concept.

    Prichard, R S


    The use of surgical drains in patients undergoing thyroid surgery is standard surgical teaching. Life-threatening complications, arising from post-operative haematomas, mandates their utilization. There is increasing evidence to suggest that this is an outdated practice. This paper determines whether thyroid surgery can be safely performed without the routine use of drains. A retrospective review of patients undergoing thyroid surgery, over a three year period was performed and post-operative complications documented. One hundred and four thyroidectomies were performed. 63 (60.6%) patients had a partial thyroidectomy, 27 (25.9%) had a total thyroidectomy and 14 (13.5%) had a sub-total thyroidectomy. Suction drains were not inserted in any patient. A cervical haematoma did not develop in any patient in this series and no patient required re-operation. There is no evidence to suggest the routine use of surgical drains following uncomplicated thyroid surgery reduces the rate of haematoma formation or re-operation rates and indeed is now unwarranted.

  4. Comparison of the Incidence of Complications and Secondary Surgical Interventions Necessary in Patients with Chronic Lower Limb Ischemia Treated by Both Open and Endovascular Surgeries

    Janczak, Dariusz; Malinowski, Maciej; Bąkowski, Wojciech; Krakowska, Katarzyna; Marschollek, Karol; Marschollek, Paweł


    Background: Peripheral arterial disease (PAD) affects 3%–10% of the population before the age of 70 years and 15%–20% after that age. The aim of the study was to compare the incidence of complications and secondary interventions in patients who underwent each type of treatment. Methods: We analyzed 734 medical records of the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, In total, 394 were operated on with open surgery; an endarterectomy (59.39%), a vascular prosthesis implantation (31.01%), or both of these techniques (6.6%), and 340 patients had angioplasty with (50.59%) or without stenting (49.41%). Results: There were no statistically significant differences in the incidence of corresponding complications. The exception was the infection of the wound; significantly fewer were reported in the case of endovascular procedures (p = 0.0087). There were 12 occasions (3.53%) during endovascular surgeries when intraoperative conversion or re-operation using the open method occurred. In the case of open surgery, the mean hospital stay was 7.77 days (median: 8, mode: 8), while for endovascular management it was equal to 4.68 days (median: 4, mode: 3), p <0.0001. Conclusion: The endovascular method results in a similar re-operation rate and number of complications as open surgery. PMID:28496017

  5. Redo mitral valve replacement through a right mini-thoracotomy with an unclamped aorta.

    Botta, Luca; Fratto, Pasquale; Cannata, Aldo; Bruschi, Giuseppe; Merlanti, Bruno; Brignani, Christian; Bosi, Mauro; Martinelli, Luigi


    Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) re operations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, leaks or thrombosis). In this article we describe our technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury. Moderate hypothermia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing the dangers of an incomplete or imperfect aortic clamping at mild hypothermia and potential lesions due to demanding clamp placing. Complex MV reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space with an unclamped aorta.

  6. Prevention and treatment of rethrombosis after liver transplantation with an implantable pump of the portal vein.

    Shi, Zhengrong; Yan, Lunan; Zhao, Jichun; Li, Bo; Wen, Tianfu; Xu, Mingqing; Wang, Wentao; Chen, Zheyu; Yang, Jiaying


    Implantable pumps have been used to prevent deep vein thrombosis and other diseases. In this article, we report for the first time the prevention and treatment of rethrombosis of the portal vein in liver transplantation with an implantable pump of the portal vein. Four hundred four orthotopic liver transplantation cases were retrospectively reviewed and divided into 3 groups: portal vein thrombosis (PVT) patients with an implantable pump (n = 28), PVT patients without an implantable pump (n = 20), and patients without preexisting PVT (n = 356). The following parameters for the 3 groups of patients were calculated and compared: (1) preoperative parameters, including baseline data of the donors and recipients and times of graft ischemia; (2) intraoperative and postoperative parameters, including surgery time, red blood cell and plasma transfusion, platelet concentrate transfusion, bleeding and primary graft malfunction, and duration of the hospital and intensive care unit stays; and (3) follow-up information for the patency of the portal vein, rethrombosis rate, stenosis and reoperation (relaparotomy or retransplantation), in-hospital mortality, and actuarial 1-year survival rate. Among the 3 groups of recipients, no significant differences were detected in preoperative and intraoperative parameters. However, compared to PVT patients without an implantable pump, PVT patients with an implantable pump showed remarkable reductions in their postoperative hospital stay, rethrombosis, reoperation rate, and in-hospital mortality. An implantable pump of the portal vein in liver transplantation patients can prevent and facilitate the treatment of portal vein rethrombosis and is associated with a reduction of in-hospital mortality.

  7. Stent grafting of acute hepatic artery bleeding following pancreatic head resection

    Stoupis, Christoforos [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Kreisspital, Radiology, Maennedorf (Switzerland); Ludwig, Karin; Triller, Juergen [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Inderbitzin, Daniel [University of Berne, Inselspital, Clinic for Visceral and Transplantation Surgery, Berne (Switzerland); Do, Dai-Do [University of Berne, Inselspital, Clinic for Angiology, Berne (Switzerland)


    The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. (orig.)

  8. Incidence and risk factors of nosocomial infections after cardiac surgery in Georgian population with congenital heart diseases.

    Lomtadze, M; Chkhaidze, M; Mgeladze, E; Metreveli, I; Tsintsadze, A


    Nosocomial infections still remain a serious problem in patients undergoing open heart surgery. The aim of the study was to determine the incidence, etiology and main risk factors of nosocomial infections (NI) following cardiac surgery in congenital heart diseases population. Retrospective case study was conducted. 387 patients with congenital heart disease (CHD), who underwent cardiac surgery from January 2007 to December 2008 were studied. The age of the most patients varied between 1 day to 15 years, 73 patients (18,8%) were older than 15 years. All 387 patients underwent cardiac surgery. The rate of NI was 16%. The most common infections were bloodstream infections (BSI) (7,75%) and respiratory tract infections (7%) respectively. The rate of NI was higher in patients under 1 year of age, after urgent surgery and urgent reoperation, long cardiopulmonary bypass (CPB) and aortic cross-clamp time, also in patients with prolonged mechanical ventilation, massive haemotransfusion, with open heart bone after surgery, reintubation, hospitalization in another hospital during last three month. It was concluded that the most common nosocomial infection after cardiac surgery congenital heart diseases in Georgian population was blood stream infection. The main risk factors of NI in the same setting were age under 1 year, urgent surgery, urgent reoperation, long CPB and aortic cross-clamp time, long duration of mechanical ventilation, massive haemotransfusion, open heart bone after surgery, reintubation, hospitalization in another hospital during last three month.

  9. Roux-en-Y gastric bypass vs gastric banding for morbid obesity: a case-matched study of 442 patients.

    Romy, Sébastien; Donadini, Andrea; Giusti, Vittorio; Suter, Michel


    Gastric banding (GB) and Roux-en-Y gastric bypass (RYGBP) are used in the treatment of morbidly obese patients. We hypothesized that RYGBP provides superior results. Matched-pair study in patients with a body mass index (BMI) less than 50. University hospital and regional community hospital with a common bariatric surgeon. Four hundred forty-two patients were matched according to sex, age, and BMI. Laparoscopic GB or RYGBP. Operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile, and long-term morbidity. Follow-up was 92.3% at the end of the study period (6 years postoperatively). Early morbidity was higher after RYGBP than after GB (17.2% vs 5.4%; P35 or reversal of the procedure/conversion) after GB (48.3% vs 12.3%; P<.001). There were more long-term complications (41.6% vs 19%; P.001) and more reoperations (26.7% vs 12.7%; P<.001) after GB. Comorbidities improved more after RYGBP. Roux-en-Y gastric bypass is associated with better weight loss, resulting in a better correction of some comorbidities than GB, at the price of a higher early complication rate. This difference, however, is largely compensated by the much higher long-term complication and reoperation rates seen after GB.

  10. Comparison of Transverse Intraosseous Loop Technique and Pull Out Suture for Reinsertion of the Flexor Digitorum Profundus tendon. A Retrospective Study.

    Rigó, István Zoltán; Røkkum, Magne


    We compared the results of two methods for reinsertion of flexor digitorum profundus tendons retrospectively. In 35 fingers of 29 patients pull-out suture and in 13 fingers of 11 patients transverse intraosseous loop technique was performed with a mean follow-up of 8 and 6 months, respectively. Eleven and nine fingers achieved "excellent" or "good" function according to Strickland and Glogovac at 8 weeks; 20 and ten at the last control in the pull-out and transverse intraosseous loop groups, respectively. The difference at 8 weeks was statistically significant in favour of the transverse intraosseous loop group. Ten patients underwent 12 complications in the pull-out group (four superficial infections; one rerupture, one PIP and one DIP joint contracture, one adhesion, two granulomas, one nail deformity and one carpal tunnel syndrome) and four of them were reoperated (one carpal tunnel release, one teno-arthrolysis and two resections of granuloma). There was no complication and no reoperation in the transverse intraosseous loop group, the difference being statistically significant for the former. In our study the transverse intraosseous loop technique seemed to be a safe alternative with possibly better functional results compared to the pull-out suture.

  11. Tratamento cirúrgico das valvopatias: parte 2 Valvopathies: surgical treatment. Part 2

    Domingo M Braile


    Full Text Available Esta segunda parte abordará técnica operatória, conduta pós-operatória e reoperações de pacientes com valvopatias. Em Técnica Operatória são descritos os procedimentos de anestesia, a abordagem cirúrgica, que inclui a instalação da circulação extracorpórea, e as cirurgias das valvas mitral, aórtica, tricúspide e pulmonar. Em Conduta Pós-Operatória é relatada a rotina na Unidade de Terapia Intensiva, e em Reoperações é abordada a técnica cirúrgica.This second part will cover operative technique, postoperative approach and reoperations of valvopathy patients. In Operative Technique, there is the description of the anesthesia procedures, surgical approach which includes the assembling of the extracorporeal circulation and surgeries of mitral, aortic, tricuspid and pulmonary valves. In the Postoperative Approach, the routine in the Intensive Care Unity is reported, and in Reoperations the surgical technique is covered.

  12. Foramen Magnum Decompression and Duraplasty is Superior to Only Foramen Magnum Decompression in Chiari Malformation Type 1 Associated with Syringomyelia in Adults.

    Gürbüz, Mehmet Sabri; Berkman, Mehmet Zafer; Ünal, Emre; Akpınar, Elif; Gök, Şevki; Orakdöğen, Metin; Aydın, Salih


    Retrospective cohort study. To compare surgical results of foramen magnum decompression with and without duraplasty in Chiari malformation type 1 (CM-1) associated syringomyelia (SM). The optimal surgical treatment of CM-1 associated with SM is unclear. Twenty-five cases of CM-1 with SM were included. There were 12 patients (48%) in the non-duraplasty group and 13 patients (52%) in the duraplasty group. The rate of improvement, state of postoperative SM size, amount of tonsillar herniation, preoperative symptom duration, complications and reoperation rates were analysed. The rate of clinical improvement was significantly higher with duraplasty (84.6%) than without (33.3%, p <0.05). The rate of postoperative syrinx regression was significantly higher in the duraplasty group (84.6%) than in the non-duraplasty group (33.3%, p <0.05). One case in the duraplasty group needed a reoperation compared with five cases in the non-duraplasty group (p =0.059). Duraplasty is superior to non-duraplasty in CM-1 associated with SM despite a slightly higher complication rate.

  13. Autologous chondrocyte implantation: superior biologic properties of hyaline cartilage repairs.

    Henderson, Ian; Lavigne, Patrick; Valenzuela, Herminio; Oakes, Barry


    Information regarding the quality of autologous chondrocyte implantation repair is needed to determine whether the current autologous chondrocyte implantation surgical technology and the subsequent biologic repair processes are capable of reliably forming durable hyaline or hyaline-like cartilage in vivo. We report and analyze the properties and qualities of autologous chondrocyte implantation repairs. We evaluated 66 autologous chondrocyte implantation repairs in 57 patients, 55 of whom had histology, indentometry, and International Cartilage Repair Society repair scoring at reoperation for mechanical symptoms or pain. International Knee Documentation Committee scores were used to address clinical outcome. Maximum stiffness, normalized stiffness, and International Cartilage Repair Society repair scoring were higher for hyaline articular cartilage repairs compared with fibrocartilage, with no difference in clinical outcome. Reoperations revealed 32 macroscopically abnormal repairs (Group B) and 23 knees with normal-looking repairs in which symptoms leading to arthroscopy were accounted for by other joint disorders (Group A). In Group A, 65% of repairs were either hyaline or hyaline-like cartilage compared with 28% in Group B. Autologous chondrocyte repairs composed of fibrocartilage showed more morphologic abnormalities and became symptomatic earlier than hyaline or hyaline-like cartilage repairs. The hyaline articular cartilage repairs had biomechanical properties comparable to surrounding cartilage and superior to those associated with fibrocartilage repairs.

  14. Patient outcome and valve performance following a second aortic valve homograft replacement.

    Hasnat, K; Birks, E J; Liddicoat, J; Hon, J K; Edwards, S; Glennon, S; Yacoub, M H


    Homograft valves offer many advantages; however, there is concern about their use in second aortic valve replacement because of the complexity of the procedure and the possibility of accelerated degeneration. One hundred and forty-four patients underwent a second aortic homograft replacement between 1973 and 1997 (mean follow-up 6.5+/-5 years, range 1 to 20 years). Eighty-three were male, and 61 were female, aged 17 to 77 years, mean 49.0 years. All patients had undergone previous aortic valve replacement with a homograft. The indication for reoperation was aortic regurgitation in 75 patients (52.1%), aortic stenosis in 28 (19.4%), and mixed aortic valve disease in 41 (28.5%). Root replacement was performed in 54 patients (38%) and subcoronary in 90 (62.5%). Early mortality was 3.4%. The actuarial survival rate was 93% and 82% at 5 and 10 years, respectively. Freedom from tissue degeneration was 96% and 80% at 5 and 10 years, respectively, and freedom from reoperation was 97% and 82% at 5 and 10 years, respectively. This study shows that a second aortic valve homograft replacement results in good early and long-term survival. Accelerated degeneration does not occur. Left ventricular performance is improved, and earlier surgery could further improve outcome, indicating that an aortic homograft is a safe, durable option for patients requiring a second aortic valve replacement.

  15. Endovascular treatment of coarctation and related aneurysms.

    Galiñanes, E L; Krajcer, Z


    Today,surgical repair has almost doubled the 30year survival rate in patients with coarctation of the aorta (CoA), and 72% to 98% of patients now reach adulthood. Possible late complications include malignant hypertension, left ventricular dysfunction, aortic valve dysfunction, recurrent CoA, and aneurysm formation with risk of rupture. Treating postoperative CoA-related aneurysms with observation alone is associated with a mortality rate of 36%, compared with 9% for surgical repair. Even in the best surgeons' hands, aortic surgery has associated complications, and the complexity of reoperative surgery makes the risks substantially greater. For patients with CoA-related aneurysm, endovascular treatment constitutes a good alternative to reoperative surgery because it poses a lower risk of morbidity and mortality. Implanting an endograft has been shown to be successful in treating CoA and related aneurysms, producing excellent intermediate outcomes and minimal morbidity and mortality. Despite evidence that using covered stents improves outcomes, the superiority of any particular stent type has yet to be established. With a variety of endografts available, the decision of which stent to use depends on anatomy, availability, and operator preference.

  16. Initial outcomes of laparoscopic paraesophageal hiatal hernia repair with mesh.

    Gebhart, Alana; Vu, Steven; Armstrong, Chris; Smith, Brian R; Nguyen, Ninh T


    The use of mesh in laparoscopic paraesophageal hiatal hernia repair (LHR) may reduce the risk of late hernia recurrence. The aim of this study was to evaluate initial outcomes and recurrence rate of 92 patients who underwent LHR reinforced with a synthetic bioabsorbable mesh. Surgical approaches included LHR and Nissen fundoplication (n = 64), LHR without fundoplication (n = 10), reoperative LHR (n = 9), LHR with a bariatric operation (n = 6), and emergent LHR (n = 3). The mean length of hospital stay was 2 ± 3 days (range, 1 to 30 days). There were no conversions to open laparotomy and no intraoperative complications. One of 92 patients (1.1%) required intensive care unit stay. The 90-day mortality was zero. Minor complications occurred in 3.3 per cent, major complications in 2.2 per cent, and late complications in 5.5 per cent of patients. There were no perforations or early hernia recurrence. The 30-day reoperation rate was 1.1 per cent. For patients with available 1-year follow-up, the overall recurrence rate was 18.5 per cent with a mean follow-up of 30 months (range, 12 to 51 months). LHR repair with mesh is associated with low perioperative morbidity and no mortality. The use of bioabsorbable mesh appears to be safe with no early hiatal hernia recurrence or late mesh erosion. Longer follow-up is needed to determine the long-term rate of hernia recurrence associated with LHR with mesh.

  17. Surgical site infection in women undergoing surgery for gynecologic cancer.

    Mahdi, Haider; Gojayev, Anar; Buechel, Megan; Knight, Jason; SanMarco, Janice; Lockhart, David; Michener, Chad; Moslemi-Kebria, Mehdi


    The objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome. Patients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. Of 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI. Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

  18. Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma

    Polistina, Francesco A.; Costantin, Giorgio; Settin, Alessandro; Lumachi, Franco; Ambrosino, Giovanni


    Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree. PMID:21103208

  19. Outcomes of manual extracapsular versus phacoemulsification cataract extraction by beginner resident surgeons.

    Meeks, Landen A; Blomquist, Preston H; Sullivan, Brian R


    To evaluate the safety and efficacy of phacoemulsification cataract extraction and manual extracapsular cataract extraction (ECCE) performed by beginning resident surgeons. Dallas Veterans Affairs Medical Center, Dallas, Texas, USA. Retrospective cohort study. A review was performed of each resident's series of initial cataract surgery procedures as a late first-year or second-year resident. Data were collected for cases performed over almost a 6-year period during which initially the first primary surgeon cases were ECCE and later, the first primary surgeon cases were phacoemulsification. For each case, the following data were gathered: technique of cataract extraction, laterality, resident, vitreous loss or dropped nucleus, placement of posterior chamber intraocular lens (IOL), and need for reoperation within 90 days of surgery. Complications occurred in 6 (2.5%) of 244 cases in which phacoemulsification was performed by a beginner resident primary surgeon and in 7 (4.1%) of 172 cases in which ECCE was used (P=.40). Posterior chamber IOLs were placed in all but 2 phacoemulsification cases and 4 ECCE cases (P=.24). Moreover, 3 cases in the phacoemulsification group and 1 case in the ECCE group required a reoperation within 90 days (P=.65). Phacoemulsification cataract extraction can be taught safely and effectively to residents with no cataract surgery experience as a primary surgeon. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  20. Betadine irrigation and post-craniotomy wound infection

    Patel, Kunal S.; Goldenberg, Brandon; Schwartz, Theodore H.


    Object The purpose of this study is to evaluate the efficacy of betadine irrigation in preventing postoperative wound infection in cranial neurosurgical procedures. Methods A total of 473 consecutive cranial neurosurgical procedures, including craniotomies and burr hole procedures were retrospectively reviewed. Patients had either antibiotic irrigation or dilute betadine plus antibiotic irrigation prior to skin closure. Infection was determined by purulence noted on reoperation and confirmed with bacterial growth culture. One and three month postoperative infection rates were calculated. Statistical analysis was performed using chi-squared tests. Results This study included 404 patients. Betadine was used in 117 (29.0%). At 1 month after surgery, there was no difference in the rate of wound infection between the two groups (1.7% each). However, at 90 days, the betadine group had a 2.6% infection rate compared with 3.8% in the antibiotic group, indicating a 33% decrease in infection rates with the addition of betadine (p=.527). The small sample size of the study produced a low power and high beta error. Conclusions In this small preliminary study, betadine decreased postoperative infection rates compared with antibiotic prophylaxis alone at 90 days but not 30 days. This was not statistically significant, but a larger sample size would lower the beta error and decrease confounding bias associated with group heterogeneity. The potential for betadine, a cheap, low toxicity antimicrobial, to decrease infection rates and reoperations for infection warrants a larger multicenter trial. PMID:24529229

  1. Does the uterus need to be removed to correct uterovaginal prolapse?

    Gutman, Robert E


    Owing to growing interest in uterine preservation, this evidence-based review compares hysteropexy with hysterectomy during surgery for uterovaginal prolapse. LeFort colpocleisis is preferred over vaginal hysterectomy and total colpocleisis. The majority of studies show no differences in outcomes comparing sacrospinous hysteropexy with vaginal hysterectomy native tissue prolapse repair except for a single randomized controlled trial showing increased apical recurrences with advanced prolapse. Results comparing uterosacral hysteropexy and sacral hysteropexy with hysterectomy native tissue repairs are inconclusive. Potentially better outcomes are reported when laparoscopic hysterectomy (total or supracervical) is performed with sacral colpopexy compared with laparoscopic sacral hysteropexy, but mesh and morcellation risks should be considered. Data comparing vaginal mesh hysteropexy with currently available products with hysterectomy prolapse repairs are lacking but a high-quality study is underway. High satisfaction and low reoperation rates can be accomplished using a variety of hysteropexy techniques. The advantages and disadvantages of uterine conservation must be considered when planning uterovaginal prolapse surgery. The type of hysteropexy and possible graft configuration may impact reoperation rates for recurrent prolapse. Vaginal mesh risks must be considered and laparoscopic mesh risks must be balanced with potential difficulty of future hysterectomy if needed.

  2. Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients.

    Veit-Rubin, Nikolaus; Dubuisson, Jean-Bernard; Lange, Sören; Eperon, Isabelle; Dubuisson, Jean


    Changes in the psychological value of reproductive organs have led to a growing interest in uterine-preserving surgery for pelvic organ prolapse (POP). Sacral hysteropexy is considered as gold standard, although dissection of the promontory may be challenging. We show a video and present a report on a series of patients operated by laparoscopic lateral suspension with mesh as an alternative. Clinical evaluation was performed using the simplified Pelvic Organ Prolapse Quantification System (POP-Q). Primary outcomes were subjective and objective cure; secondary outcomes were rates for reoperation and complications. We assessed patient's satisfaction in a telephone interview using a visual analogue scale and the Patient Global Impression of Improvement Scale (PGI-I) scale. Two hundred and fifty-four patients were treated between 2004 and 2011 with a median follow-up of 7.5 years. At 1 year 82.7 % of patients were asymptomatic, and anatomic success rates were 88.2 % for the anterior, 86.1 % for the apical and 80.8 % for the posterior compartment; 1.2 % had mesh exposure, and the reoperation rate was 7.4 %. More than 80 % of patients were highly satisfied with the outcome. Uterine-preserving laparoscopic lateral suspension with mesh is a safe technique with promising results and low complication rates. It may be an alternative to sacral hysteropexy for high-morbidity patients.

  3. Optimal management strategies for placenta accreta.

    Eller, A G; Porter, T F; Soisson, P; Silver, R M


    To determine which interventions for managing placenta accreta were associated with reduced maternal morbidity. Retrospective cohort study. Two tertiary care teaching hospitals in Utah. All identified cases of placenta accreta from 1996 to 2008. Cases of placenta accreta were identified using standard ICD-9 codes for placenta accreta, placenta praevia, and caesarean hysterectomy. Medical records were then abstracted for maternal medical history, hospital course, and maternal and neonatal outcomes. Maternal and neonatal complications were compared according to antenatal suspicion of accreta, indications for delivery, preoperative preparation, attempts at placental removal before hysterectomy, and hypogastric artery ligation. Early morbidity (prolonged maternal intensive care unit admission, large volume of blood transfusion, coagulopathy, ureteral injury, or early re-operation) and late morbidity (intra-abdominal infection, hospital re-admission, or need for delayed re-operation). Results Seventy-six cases of placenta accreta were identified. When accreta was suspected, scheduled caesarean hysterectomy without attempting placental removal was associated with a significantly reduced rate of early morbidity compared with cases in which placental removal was attempted (67 versus 36%, P=0.038). Women with preoperative bilateral ureteric stents had a lower incidence of early morbidity compared with women without stents (18 versus 55%, P=0.018). Hypogastric artery ligation did not reduce maternal morbidity. Scheduled caesarean hysterectomy with preoperative ureteric stent placement and avoiding attempted placental removal are associated with reduced maternal morbidity in women with suspected placenta accreta.

  4. Slip of the T tube within the common bile duct: A little known complication of the T tube drainage

    Čolović Radoje


    Full Text Available Complications related to the T tube drainage of the common bile duct are not uncommon. Some, like dislocations of the T tube out of the common bile duct, could be very serious, particularly if developed during the first few days after surgery, when the abdominal drain in the subhepatic space had been already removed. Then, an emergency reoperation might be necessary. The slip of the T tube upwards or downwards inside the common bile duct is not so rare. Fortunately, it is less dangerous and can usually be resolved without reoperation. It takes place several days after surgery, followed by the right subcostal pain, occasionally with temperature, rise of the bilirubin and with decrease or complete cessation of the bile drainage through the T tube. The diagnosis can be made only on the basis of T tube cholangiography. The re-establishment of the proper T tube position must be done under X-ray visualization. Seven cases of the T tube slip within the common bile duct, its clinical presentation, diagnosis and method of repositioning were presented. Possible mechanism of complication was described. As far as we know, the complications have not been described by other authors.

  5. Aortic valve debridement by ultrasonic surgical aspirator: a word of caution.

    Craver, J M


    Aortic stenosis was relieved in 11 patients by ultrasonic debridement of the valve and annulus, while 102 other patients underwent valve replacement for aortic stenosis during 1988. Debridement was selectively applied based on findings of small annulus size (19 mm or less) and extensive calcification. Additional patient characteristics were mean transvalvular gradient of 78 mm Hg, advanced age, and marked left ventricular hypertrophy. Six patients had no residual gradient and 5 others a mean gradient less than 10 mm Hg. There were no complications related to the debridement process. Intraoperative transesophageal Doppler echocardiography demonstrated improved leaflet mobility and elimination of the gradient in all patients and elimination of associated valvular insufficiency in 2 patients. Follow-up echocardiography demonstrated late onset of new valvular regurgitation in 5 patients that was progressive and required reoperation in 3. Thickened, hardened, and retracted valve leaflets with loss of central coaptation were found in all 3 patients who underwent reoperation. Ultrasonic debridement can effectively relieve aortic stenosis, provide an excellent immediate hemodynamic result, and decrease operative time. However, the early occurrence of aortic insufficiency in a high percentage of patients makes it an unacceptable alternative to valve replacement, and the technique should be abandoned as a treatment for severe calcific aortic stenosis.

  6. The surgical treatment of fixed subaortic stenosis: a clinical experience in Japan.

    Aeba, R; Katogi, T; Ito, T; Goto, T; Cho, Y; Inoue, Y; Omoto, T; Moro, K; Nakao, Y; Yozu, R; Takeuchi, S; Kawada, S


    We report herein the results of a retrospective study conducted on ten consecutive Japanese patients who underwent successful surgical relief of fixed subaortic stenosis between 1972 and 1994 at ages ranging from 8 months to 21 years, and followed for 3.6 years and 26 years. Associated cardiovascular defects were present in six patients, two had a history of infective endocarditis, a discrete fibrous ring was found in nine patients, and a redundant abnormal sheet was found in one. A stenotic structure was removed in nine patients and incised in one, while myotomy was additionally performed in one. There were no early complications or deaths. Cardiac catheterization revealed a significant decrease in the peak systolic pressure gradient from 84+/-22 mm Hg preoperatively to 32+/-22 mm Hg postoperatively (P = 0.0017). Reoperation of an aortic valve replacement with or without valvular annulus enlargement was required in four patients because of a small annulus with aortic insufficiency or infective endocarditis. Infective endocarditis was a major cause of late mortality (n = 1) and morbidity (n = 1), but the remaining eight patients have been asymptomatic. Thus, although this lesion is relatively rare in Japan, the typical discrete type may be more common than previously believed. While a relief operation is associated with low early mortality, the palliative aspect regarding pathology of the aortic valve should not be underestimated, including poor growth of the valve annulus, deterioration of aortic insufficiency, and infective endocarditis. The most appropriate operative procedure for reoperation remains to be evolved.

  7. In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children: A Single-center Retrospective Cohort Study.

    Almström, Markus; Svensson, Jan F; Patkova, Barbora; Svenningsson, Anna; Wester, Tomas


    To investigate the correlation between in-hospital surgical delay before appendectomy for suspected appendicitis and the finding of perforated appendicitis in children. All children undergoing acute appendectomy for suspected acute appendicitis at Karolinska University Hospital, Stockholm, Sweden from 2006 to 2013 were reviewed for the exposure of surgical delay. Primary endpoint was the histopathologic finding of perforated appendicitis. The main explanatory variable was in-hospital surgical delay, using surgery within 12 hours as reference. Secondary endpoints were postoperative wound infection, intra-abdominal abscess, reoperation, length of hospital stay, and readmission. To adjust for selection bias, a logistic regression model was created to estimate odds ratios for the main outcome measures. Missing data were replaced using multiple imputation. The study comprised 2756 children operated for acute appendicitis. Six hundred sixty-one (24.0%) had a histopathologic diagnosis of perforated appendicitis. In the multivariate logistic regression analysis, increased time to surgery was not associated with increased risk of histopathologic perforation. There was no association between the timing of surgery and postoperative wound infection, intra-abdominal abscess, reoperation, or readmission. In-hospital delay of acute appendectomy in children was not associated with an increased rate of histopathologic perforation. Timing of surgery was not an independent risk factor for postoperative complications. The results were not dependent on the magnitude of the surgical delay. The findings are analogous with previous findings in adults and may aid the utilization of available hospital- and operative resources.

  8. Perioperative morbidity of radical cystectomy: A review

    Jagdeesh N Kulkarni


    Full Text Available systematic review of the literature on perioperative morbidity (POM was done using Medline software with a combination of keywords like mortality, morbidity, and complications. In addition, we review the analysis of our hospital data of 261 Radical cystectomies (RCs performed in an 11-year period and our latest clinical pathway for RC. Age range in our series was 50 to 81 years with 240 males and 21 females. RCs were performed by intraperitoneal method in 172 patients and by our extraperitoneal (EP method in 89 patients. Urinary diversion was ileal conduit in 159 patients and neobladder in 102 patients. Blood loss ranged between 500 and 1500 ccs. Postoperative mortality occurred in eight patients (3%. Among the other early post-op complications, major urinary leak was seen in nine and minor in 11, requiring PCN in five patients and reoperation in four patients. Bowel leak or obstruction was seen in six and four patients, respectively, requiring reoperation in six patients. EP RC in our series showed some benefit in reduction of POM. The mortality of RC has declined but the POM still ranges from 11 to 68%, as reported in 23 series (1999-2008 comprising of 14 076 patients. Various risk factors leading to POM and some corrective measures are discussed in detail. However, most of these series are retrospective and lack standard complication reporting, which limits the comparison of outcomes. Various modifications in open surgical technique and laparoscopic and Robotic approaches are aimed at reduction in mortality and POM of RC.

  9. Laparoscopic Gastric Plication for the Treatment of Morbid Obesity: A Review

    Michael Kourkoulos


    Full Text Available Introduction. Laparoscopic greater curvature plication is an operation that is gaining ground in the treatment of morbid obesity, as it appears to replicate the results of laparoscopic sleeve gastrectomy with fewer complications. Aim. Review of current literature, especially results on weight loss and complications. Method. 11 (eleven published articles on laparoscopic gastric plication, of which 1 preclinical study, 8 prospective studies for a total of 521 patients and 2 case reports of unusual complications. Results. Reported Paracentage of EWL in all studies is comparable to Laparoscopic Sleeve Gastrectomy (around 50% in 6 months, 60–65% in 12 months, 60–65% in 24 months and total complication rate is at 15,1% with minor complications in 10,7%, major complications in 4,4%. Reoperation rate was 3%, conversion rate was 0,2%, and mortality was zero. Conclusion. Current literature on gastric plication and its modifications is limited and sketchy at times. Low cost, short hospital stay, absence of prosthetic material, and reversibility make it an attractive option. Initial data show that LGCP is effective for short- and medium-term weight loss, complication and reoperation rates are low, and GERD symptoms are unaffected. More data is required, and randomized control trials must be completed in order to reach safe conclusions.

  10. A systematic review on dynamic versus static distal tibiofibular fixation.

    Inge, S Y; Pull Ter Gunne, A F; Aarts, C A M; Bemelman, M


    In the last couple of years dynamic fixation for syndesmosis injuries, using a suture-button technique, raised more interest due to its advantages over the static fixation. In the current systematic review suture-button fixation is compared to the traditionally applied static fixation in unstable ankle fractures accompanied with distal tibiofibular syndesmosis injury, including the functional outcome, post-operative complications, reoperation rate, recurrent diastasis and financial aspects. A computerized literature search using PubMed/MEDLINE and EMBASE was conducted in search of suitable articles between January 2006 and February 2016. A total of 4 suture-button studies, 5 suture-button vs. static fixation studies and 1 study discussing the financial aspects were identified. The AOFAS of 104 patients treated with the suture-button device was 91.08 points with an average study-follow up of 24.85 months. The AOFAS of 106 patients treated with a static fixation device was 87.95 with an average follow-up of 24.78 months. Removal of the suture-button device was reported in 10.5% of 229 patients and removal of the screws in 38.5%. Dynamic fixation demonstrated to be a viable alternative to the static fixation device, with lower reoperation rates and less complications. They can accurately stabilize the ruptured syndesmosis without device breakage or loss of reduction. 1A economic/decision. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Gene polymorphisms in APOE, NOS3, and LIPC genes may be risk factors for cardiac adverse events after primary CABG

    Nollert Georg


    Full Text Available Abstract Introduction Coronary artery disease progression after primary coronary artery bypass grafting may, beside classical atherosclerosis risk factors, be depending on genetic predisposition. Methods We investigated 192 CABG patients (18% female, age: 60.9 ± 7.4 years. Clinically cardiac adverse events were defined as need for reoperation (n = 88; 46%, reintervention (n = 58; 30%, or angina (n = 89; 46%. Mean follow-up time measured 10.1 ± 5.1 years. Gene polymorphisms (ApoE, NOS3, LIPC, CETP, SERPINE-1, Prothrombin were investigated separately and combined (gene risk profile. Results Among classical risk factors, arterial hypertension and hypercholesterinemia significantly influenced CAD progression. Single ApoE, NOS3 and LIPC polymorphisms provided limited information. Patients missing the most common ApoE ε3 allele (5,2%, showed recurrent symptoms (p = 0,077 and had more frequently reintervention (p = 0,001. NOS3 a allele was associated with a significant increase for reintervention (p = 0,041 and recurrent symptoms (p = 0,042. Homozygous LIPC patients had a higher reoperation rate (p = 0.049. A gene risk profile enabled us to discriminate between faster and slower occurrence of cardiac adverse events (p = 0.0012. Conclusion Single APOE, LIPC and NOS3 polymorphisms permitted limited prognosis of cardiac adverse events in patients after CABG. Risk profile, in contrast, allowed for risk stratification.

  12. Effectiveness of Tachosil(®) in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis.

    Hüttner, Felix J; Mihaljevic, André L; Hackert, Thilo; Ulrich, Alexis; Büchler, Markus W; Diener, Markus K


    Postoperative pancreatic fistula (POPF) is a frequent and clinically relevant problem after distal pancreatectomy. A variety of methods have been tested in the attempt to prevent POPF, most of them without convincing results. A systematic literature search was conducted in PubMed, Embase and the Cochrane Library to identify clinical studies comparing pancreatic stump closure with the addition of Tachosil(®) to conventional stump closure. The identified studies were critically appraised, and meta-analyses were performed using a random-effects model. Dichotomous data were pooled using odds ratios, and weighted mean differences were calculated for continuous outcomes, together with the corresponding 95 % confidence intervals. Four studies (two randomised controlled trials and two retrospective clinical studies) reporting data from 738 patients were included in the meta-analysis. Overall POPF, clinically-relevant POPF, mortality, reoperations, intraoperative blood loss and length of hospital stay did not differ significantly between conventional closure and additional covering of the pancreatic stump with Tachosil(®). A sensitivity analysis of only randomised controlled trials confirmed the results. The application of Tachosil(®) to the pancreatic stump after distal pancreatectomy is a safe procedure but provides no relevant benefit in terms of POPF, mortality, reoperation rate, blood loss or length of hospital stay. Future research should concentrate on novel methods of pancreatic stump closure to prevent POPF after distal pancreatectomy.

  13. Assessment of laser treated silicone (LTS membrane as a pericardial substitute: an InVivo Study

    H. Ahmadi


    Full Text Available Baekgrouund & purpose: Retrosterenal and pericardial adhesions formation after cardiac surgery makes a repeat Sternotomy is time consuming and dangerous, with high risk of iatrogenic trauma to heart, aorta, innominate vessels and grafts. Therefore we decided to find another substitute for pericard other than the ordinary ones in use, withthe advantage of lower cost but good results.Materials and Methods: Thirty sheep,35-45 kg were used in this study and categorized test group and control groups. In group one (n=18 pericardium was excised and the LTS ( Laser-Treated Sil- icone membrane implanted as a pericardial . In control group( n=12 the pericardium was excised without LTS membrane implantation. During followup ranging from 3-24 months, sheep were observed for any clinical– sign of post operation problems. Reoperation was done in all animals of test and control groups to evaluate-adhesions formation .Results:In the control group dense adhesions were observed, while in the study group adhesions- formation was reduced at all sites covered by LTS membrane and no infection or other complications were- observed .Conclusions: The LTS membrane is safe and efficient in reducing pericardial adhesions formation whom might be used in patients undergoing cardiac surgery whom may need reoperation, and due to Lower costs it may replace other substitutes such as PTFF.


    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi


    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  15. Surgical management of spontaneous ruptured hepatocellular adenoma

    Marcelo Augusto Fontenelle Ribeiro Junior


    Full Text Available AIMS: Spontaneous ruptured hepatocellular adenoma (SRHA is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS: We reviewed medical records and radiology files of 28 patients (from 1989 to 2006 with a proven diagnosis of hepatocellular adenoma (HA. Three (10.7% of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS: The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation, as well as intraperitoneal abscess (re-operation and pleural effusion. CONCLUSION: Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.

  16. A Comparative Study to Evaluate a Simple Method for the Management of Postoperative Bleeding Following Palatoplasty

    Percy Rossell-Perry


    Full Text Available Bleeding, is one of the most common postoperative complications after palatoplasty in pa­tients with cleft palate. The purpose of this article is to present our experience using a Foley catheter balloon for perioperative palatoplasty bleeding management. A retrospective data analysis was performed for all cases of palatoplasty performed by the author from 1999 to 2012 that experienced postoperative hemorrhage. These patients were managed by utilizing posterior nasal compression with a Foley catheter balloon for the period 2006 to 2012. We have compared two methods (we use before 2006 the reoperative method with regards to the later development of palatal fistulae and cases with reoperative hemostasis. The study found no statistically significant differences between the conventional and proposed method in relation to the development of palatal fistulae (P=0.7. These findings suggest that nasal packing using a Foley balloon is a safe and effective method for postoperative bleeding con­trol after palatoplasty in patients with cleft palate.

  17. Costs and resource use following defunctioning stoma in low anterior resection for cancer - A long-term analysis of a randomized multicenter trial.

    Floodeen, H; Hallböök, O; Hagberg, L A; Matthiessen, P


    Defunctioning stoma in low anterior resection (LAR) for rectal cancer can prevent major complications, but overall cost-effectiveness for the healthcare provider is unknown. This study compared inpatient healthcare resources and costs within 5 years of LAR between two randomized groups of patients undergoing LAR with and without defunctioning stoma. Five-year follow-up of a randomized, multicenter trial on LAR (NCT 00636948) with (stoma; n = 116) or without (no stoma; n = 118) defunctioning stoma comparing inpatient healthcare resources and costs. Unplanned stoma formation, days with stoma, length of hospital stay, reoperations, and total associated inpatient costs were analyzed. Average costs were € 21.663 per patient with defunctioning stoma and € 15.922 per patient without defunctioning stoma within 5 years of LAR, resulting in an average cost-saving of € 5.741. There was no difference between groups regarding the total number of days with any stoma (stoma = 33 398 vs. no stoma = 34 068). The total number of unplanned reoperations were 70 (no stoma) and 32 (stoma); p cost-savings associated with a reduced frequency of anastomotic leakage. Both groups required the same total number of days with a stoma within five years of LAR. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  18. Resultados tardios da plastia mitral em pacientes reumáticos Late outcomes of mitral repair in rheumatic patients

    Elaine Soraya Barbosa de Oliveira Severino


    Full Text Available INTRODUÇÃO: Os resultados tardios da plastia mitral em pacientes reumáticos são controversos na literatura. OBJETIVO: Estudo observacional e prospectivo que avalia os resultados tardios e identifica os fatores associados à reoperação e à mortalidade em pacientes reumáticos submetidos à plastia da valva mitral. MÉTODOS: Incluídos somente os pacientes com valvopatia mitral reumática submetidos a plastia, com insuficiência tricúspide associada ou não. Excluídos os pacientes com outros procedimentos associados. Um total de 104 pacientes foi estudado. Sobrevida e reoperação foram avaliadas pela analise de Kaplan-Meier e regressão logística de Cox. RESULTADOS: O tempo de seguimento foi de 63 ± 39 meses (IC 95% 36 a 74 meses. A classe funcional III e IV estava presente em 65,4% dos pacientes no pré-operatório. Foram realizadas 33 plastias do anel posterior, 21 comissurotomias, 50 comissurotomias e plastias do anel posterior. Não houve mortalidade operatória e a tardia foi de três (2,8% pacientes. A reoperação tardia esteve associada à insuficiência mitral residual no pós-operatório (PINTRODUCTION AND AIMS: The long-term results after surgical repair of rheumatic mitral valve remain controversial in literature. Our aim was to determine the predictive factors which impact the long-term results after isolated rheumatic mitral valve repair and to evaluate the effect of those factors on reoperation and late mortality. METHODS: One hundred and four patients with rheumatic valve disease who had undergone mitral valve repair with or without tricuspid valve annuloplasty were included. All patients with associated procedures were excluded. The predictive variables for reoperation were assessed with Cox regression and Kaplan Meier survival curves. RESULTS: The mean follow-up time was 63 ± 39 months (CI 95% 36 to 74 months. The functional class III and IV was observed in 65.4% of all patients. The posterior ring annuloplasty was

  19. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion.

    Maulucci, Christopher M; Ghobrial, George M; Sharan, Ashwini D; Harrop, James S; Jallo, Jack I; Vaccaro, Alexander R; Prasad, Srinivas K


    aspect of the occipital protuberance and a line determined by the posterior aspect of the facets of the third and fourth cervical vertebrae, calculated after stabilization, was 107.1 degrees (range, 72-140 degrees). Reoperation was required in 11 patients (11/107, 10.3%). The mean POCA for the reoperation group was 109.5 degrees (range, 72-123) and was not significantly different than patients not requiring reoperation (106.5, p > 0.05). However, for all pathologies excluding infection as a cause for reoperation, the mean POCA was significantly higher, 115.14 degrees (p = 0.039) (Table 1). Seven patients (6.5%) complained of dysphagia postoperatively with a significantly higher POCA of 115 degrees (p = 0.039). Of these seven patients, six underwent posterior-only procedures. One patient underwent anterior and posterior procedures for a severe kyphotic deformity. The dysphagia resolved in six patients over a mean of 3 weeks (range, 2-4 weeks). One patient, whose surgery was posterior only, required the insertion of a gastrostomy tube. Conclusions An elevated POCA may result in need for reoperation due to increased biomechanical stress upon adjacent segments or the construct itself due to flexion in an attempt to maintain forward gaze. Further, an elevated POCA seems to also correlate with a higher incidence of dysphagia. Further investigation is necessary to determine the ideal craniocervical angle which is likely individualized to a particular patient based on global and regional spinal alignments.

  20. Clinical features and surgical outcomes of complete transposition of the great arteries

    Suk Jin Hong


    Full Text Available &lt;B&gt;Purpose:&lt;/B&gt; This single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA. &lt;B&gt;Methods:&lt;/B&gt; TGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status. &lt;B&gt;Results:&lt;/B&gt; Twenty-eight patients (17 boys and 11 girls, mean age= 10.6±21.5 days were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13; group II, TGA with ventricular septal defect (VSD, n=12; and group III, TGA/VSD with pulmonary stenosis (n=3. Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication. Group II showed the highest incidence of heart failure (P&lt;0.05. Usual and unusual coronary anatomy patterns were observed in 20 (71% and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III, respectively. Postoperative complications included cardiac arrhythmias (8 patients, central nervous system complications (3 patients, acute renal failure (1 patient, infections (3 patients, and cardiac tamponade (1 patient, and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P&lt;0.05. One patient underwent reoperation, and 1 died. The overall mortality rate was 4%. &lt;B&gt;Conclusion:&lt;/B&gt; Our study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were

  1. Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass.

    Buchwald, H; Buchwald, J N; McGlennon, T W


    This is the first systematic review and meta-analysis focused exclusively on intermediate-term outcomes for the banded Roux-en-Y gastric bypass (B-RYGB). B-RYGB articles published from 1990 to 2013 were identified through MEDLINE, ScienceDirect, and SpringerLink databases augmented by manual reference review. Articles were assigned an evidence level (Centre for Evidence-Based Medicine [Oxford UK] criteria) and Jadad quality score (randomized controlled trials). Simple and weighted means (95% confidence interval (CI)) for excess weight loss (EWL) at follow-up (1-10+ years) were calculated. At 5 years, a pooled estimate for BMI (kg/m(2)) change (weighted mean difference and 95% CI) for banded bypass patients was computed. Rates for weighted mean complications, non-band- and band-related reoperations, and overall comorbidity resolution were calculated. Three hundred twenty-one articles were identified: 286 failed inclusion criteria (i.e., non-English, B-RYGB unrelated, <10 per arm, <3-year follow-up), leaving 35 articles. Manual review added 10 potentially relevant articles; 30 that failed inclusion criteria were excluded, leaving 15 for analysis. B-RYGB was performed on 8,707 patients: 79.0% female, mean age 38.7, and BMI 47.6 (41.0-59.4). Overall BMI weighted mean difference (reduction) at 5 years was 17.8 (95% CI 12.8, 22.7; p < 0.001). Five-year weighted mean EWL of 72.5% (67.5, 77.4) was sustained at 10+ years (69.4%; 58.9, 80.0). Weighted mean complication rates were as follows: early, 10.9%, and late, 20.0%. Non-band-related reoperation rate was 15.2%, and band-specific reoperation rate was 4.1%. Gastric outlet stenosis, band erosion, and band slippage were 2.8, 2.3, and 1.5%, respectively. Diabetes remitted in 80/95 (84.2%). By systematic review and meta-analysis, albeit with limited rates of follow-up, B-RYGB appeared to result in significant, sustained excess weight loss of approximately 70.0% out to 10 years.

  2. Risk Factors for Late Aortic Valve Dysfunction After the David V Valve-Sparing Root Replacement.

    Esaki, Jiro; Leshnower, Bradley G; Binongo, Jose N; Lasanajak, Yi; McPherson, LaRonica; Guyton, Robert A; Chen, Edward P


    Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. However, late aortic valve dysfunction requiring reoperation remains a primary concern of this procedure. This study examines risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) after David V VSRR. A retrospective review from 2005 to 2015 at a US academic center identified 282 patients who underwent VSRR. Cox proportional hazards regression analysis was used to identify risk factors for late AI and AS after VSRR. The mean age was 46.4 years. Sixty-four patients (22.7%) had bicuspid valves, and 41 patients (14.5%) had Marfan syndrome. The incidence of reoperations was 27 (9.6%), and 42 cases (14.9%) presented with acute type A dissection. Operative mortality was 8 (2.8%). Seven-year survival was 90.9%. Seven-year cumulative incidence of reoperation, greater than 2+ AI and greater than moderate AS were 3.1%, 2.2%, and 0.8%, respectively. Multivariable analysis showed aortic root size 55 mm or larger (hazard ratio 3.44, 95% confidence interval: 1.27 to 9.29, p = 0.01) to be a risk factor for late AI whereas bicuspid valve (hazard ratio 16.07, 95% confidence interval: 3.12 to 82.68, p = 0.001) and cusp repair were found to be risk factors (hazard ratio 5.91, 95% confidence interval: 1.17 to 29.86, p = 0.03) for late AS. Valve-sparing root replacement can be performed with low operative risk and good overall long-term survival even in complex clinical settings. Durable valve function can be expected; however, aortic root size 55 cm or more, bicuspid valve anatomy, and cusp repair represent independent risk factors for late aortic valve dysfunction after these procedures. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years.

    Anselmi, Amedeo; Flecher, Erwan; Chabanne, Celine; Ruggieri, Vito Giovanni; Langanay, Thierry; Corbineau, Hervé; Leguerrier, Alain; Verhoye, Jean-Philippe


    To address the long-term durability of bioprostheses used for aortic valve replacement (AVR) in adult patients aged ≤60 years at the time of surgery. Through a retrospective review of a prospectively collected database, we identified 416 bioprosthetic AVRs performed between 1977 and 2013. A prospective follow-up of valve-related and non-valve-related events was performed. Follow-up was 98.5% complete (2423.1 patient-years; average, 6 ± 5.5 years). At 15 years, overall survival was 62.1 ± 4.4%; freedom from valve-related death was 97.1 ± 1.6%. There were 68 SVD events (11.9 ± 28.8 years after surgery). Freedom from SVD at 15 years was 48.7 ± 5.5% for Kaplan-Meier analysis and 61.4 ± 4.3% for competing-risks analysis. After stratification into age subgroups (SVD (P = .50). The average delay to SVD was not statistically different among subgroups (P = .30). There were 57 reoperations for SVD (11.8 ± 5.2 years after implantation). The 15 year freedom from reoperation for SVD was 55.4 ± 5.6% by Kaplan-Meier analysis and 67.1 ± 4.2% by competing-risks analysis. After stratification by age, freedom from reoperation for SVD was comparable (P = .13). Freedom from any valve-related complication or death was 42 ± 5% by Kaplan-Meier analysis and 54.4 ± 4.1% by competing-risks analysis. The lifetime risk of SVD is considerable in patients aged ≤60 years at the time of bioprosthesis implantation. Nonetheless, durability remains consistent during the first decade; additional data are required for the second decade. Patients' information is pivotal for valve choice (competing-risks method). Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. The fate of small-size pericardial heart valve prostheses in an older patient population.

    De Paulis, Ruggero; D'Aleo, Salvatore; Bellisario, Alessandro; Salica, Andrea; Weltert, Luca P; Scaffa, Raffaele; Wolf, Lorenzo Guerrieri; Maselli, Daniele; Di Mauro, Michele


    Structural valve deterioration (SVD) is the Achilles' heel of bioprostheses. Its correlation with younger age is well known. In recent years we exclusively reserved use of small-size Mitroflow valve prostheses (LivaNova, London, United Kingdom) to an older patient population with small aortic annuli. This study aimed to assess the incidence of SVD and its effect on patient survival and need for reoperation. Two hundred five patients (aged 75.9 ± 5.3 years; range, 62-92 years) underwent aortic valve replacement with a 19-mm or 21-mm Mitroflow valve prosthesis between 2005 and 2011. The great majority was female (n = 170; 83%). In half of patients it was an isolated procedure. All valve prostheses were implanted in a supra-annular position using pledgeted sutures. A 19-mm valve was implanted in 93 patients (45.3%), whereas in 112 patients (54.6%) a 21-mm valve was used. Twenty-three patients (11.2%) were diagnosed with early SVD by echocardiography. Average time from surgery to diagnosis of SVD was 64.3 ± 26.8 months. Ten patients needed a reoperation for SVD. Average time from surgery to a second operation was 45.7 ± 35.7 months. Overall survival was 64.5% and 42.3% at 5 and 9 years, respectively. Cumulative freedom from SVD at 5 and 9 years was 94.8% ± 1.6% and 77.4% ± 5.4%, respectively. In 4 patients death was linked to the presence of SVD. There were no differences in mortality, reoperation, or SVD between the 2 Mitroflow valve sizes. Small-size Mitroflow pericardial valve prostheses have shown a worrisome incidence of SVD even in patients aged >70 years. Based on this experience we have discontinued their use. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. Risk factors of acute renal failure after liver transplantation.

    Cabezuelo, J B; Ramírez, P; Ríos, A; Acosta, F; Torres, D; Sansano, T; Pons, J A; Bru, M; Montoya, M; Bueno, F S; Robles, R; Parrilla, P


    The objective of this study was to determine the risk factors of postoperative acute renal failure (ARF) in orthotopic liver transplantation (OLT). We reviewed 184 consecutive OLT. Postoperative ARF was defined as a persistent rise of 50% increase or more of the S-creatinine (S-Cr). The patients were classified as early postoperative ARF (E-ARF) (first week) and late postoperative ARF (L-ARF) (second to fourth week). Preoperative variables were age, sex, comorbidity, indication for OLT, Child-Pugh stage, united network for organ sharing status, analysis of the blood and urine, and donor's data. Intraoperative variables were systolic arterial pressure, mean arterial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance index. Surgical technique, number of blood products transfused, need for adrenergic agonist drugs, and intraoperative complications were also important. Postoperative variables were duration of stay in the intensive care unit, time on mechanic ventilation, liver graft dysfunction, need for adrenergic agonist drugs, units of blood products infused, episodes of acute rejection, re-operations, and bacterial infections. Firstly we carried out a univariate statistical analysis, and secondly a logistic regression analysis. The risk factors for E-ARF were: pretransplant ARF (odds ratio (OR)=10.2, P=0.025), S-albumin (OR=0.3, P=0.001), duration of treatment with dopamine (OR=1.6, P=0.001), and grade II-IV dysfunction of the liver graft (OR=5.6, P=0.002). The risk factors for L-ARF were: re-operation (OR=3.1, P=0.013) and bacterial infection (OR=2.9, P=0.017). The development of E-ARF is influenced by preoperative factors such as ARF and hypoalbuminemia, as well as postoperative factors such as liver dysfunction and prolonged treatment with dopamine. The predicting factors of L-ARF differ from E-ARF and correspond to postoperative causes such as bacterial infection and surgical re-operation.

  6. Longitudinal comparison of quality of life in patients undergoing laparoscopic Toupet fundoplication versus magnetic sphincter augmentation: Observational cohort study with propensity score analysis.

    Asti, Emanuele; Bonitta, Gianluca; Lovece, Andrea; Lazzari, Veronica; Bonavina, Luigi


    Only a minority of patients with gastro-esophageal reflux disease (GERD) are offered a surgical option. This is mostly due to the fear of potential side effects, the variable success rate, and the extreme alteration of gastric anatomy with the current gold standard, the laparoscopic Nissen fundoplication. It has been reported that laparoscopic Toupet fundoplication (LTF) and laparoscopic sphincter augmentation using a magnetic device (LINX) can treat reflux more physiologically and with a lower incidence of side-effects and reoperation rate. We present the first comparing quality of life in patients undergoing LTF versus LINX.Observational cohort study. Consecutive patients undergoing LTF or LINX over the same time period were compared by using the propensity score full matching method and generalized estimating equation. Criteria of exclusion were >3 cm hiatal hernia, grade C-D esophagitis, ineffective esophageal motility, body mass index >35, and previous upper abdominal surgery. The primary study outcome was quality of life measured with the Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire. Secondary outcomes were proton pump inhibitors (PPI) use, presence of gas-related symptoms or dysphagia, and reoperation-free probability.Between March 2007 and July 2014, 238 patients with GERD met the criteria of inclusion in the study. Of these, 103 underwent an LTF and 135 a LINX procedure. All patients had a minimum 1-year follow-up. Over time, patients in both groups had similar GERD-HRQL scores (odds ratio [OR] 1.04, confidence interval [CI] 0.89-1.27; P = 0.578), PPI use (OR 1.18, CI 0.81-1.70; P = 0.388), gas-related symptoms (OR 0.69, CI 0.21-2.28; P = 0.542), dysphagia (OR 0.62, CI 0.26-1.30; P = 0.241), and reoperation-free probability (stratified log-rank test = 0.556).In 2 concurrent cohorts of patients with early stage GERD undergoing LTF or LINX and matched by propensity score analysis, health

  7. 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: A NSQIP pediatric analysis.

    McNamara, Erin R; Kurtz, Michael P; Schaeffer, Anthony J; Logvinenko, Tanya; Nelson, Caleb P


    Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures. Although there is literature identifying long-term outcomes in these patients, the reporting of short-term postoperative outcomes has been limited by small numbers of cases and lack of prospective data collection. Here we report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these procedures. To determine 30-day complication, readmission and reoperation after augmentation enterocystoplasty and appendicovesicostomy in a large national sample of pediatric patients, and to explore the association between preoperative and intraoperative characteristics and occurrence of any 30-day event. We queried the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS-NSQIPP) for all patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy. Surgical risk score was classified on a linear scale using a validated pediatric-specific comorbidity score. Intraoperative characteristics and postoperative 30-day events were reported from prospectively collected data. A composite measure of complication, readmission and/or reoperation was used as primary outcome for the multivariate logistic regression. There were 461 patients included in the analysis: 245 had appendicovesicostomy, 97 had augmentation enterocystoplasty and 119 had both procedures. There were a total of 110 NSQIP complications seen in 87 patients. The most common complication was urinary tract infection (see Table for 30-day outcomes by patient). The composite measure of any 30-day event was seen in 27.8% of the cohort and this was associated with longer operative time, increased number of procedures done at time of primary surgical procedure and higher surgical risk score. The ACS-NSQIPP provides a tool to examine short-term outcomes for these complex urologic procedures that has not

  8. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures.

    Hsu, Andrew R; Jones, Carroll P; Cohen, Bruce E; Davis, W Hodges; Ellington, J Kent; Anderson, Robert B


    Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures. Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision with FiberWire in a Krackow fashion reinforced with absorbable sutures. Patient demographics were recorded along with medical comorbidities, activity at injury, time from injury to surgery, length of follow-up, return to baseline activities by 5 months, and postoperative complications. The most common activity during injury for both groups was basketball (PARS: 39%, open: 47%). A greater number of patients treated with PARS were able to return to baseline physical activities by 5 months compared with the open group (PARS: 98%, open: 82%; P = .0001). There were no significant differences (P > .05) between groups in rates of rerupture (P = 1.0), sural neuritis (P = .16), wound dehiscence (P = .74), superficial (P = .29) and/or deep infection (P = .29), or reoperation (P = .13). There were no deep vein thromboses (DVTs) or reruptures in either group. In the PARS group, there were no cases of sural neuritis, 3 cases (3%) of superficial wound dehiscence, and 2 reoperations (2%) for superficial

  9. 5. Mitral valve replacement for mitral stenosis: 15 years single center experience

    A. Arifi


    Full Text Available Mitral valve replacement (MVR with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. This study aimed to evaluate and compare the early and late outcome of mitral valve replacement (mechanical versus bioprosthetic for severe mitral stenosis. A retrospective cohort study was performed on prospectively collected data involving mitral stenosis patients who have undergone MVR with either bioprosthetic (BMV (n = 50 or mechanical (MMV (n = 145 valves in our institute from 1999 to 2012. Data were analyzed for early and late mortality, NYHA functional classes, stroke, early and late valve-related complications, and survival. Chi Square test, logistic regression, Kaplan Meier curve, and dependent proportions tests were performed. A total of 195 patients were included in the study with a follow-up of 190 patients (97.5%. One patient died early post-operatively; twelve patients died late in the post-operative period, BMV group (6 and the MMV (6. The Late mortality had significantly associated with post-op stroke (p < 0.001 and post-op NYHA classes III and IV (p = 0.002. Post-op NYHA class was significantly associated with age (p = 0.003, pulmonary disease (p = 0.02, mitral valve implant type (p = 0.01, and post-op stroke (p = 0.02; 14 patients had strokes in the MMV (9 and in the BMV (5 groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001. Bioprosthetic valves were significantly associated with worse survival (p = 0.03, worse NYHA post-op (p = 0.01, and more re-operations (p = 0.006. Survival was significantly better with mechanical valves (p = 0.03. When the two groups were matched for age and mitral regurgitation, the analysis revealed that bioprosthetic valves were significantly associated with re-operations (p = 0.02 but not significantly associated with worse survival (p = 0.4 or worse NYHA (p = 0.4. Mechanical mitral valve

  10. Effect of preoperatively continued aspirin use on early and mid-term outcomes in off-pump coronary bypass surgery: a propensity score-matched study of 1418 patients.

    Fucheng Xiao

    Full Text Available To date, effect of preoperatively continued aspirin administration in off-pump coronary artery bypass grafting (CABG is less known. We aimed to assess the effect of preoperatively continued aspirin use on early and mid-term outcomes in patients receiving off-pump CABG.From October 2009 to September 2013 at the Fuwai Hospital, 709 preoperative aspirin users were matched with unique 709 nonaspirin users using propensity score matching to obtain risk-adjusted outcome comparisons between the two groups. Early outcomes were in-hospital death, stroke, intra- and post-operative blood loss, reoperation for bleeding and blood product transfusion. Major adverse cardiac events (death, myocardial infarction or repeat revascularization, angina recurrence and cardiogenic readmission were considered as mid-term endpoints.There were no significant differences among the groups in baseline characteristics after propensity score matching. The median intraoperative blood loss (600 ml versus 450 ml, P = 0.56, median postoperative blood loss (800 ml versus 790 ml, P = 0.60, blood transfusion requirements (25.1% versus 24.4%, P = 0.76 and composite outcome of in-hospital death, stroke and reoperation for bleeding (2.8% versus 1.6%, P = 0.10 were similar in aspirin and nonaspirin use group. At about 4 years follow-up, no significant difference was observed among the aspirin and nonaspirin use group in major adverse cardiac events free survival estimates (95.7% versus 91.5%, P = 0.23 and freedom from cardiogenic readmission (88.5% versus 85.3%, P = 0.77 whereas the angina recurrence free survival rates was 83.7% and 73.9% in the aspirin and nonaspirin use group respectively (P = 0.02, with odd ratio for preoperative aspirin estimated at 0.71 (95% confidence interval, 0.49-1.04, P = 0.08.Preoperatively continued aspirin use was not associated with increased risk of intra- and post-operative blood loss, blood transfusion requirements and composite outcome of in

  11. Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial.

    Stenberg, Erik; Szabo, Eva; Ågren, Göran; Ottosson, Johan; Marsk, Richard; Lönroth, Hans; Boman, Lars; Magnuson, Anders; Thorell, Anders; Näslund, Ingmar


    Small bowel obstruction due to internal hernia is a common and potentially serious complication after laparoscopic gastric bypass surgery. Whether closure of surgically created mesenteric defects might reduce the incidence is unknown, so we did a large randomised trial to investigate. This study was a multicentre, randomised trial with a two-arm, parallel design done at 12 centres for bariatric surgery in Sweden. Patients planned for laparoscopic gastric bypass surgery at any of the participating centres were offered inclusion. During the operation, a concealed envelope was opened and the patient was randomly assigned to either closure of mesenteric defects beneath the jejunojejunostomy and at Petersen's space or non-closure. After surgery, assignment was open label. The main outcomes were reoperation for small bowel obstruction and severe postoperative complications. Outcome data and safety were analysed in the intention-to-treat population. This trial is registered with, number NCT01137201. Between May 1, 2010, and Nov 14, 2011, 2507 patients were recruited to the study and randomly assigned to closure of the mesenteric defects (n=1259) or non-closure (n=1248). 2503 (99·8%) patients had follow-up for severe postoperative complications at day 30 and 2482 (99·0%) patients had follow-up for reoperation due to small bowel obstruction at 25 months. At 3 years after surgery, the cumulative incidence of reoperation because of small bowel obstruction was significantly reduced in the closure group (cumulative probability 0·055 for closure vs 0·102 for non-closure, hazard ratio 0·56, 95% CI 0·41-0·76, p=0·0002). Closure of mesenteric defects increased the risk for severe postoperative complications (54 [4·3%] for closure vs 35 [2·8%] for non-closure, odds ratio 1·55, 95% CI 1·01-2·39, p=0·044), mainly because of kinking of the jejunojejunostomy. The results of our study support the routine closure of the mesenteric defects in laparoscopic

  12. Early investigation of silver-coated Silzone heart valves prosthesis in 126 patients.

    Auer, J; Berent, R; Ng, C K; Punzengruber, C; Mayr, H; Lassnig, E; Schwarz, C; Puschmann, R; Hartl, P; Eber, B


    Permanent silver (Silzone) coating of the sewing cuff of St. Jude Medical prosthetic heart valves may reduce the rate of prosthetic valve endocarditis (PVE). However, the incidence of paravalvular leaks and stroke in patients after implantation of Silzone-coated heart valve prostheses is largely unknown. Complications were analyzed among 126 consecutive patients (78 males, 48 females; mean age 64.7 years; range: 40-80 years) who received Silzone-coated prostheses at our institution between February 1998 and December 1999. Among patients, 94 had aortic valve replacement, 29 mitral valve replacement, and three had aortic and mitral valve replacement. Concomitant cardiac procedures (mainly coronary bypass) were performed in 47 patients (37.3%). Hospital mortality was 1.6% (2/126) and freedom from valve-related mortality 99.2+/-0.9%. Total follow up was 137.4 patient-years, and 98.4% complete. Strokes or transitory ischemic attacks (TIAs) occurred in four cases (two strokes, two TIAs; stroke rate 1.5%/year; 95% CI 0.4-2.6%/year; stroke+TIA rate 3%/year; 95% CI 0.4-5.25%/year). There was no case of prosthetic valve dysfunction or PVE. Freedom from reoperation due to procedure-associated complications was 97.6% (one aortic dissection, two major bleeds). Paravalvular leak was detected in 19 cases, and graded trivial or mild in 17 cases (11 grade 0-I, six grade I), and moderate in two cases (grade I-II in one, grade II in one). No patient needed reoperation due to paravalvular leak. Left ventricular (LV) function was normal in 80 cases, but was impaired mildly in 20 cases, moderately in 16, and severely in eight. Bicycle exercise testing in 92 patients (73%) showed median exercise performance (81.4+/-23.9% of normal) after correction for age and weight. Cerebral magnetic resonance imaging was performed in 64 patients (50.8%); median MRI score was 2.0+/-1.8 according to a 12-scaled score system. The overall incidence of echocardiographic paravalvular leak graded more than

  13. "Ultra" E.R.A.S. in laparoscopic colectomy for cancer: discharge after the first flatus? A prospective, randomized trial.

    Garulli, Gianluca; Lucchi, Andrea; Berti, Pierluigi; Gabbianelli, Carlo; Siani, Luca Maria


    Enhanced Recovery After Surgery (E.R.A.S.) programs are now widely accepted in colonic laparoscopic resections because of faster recovery and less perioperative complications. The aim of this study was to assess safety and feasibility of discharging patients operated on by laparoscopic colectomy on postoperative day 2, so long as the first flatus has passed and in the absence of complication-related symptoms. This study was a non-inferiority, open-label, single-center, prospective, randomized study comparing "Ultra" to Classic E.R.A.S. with discharge on POD 2 and 4, respectively. Seven hundred and sixty-five patients with resectable non-metastatic colonic cancer were analyzed: 384 patients were assigned to "Ultra" E.R.A.S. and 381 to Classic E.R.A.S. Primary end-point was mortality; secondary end-points were morbidity, readmission and reoperation rate. Limitations are: it is a single-center experience; it is not double-blind, with the intrinsic risk of intentional or unconscious bias; exclusion criteria because of "non-compliance" may be considered arbitrary. Mortality was 0.89 % in "Ultra" E.R.A.S. group and 0.59 % in Classic E.R.A.S. (p = 0.571). Morbidity was 34.1 % for "Ultra" E.R.A.S. arm and 35.4 % for Classic E.R.A.S. (p = 0.753). Readmissions were 5.6 % for "Ultra" E.R.A.S. and 5.9 % for Classic E.R.A.S. (p = 0.359). Reoperation rate was 3.8 % for "Ultra" ERAS and 4.7 % for Classic E.R.A.S. (p = 0.713). Multivariate regression analyses using Cox's proportional hazard model showed that mortality (primary end-point), morbidity, reoperation and readmission (secondary end-points) were not significantly influenced by the two different perioperative regimens; conversely, the global cost of "Ultra" E.R.A.S. regimen was more economically effective. "Ultra" E.R.A.S. showed to be safe, actual and effective; discharge on postoperative day 2 after the first flatus passage, in the absence of complication-related symptoms, should be actively considered in

  14. Surgical site infections after lower extremity revascularization procedures involving groin incisions.

    Kuy, SreyRam; Dua, Anahita; Desai, Sapan; Dua, Arshish; Patel, Bhavin; Tondravi, Nader; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian D; Lee, Cheong J; Kuy, SreyReath; Subbarayan, Rishi; Rossi, Peter J


    We sought to evaluate the incidence, epidemiology, and factors associated with surgical site infections (SSIs) after lower extremity revascularization procedures involving groin incisions and determine outcomes based on SSI status. This is a single-institution, retrospective cohort study of 106 patients who underwent lower extremity revascularization procedures involving femoral artery exposure through a groin incision at a tertiary referral hospital. The primary outcome was occurrence of SSI at the groin wound. The duration of hospital stay, reoperation within 30 days, discharge disposition, and 30-day mortality were also evaluated. Independent variables included patient demographics and operative variables (i.e., procedure type, transfusion requirements, preoperative antibiotics, intraoperative vasopressors, and operative duration). Statistical analysis included chi-squared tests, t-tests, and multivariable regression analysis. Of the 106 patients who underwent a lower extremity revascularization procedure with a groin incision for femoral artery exposure, 62% were male, and the mean age was 62 years. Comorbidities included hypertension (93%), dyslipidemia (65%), statin use (63%), active smoker (50%), diabetes (24%), and chronic obstructive pulmonary disease (23%). All patients received preoperative antibiotics, 50% required intraoperative pressors, 21% received a blood transfusion, and the mean operative time was 296 min. The overall duration of stay was 10.7 days, the 30-day reoperation rate was 18%, and the 30-day mortality rate was 12%. Overall, 22% developed a seroma or hematoma, and 31% developed a SSI. Patients who developed an SSI compared with those who did not were more likely to have a postoperative seroma or hematoma (55% vs 5%) and to receive a blood transfusion (33% vs 15%), but less likely to be treated with a statin (47% vs 69%) or carry a diagnosis of dyslipidemia (50% vs 72%), respectively, all P surgical site complications after lower

  15. Perioperative Outcome of Adolescents Undergoing Bariatric Surgery: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

    Inge, T.H.; Zeller, M.H.; Jenkins, T.M.; Helmrath, M.; Brandt, M.L.; Michalsky, M.P.; Harmon, C.M.; Courcoulas, A.; Horlick, M.; Xanthakos, S.A.; Dolan, L.; Mitsnefes, M.; Barnett, S.J.; Buncher, C.R.


    Importance Severe obesity in childhood is a major health problem with few effective treatments. Weight loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally-invasive procedures. Objective To assess preoperative clinical characteristics perioperative safety outcomes of severely obese adolescents undergoing WLS. Design This prospective, multi-site observational study enrolled from 2007 through 2012. Setting This study was conducted at 5 academic referral centers in the U.S Participants Consecutive subjects ≤ age 19 years who were approved to undergo (n=277) were offered enrollment into the study; 13 declined participation and 22 did not undergo surgery after enrollment thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. Main Outcomes & Measures This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Re-operations and hospital re-admissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. Results Mean age of participants was 17.1±1.6 years and the median BMI was 50.5 kg/m2. Fifty-one percent demonstrated four or more major co-morbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of subjects, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg., reoperation) were seen in 19 subjects (8%). Minor complications (eg., readmission for dehydration) were noted in 36 subjects (15%). All re-operations and 85% of re-admissions were related to WLS. Conclusions & Relevance In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed a favorable short

  16. Long-segment, supercharged, pedicled jejunal flap for total esophageal reconstruction.

    Ascioti, Anthony J; Hofstetter, Wayne L; Miller, Michael J; Rice, David C; Swisher, Stephen G; Vaporciyan, Ara A; Roth, Jack A; Putnam, J B; Smythe, W Roy; Feig, Barry W; Mansfield, Paul F; Pisters, Peter W T; Torres, Marla T; Walsh, Garrett L


    Many patients with cancer have limited esophageal reconstruction options when the stomach is unavailable as a replacement conduit or when long-segment discontinuity exists. Jejunum has been used as an alternative conduit, both as a pedicled or free flap interposition; however, reports of this are usually limited to short-segment repairs. Microvascular augmentation of a pedicled jejunal flap allows creation of a longer conduit, making it possible to replace the entire esophagus with jejunum. Few reports describe this technique in patients with cancer. We report our initial experience with "supercharged" pedicled jejunum as an alternative conduit for total esophageal reconstruction. Review of a prospectively collected departmental database was performed to identify those patients who underwent total esophageal reconstruction with supercharged pedicled jejunum. Data regarding their perioperative course and postoperative function were gathered from the prospectively collected clinical data, review of hospital records, and patient interviews. Total esophageal reconstruction with supercharged pedicled jejunum was attempted in 26 patients (age range, 37-74 years) between March 2000 and April 2004. Twenty-four of 26 patients were ultimately discharged with an intact supercharged pedicled jejunum flap, for an overall success rate of 92.3%. One patient experienced intraoperative flap loss caused by technical difficulties harvesting the flap and never had the flap interposed. One other flap loss occurred in the early postoperative period in a patient who had multisystem organ failure after a prolonged reconstruction. Cervical anastomotic leaks occurred in 19.2% (5/26) of the patients. Two midconduit leaks occurred that were suspicious for iatrogenic perforation from nasogastric tube placement; one required reoperation. One additional early reoperation was performed for cecal ischemia. There were no mortalities. Functional results were available in 95.4% (21/22) of the

  17. Mid- to long-term outcome comparison of the Medtronic Hancock II and bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis.

    Wang, Yin; Chen, Si; Shi, Jiawei; Li, Geng; Dong, Nianguo


    This study aims to compare mid-long-term clinical outcomes between patients younger than 60 years of age undergoing bioprosthetic and mechanical aortic valve replacement. From January 2002 to December 2009, patients younger than 60 years of age who received Medtronic Hancock II porcine bioprostheses were selected and compared with those who received mechanical bi-leaflet valves in the aortic position. A stepwise logistic regression propensity score identified a subset of 112 evenly matched patient-pairs. Mid-long-term outcomes of survival, valve-related reoperations, thromboembolic events and bleeding events were assessed. The follow-up was only 95.1% complete. Fourteen measurable variables were statistically similar for the matched cohort. Postoperative in-hospital mortality was 3.6% (bioprosthetic valves) and 2.7% (mechanical valves) (P = 0.700). Survival at 5 and 10 years was 96.3 and 88.7% for patients receiving bioprosthetic valve replacement versus 96.3 and 87.9% for patients receiving mechanical valve replacement (P = 0.860), respectively. At 5 and 10 years after operations, freedom from valve-related reoperation was 97.2 and 94.8% for patients receiving mechanical valve replacement, and 96.3 and 90.2% for patients receiving bioprosthetic valve replacement (P = 0.296), respectively. There was no difference between freedom from thromboembolic events (P = 0.528) and bleeding events (P = 0.128) between the matched groups during the postoperative 10 years. In patients younger than 60 years of age undergoing aortic valve replacement, mid-long-term survival rate was similar for patients receiving bioprosthetic versus mechanical valve replacement. Bioprosthetic valves were associated with a trend for a lower risk of anticoagulation treatment and did not have significantly greater likelihood of a reoperation. These findings suggest that a bioprosthetic valve may be a reasonable choice for AVR in patients younger than 60 years of age. © The Author 2015. Published by

  18. Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.

    Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E


    OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas

  19. Clinical outcomes following spinal fusion using an intraoperative computed tomographic 3D imaging system.

    Xiao, Roy; Miller, Jacob A; Sabharwal, Navin C; Lubelski, Daniel; Alentado, Vincent J; Healy, Andrew T; Mroz, Thomas E; Benzel, Edward C


    OBJECTIVE Improvements in imaging technology have steadily advanced surgical approaches. Within the field of spine surgery, assistance from the O-arm Multidimensional Surgical Imaging System has been established to yield superior accuracy of pedicle screw insertion compared with freehand and fluoroscopic approaches. Despite this evidence, no studies have investigated the clinical relevance associated with increased accuracy. Accordingly, the objective of this study was to investigate the clinical outcomes following thoracolumbar spinal fusion associated with O-arm-assisted navigation. The authors hypothesized that increased accuracy achieved with O-arm-assisted navigation decreases the rate of reoperation secondary to reduced hardware failure and screw misplacement. METHODS A consecutive retrospective review of all patients who underwent open thoracolumbar spinal fusion at a single tertiary-care institution between December 2012 and December 2014 was conducted. Outcomes assessed included operative time, length of hospital stay, and rates of readmission and reoperation. Mixed-effects Cox proportional hazards modeling, with surgeon as a random effect, was used to investigate the association between O-arm-assisted navigation and postoperative outcomes. RESULTS Among 1208 procedures, 614 were performed with O-arm-assisted navigation, 356 using freehand techniques, and 238 using fluoroscopic guidance. The most common indication for surgery was spondylolisthesis (56.2%), and most patients underwent a posterolateral fusion only (59.4%). Although O-arm procedures involved more vertebral levels compared with the combined freehand/fluoroscopy cohort (4.79 vs 4.26 vertebral levels; p fusion only (HR 0.39; p fusion (HR 0.22; p = 0.03), but not posterior/transforaminal lumbar interbody fusion. CONCLUSIONS To the authors' knowledge, the present study is the first to investigate clinical outcomes associated with O-arm-assisted navigation following thoracolumbar spinal fusion. O

  20. Mid- to Long-term Clinical Outcomes of Hancock II Bioprosthesis in Chinese Population

    Yin Wang


    Full Text Available Background: Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy. This research aimed to evaluate the mid- to long-term clinical performance of Hancock II bioprosthesis in the Chinese population. Methods: This study retrospectively reviewed all patients who received surgical treatments with at least one Hancock II bioprosthesis implantation from January 2004 to December 2013 at a single center in China. Totally 647 patients were included in the clinical evaluation, and 629 patients were successfully discharge, among whom 605 patients were completely followed-up. The follow-up rate was 96.2%. The mean and median follow-up time was 62.0 ± 59.0 and 56.0 months, respectively. Postoperative outcomes of survival rates, reoperations and valve related morbidities were assessed. Continuous and categorical variables were compared using the t -test and Chi-square test, respectively. Survival and freedom from adverse events were calculated by using a Kaplan-Meier method. Results: The overall in-hospital mortality was 2.8% (18/647 while there were 34 deaths (5.6%, 34/605 in the follow-up stage after discharge. The overall survival rate was 94.6% and 82.7% at 5 years and 10 years, respectively. The cumulative survival rate of 10 years was 82.8% in AVR group, 84.4% in MVR group, and 78.4% in DVR group. The overall rate of freedom from reoperations was 95.5% at 5 years and 86.8% at 10 years. The freedom from reoperation at 10 years was 87.0%, 88.1%, and 84.0% in AVR, MVR, and DVR group, respectively. The freedom from morbidities at 10 years was: 90.3% for thromboembolism, 95.2% for hemorrhage, 97.5% for prosthesis endocarditis, 95.9% for paravalvular leak, and 94.6% for structural valve deterioration, respectively. Conclusions: Hancock II bioprosthesis exhibited a satisfactory mid- to long-term durability and promising clinical

  1. Mid-to Long-term Clinical Outcomes of Hancock Ⅱ Bioprosthesis in Chinese Population

    Yin Wang; Si Chen; Xing-Jian Hu; Jia-Wei Shi; Nian-Guo Dong


    Background: Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy.This research aimed to evaluate the mid-to long-term clinical performance of Hancock Ⅱ bioprosthesis in the Chinese population.Methods: This study retrospectively reviewed all patients who received surgical treatments with at least one Hancock Ⅱ bioprosthesis implantation from January 2004 to December 2013 at a single center in China.Totally 647 patients were included in the clinical evaluation, and 629 patients were successfully discharge, among whom 605 patients were completely followed-up.The follow-up rate was 96.2%.The mean and median follow-up time was 62.0 ± 59.0 and 56.0 months, respectively Postoperative outcomes of survival rates, reoperations and valve related morbidities were assessed.Continuous and categorical variables were compared using the t-test and Chi-square test, respectively.Survival and freedom from adverse events were calculated by using a Kaplan-Meier method.Results: The overall in-hospital mortality was 2.8% (18/647) while there were 34 deaths (5.6%, 34/605) in the follow-up stage after discharge.The overall survival rate was 94.6% and 82.7% at 5 years and 10 years, respectively The cumulative survival rate of 10 years was 82.8% in AVR group, 84.4% in MVR group, and 78.4% in DVR group.The overall rate of freedom from reoperations was 95.5% at 5 years and 86.8% at 10 years.The freedom from reoperation at 10 years was 87.0%, 88.1%, and 84.0% in AVR, MVR, and DVR group, respectively.The freedom from morbidities at 10 years was: 90.3% for thromboembolism, 95.2% for hemorrhage, 97.5% for prosthesis endocarditis, 95.9% for paravalvular leak, and 94.6% for structural valve deterioration, respectively.Conclusions: Hancock Ⅱ bioprosthesis exhibited a satisfactory mid-to long-term durability and promising clinical

  2. Importance of Perioperative Glycemic Control in General Surgery

    Kwon, Steve; Thompson, Rachel; Dellinger, Patchen; Yanez, David; Farrohki, Ellen; Flum, David


    Objective To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. Background There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. Methods The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. Results Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63–2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41–2.3), and death (OR, 2.71; 95% CI, 1.72–4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72–1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89–1.89), or deaths (OR, 1.21; 95% CI, 0.61–2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180–250 mg/dL, best surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than those with normal blood glucoses. Perioperative glucose evaluation and insulin administration in patients with

  3. Efficacy of preoperative US vascular mapping for arteriovenous fistula in patients with hemodialysis

    Lee, Min Sun; Hwang, Ji Young; Kang, Byung Chul; Baek, Seung Yon [College of Medicine, Ewha Womans University, Seoul (Korea, Republic of)


    The purpose of this study is to assess the efficacy of preoperative US vascular mapping to predict postoperative patency of the arteriovenous fistula for hemodialysis. Sixty-six patients who underwent hemodialysis for end-stage renal failure (M:F = 34:32, mean age, 58.8 years) were observed prospectively from January 2001 to April 2003. The patients were divided into two groups: the vascular mapping group and the control group. A comparative analysis of the re-operation rate between the two groups was determined by use of the chi-square rest, efficacy of preoperative US vascular mapping according to the type of surgery. A comparative analysis of the secondary patency after percutaneous transluminal angioplasty was determined by the use of Fischer exact test, and a comparative analysis of the diminution of patency during the follow-up periods was determined by the use of the Logrank test. In the mapping group, the diameters of intraoperatively selected vessels were investigated and compared with the recommended diameter on preoperative US vascular mapping determined statistically by the use of Fisher's exact test. The preoperative US vascular mapping group had relatively lower re-operation rates (11.8%) than the control group (28.1%) ({rho} = 0.09). The preventive role of US vascular mapping in more effective in decreasing the re-operation rate for a native arteriovenous fistula (7.4%) than for a synthetic arteriovenous graft (25.9%) ({rho} = 0.06). For patients than had an interventional procedure, the failure rate to obtain a secondary patency was smaller than in the mapping group (33.3%), compared with the control group (46.3%) ({rho} = 0.37). Patients in the mapping group had a higher patency than the control group patients for a native arteriovenous fistula (92.0%) and a synthetic arteriovenous graft (71.4%) at one year following surgery ({rho} = 0.10, {rho} = 0.79). The arteriovenous fistulas in the mapping group had a higher patency for both a native

  4. Do alumina matrix composite bearings decrease hip noises and bearing fractures at a minimum of 5 years after THA?

    Baek, Seung-Hoon; Kim, Won Keun; Kim, Jun Young; Kim, Shin-Yoon


    Ceramic-on-ceramic bearing couples are theoretically attractive in total hip arthroplasty (THA) because of low wear, but concerns regarding ceramic fracture and squeaking have arisen. Improved material properties of newer alumina matrix composite (AMC) materials, known as Delta ceramics, may reduce these risks. In addition, the use of thinner liners and larger femoral heads may be helpful clinically to lower the rate of dislocation. However, limited short-term clinical results are available and intermediate-term effects are unclear. (1) What is the frequency of bearing-related complications (dissociation, fracture, and noise) with ceramic-on-ceramic AMC bearings in cementless THA? (2) What other complications arose in patients treated with these bearings? (3) What are the Harris hip scores (HHS) and survivorship free from reoperation and revision at a minimum of 5 years after cementless THA performed with AMC bearings? Over a 9-month period in 2009, one surgeon performed 125 THAs, of which 100 (80% of the total) were performed with cementless, AMC bearings. During the period in question, the exclusion criteria for this implant were primary THAs with severe acetabular or femoral bone defect and revision THAs. Of these, 94 hips (95%) in 91 patients were available for analysis at a minimum of 5 years (range, 5-6 years), because five patients (six hips) had died. Mean age at the time of arthroplasty was 55 ± 14 years. Prostheses with an identical design and Biolox(®) Delta ceramics were used in all patients. Noise was classified into squeaking, clicking, grinding, and popping. Ceramic fracture, dislocation, and any other complications associated with the use of AMC ceramics were also investigated. Clinical evaluation included the modified HHS preoperatively and at each followup. Survivorship free from reoperation and revision was calculated using the Kaplan-Meier method. Of 91 patients, four developed bearing-related complications, including one with liner

  5. Stoma-Const - the technical aspects of stoma construction

    Correa Marinez, Adiela; Erestam, Sofia; Haglind, Eva


    BACKGROUND: The construction of a colostomy is a common procedure, but the evidence for the different parts of the construction of the colostomy is lacking. Parastomal hernia is a common complication of colostomy formation. The aim of this study is to standardise the colostomy formation...... and to compare three types of colostomy formation (one including a mesh) regarding the development of parastomal hernia. METHODS/DESIGN: Stoma-Const is a Scandinavian randomised trial comparing three types of colostomy formation. The primary endpoint is parastomal herniation as shown by clinical examination......-related quality of life and health economic analysis as well as re-operation rate and mortality within 30 days and 12 months of primary surgery. Follow-up is scheduled at 4-6 weeks, and 6 and 12 months. Inclusion is set at 240 patients. DISCUSSION: Parastomal hernia is a common complication after colostomy...

  6. Surgical-site infections and postoperative complications: agreement between the Danish Gynecological Cancer Database and a randomized clinical trial

    Antonsen, Sofie L; Meyhoff, Christian Sylvest; Lundvall, Lene


    OBJECTIVE: Surgical-site infections are serious complications and thorough follow-up is important for accurate surveillance. We aimed to compare the frequency of complications recorded in a clinical quality database with those noted in a randomized clinical trial with follow-up visits. DESIGN......-operation, urinary tract infection, pneumonia and sepsis. RESULTS: Surgical-site infection was found in 21 of 222 patients (9.5%) in the PROXI trial versus 6 of 222 patients (2.7%) in the DGCD (p ... registered in the PROXI trial, but not in the DGCD. Agreements between secondary outcomes were very varying (kappa-value 0.77 for re-operation, 0.37 for urinary tract infections, 0.19 for sepsis and 0.18 for pneumonia). CONCLUSIONS: The randomized trial reported significantly more surgical-site infections...

  7. Complications in head and neck surgery.

    Christison-Lagay, Emily


    Head and neck anatomy is topographically complex and the region is densely populated by vital nerves and vascular and lymphatic structures. Injury to many of these structures is associated with significant morbidity and may even be fatal. A thorough knowledge of regional anatomy is imperative and complications need to be managed in a thoughtful directed manner. The pediatric surgeon may be called upon to address both congenital and acquired conditions and should be prepared to encounter reoperative fields after failed initial surgery. This review summarizes the current literature on four frequently encountered surgical conditions of the head and neck: branchial cleft anomalies, thyroglossal duct cyst, thyroid disease, and lymphatic malformations, with a focus on the prevention and treatment of complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Utility of intra-operative capnogram to detect branch pulmonary artery obstruction following total correction of tetralogy of fallot

    Garg Rajnish


    Full Text Available Branch pulmonary artery obstruction is one of the prime reasons for re-operation in patients who have undergone repair for tetralogy of Fallot. Branch pulmonary artery obstruction may develop over a period of time due to dilation of right ventricular outflow tract or it may be caused by residual stenosis after inadequate repair. This may lead to differential lung perfusion causing morbidity. Intra-operative capnogram monitoring reveals ventilation−perfusion relationship. We report two cases where the capnogram helped the diagnosis and management of branch pulmonary artery obstruction. We found a redundant patch in the first and an extra length of the homograft in second case which led to the obstruction. However, but for the changes in the intraoperative capnogram, this condition may by far remain undiagnosed considering the fact that it does not produce hemodynamic changes but can lead to postoperative morbidity.

  9. Clinical research on dissection of aorta after aortic valve replacement%主动脉瓣置换术后发生主动脉夹层的临床分析

    孙广龙; 曹向戎; 张富恩; 黄国晖; 张健群


    Objective To summarize the re-operation experience of dissection of aorta after aortic valve replacement.Methods Twelve cases of dissect:on of arota after aortic valve replacement(AVR) were collected from June 2009 to November 2010.Among the 12 cases,8 cases were ascending aortic dissection,2 cases were ascending and arch aortic dissection and 2 cases were ascending,arch and descending aortic dissection.8 patients were treated with operation on cardiopulmonary bypass(CPB).Results Primary diseases of 10 cases were aortic insufficiency and 2 cases were aortic stenosis.1 case died before reoperation,3 cases refused to perform reoperation and 1 died of multiple organ failure after operation.The false lumen closed after 3 months.No new dissection occurred.Conclusion Aortic dissection after AVR occurred in patients whose primary disease is AI with ascending aortic dilatation,which is possibly related to the first procedure and treatment of ascending aorta,however the selection of reoperation mode is also important.%目的 总结主动脉瓣病变行主动脉瓣置换(AVR)术后远期发生主动脉夹层的可能原因以及再次手术的方式选择和临床体会.方法 收集2009年6月至2010年11月收治的AVR术后形成主动脉夹层患者12例的临床资料进行回顾性分析.其中升主动脉夹层8例,升主动脉+主动脉弓部夹层2例,升主动脉+主动脉弓+降主动脉夹层2例;10例原发病为主动脉瓣关闭不全,2例为主动脉瓣狭窄.结果 12例患者中1例二次手术前死亡;3例拒绝再次手术,8例接受二次手术,1例术后由于多脏器功能衰竭死亡,余患者恢复良好.术后3个月复查,假腔闭合良好,无新发夹层,窦部大小正常,包裹腔内无异常分流.结论 AVR术后主动脉夹层多发生于术前主动脉瓣关闭不全合并升主动脉扩张的患者,同时与首次手术时未积极处理升主动脉,以及手术操作技巧有关,同时再次手术的方式选择也至关重要.

  10. Danish experience with paediatric epilepsy surgery

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find


    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... (MRI) diagnoses, surgical procedures and seizure outcomes classified according to the Engel Classification were used. Changes over time grouped as 1996-2000, 2001-2005 and 2006-2010 were analysed. RESULTS: A total of 95 children underwent epilepsy surgery. Sixty-three operations were performed...... in Denmark and 50 abroad. In all, 14 children needed reoperation. The median follow-up period was four years. At the latest follow-up, Engel class I (indicating no disabling seizures) was found in 67% of the patients. Cortical dysplasia, mesial temporal sclerosis and tumour were the most common MRI findings...

  11. Endoscopic management of a gastric leak after laparoscopic sleeve gastrectomy using the over-the-scope-clip (Ovesco® system

    Yurena Caballero

    Full Text Available Laparoscopic sleeve gastrectomy is currently used for the management of morbid obesity. Gastric fistula is the primary life-threatening complication, and its resolution continues to be a strong challenge for surgeons. Multiple treatment options are available, ranging from conservative therapy to endoscopic use of clips or stents, and even surgical reoperation involving total gastrectomy or conversion to a different bariatric technique. The applicability of each individual option will depend on the type of fistula and the patient clinical status. A clinical case is reported of a 29-year-old male patient with a body mass index at 49% who following laparoscopic sleeve gastrectomy had a delayed gastric fistula that failed to respond to conservative management but was successfully treated using the over-the-scope clip (Ovesco® system.

  12. Surgical and clinical strategies in the management of thyroid medullary carcinoma in children with and without ret proto-oncogene mutations.

    Boybeyi-Türer, Özlem; Vurallı, Doğuş; Karnak, İbrahim; Gönç, Nazlı; Yalçın, Emel Şule; Orhan, Diclehan; Kandemir, Nurgün; Tanyel, Feridun Cahit


    Medullary thyroid carcinoma (MTC) may arise sporadically or in familial manner. We presented sporadic and familial cases with MTC in order to raise awareness on management of such patients. Three medullary thyroid carcinoma (MTC) cases were presented. Case 1 had RET634 mutation; managed with total thyroidectomy (TT) and cervical lymph node dissection (CLND). Case 2 had RET804 mutation; managed with prophylactic TT. Case 3 had thyroid nodule; managed with TT and CLND. Case 1 had micro-carcinomatosis foci, Case 2 had normal thyroid tissue in histopathological examination and Case 3 had medullary thyroid carcinoma with tumor negative surgical borders. Case 1 was re-operated for persisting focus of disease. Follow-up of cases were uneventful. Clinicians and surgeons should be aware of critical timing for surgery and various surgical and clinical strategies in the management of MTC in children.

  13. Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation

    Viberg, Bjarke; Ryg, Jesper; Overgaard, Søren;


    Background and purpose - Internal fixation (IF) in femoral neck fractures has high reoperation rates and some predictors of failure are known, such as age, quality of reduction, and implant positioning. Finding new predictors of failure is an ongoing process, and in this study we evaluated...... the importance of low bone mineral density (BMD). Patients and methods - 140 consecutive patients (105 females, median age 80) treated with IF had a dual-energy X-ray absorptiometry (DXA) scan of the hip performed median 80 days after treatment. The patients' radiographs were evaluated for fracture displacement......, or new hip fracture). A stratified Cox regression model on fracture displacement was applied and adjusted for age, sex, quality of reduction, implant positioning, comorbidity, and walking disability. Results - 49 patients had a T-score below -2.5 (standard deviation from the young normal reference mean...

  14. Failure of treatment of myasthenia gravis by cyclosporin-A: a case report

    Paulo E. Marchiori


    Full Text Available Recently, cyclosporin-A (Cy-A has been used in the treatment oy myasthenia gravis (MG. This drug could be employed in some patients refractory to classic treatments or that develop undesirable side effects. It is reported the case of a 22 year-old woman with generalized and severe MG, and diabetes mellitus. She had been submitted to thymectomy and reoperated, to the classic ethiopathogenic methods of therapy, and to total body irradiation. No therapeutical results were observed. Also, she developed transient and slow bone marrow depression, and liver dysfunction. Owing to these limitations and to the absence of response to treatments mentioned, Cy-A use was attempted in this case. Unfortunately, Cy-A did not influence the myasthenic symptomatology. Cy-A also failed in suppressing anti-AChR production, which increased during Cy-A therapy. Results observed in this case are in disagreement with literature data on the subject.

  15. Total Ankle Arthroplasty: An Overview of the Canadian Experience.

    Latham, Warren C W; Lau, Johnny T C


    Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

  16. Percutaneous CT-guided treatment of recurrent spinal cyst hydatid.

    Ozdemir, Ozgur; Calisaneller, Tarkan; Yildirim, Erkan; Altinors, Nur


    The involvement of spinal column in cyst hydatid disease is rare and hard to treat. The gold standard treatment is total removal of the cysts without rupture. However, recurrence after surgery is almost inevitable and reoperations carries technical difficulties and higher morbidity. We present a 69-year-old woman with two cystic masses at the T12 level, which compress the spinal cord causing severe paresis in her left leg. Under local anestesia, the cysts were aspirated and irrigated with 20% hypertonic saline solution via bilateral T12 transpedicular route. We aimed to report that percutaneous CT guided treatment should be considered as an alternative therapeutic option in case of recurrent spinal cyst hydatid.

  17. Late-onset chest wall abscess due to a biodegradable rib pin infection after lung transplantation.

    Goda, Yasufumi; Chen-Yoshikawa, Toyofumi F; Kusunose, Masaaki; Hamaji, Masatsugu; Motoyama, Hideki; Hijiya, Kyoko; Aoyama, Akihiro; Date, Hiroshi


    A 55-year-old man with end-stage emphysema underwent a right single-lung transplantation through a posterolateral thoracotomy. The fifth rib was divided and fused back using a biodegradable pin made of polylactide acid and hydroxyapatite. Two weeks postoperatively, he suffered from central vein catheter-related sepsis due to methicillin-sensitive Staphylococcus aureus. After being successfully treated for sepsis, he was discharged. However, 3 months later, computed tomography revealed multiple loculated abscesses in the chest wall and the right pleural space. Reoperative thoracotomy revealed abscesses mainly located around the fifth rib, where the pin was inserted. Both cultures of the abscess and the fifth rib were positive for methicillin-sensitive S. aureus, which suggested that the rib pin was the cause of the secondary infection. This case suggests the rib pins, even if they are biodegradable, could have a risk of infections side effect especially for the immunosuppressed patients.

  18. Questionnaire of quality of life in patients with primary hyperhidrosis

    Campos José Ribas Milanez de


    Full Text Available BACKGROUND: Hyperhidrosis or excessive sudoresis is a chronic disease associated with important subjective distress. OBJECTIVE: To propose a specific questionnaire to evaluate the quality of life of patients with hyperhidrosis. METHODS: From October 1995 to March 2002, 378 patients (234 females, with a mean age of 26.8 years, were evaluated before and after video-assisted thoracic sympathectomy. RESULTS: Therapeutic success was obtained in 90% of the procedures. The recurrence rate was 10% for palmar and 11% for axillary hyperhidrosis; 27% of the patients who had recurrence were re-operated successfully. No serious complications were reported. Of the total number of patients, 91% answered to the quality of life questionnaire, and 86% of them reported improvement after the procedure. CONCLUSIONS: Thoracic sympathectomy is a therapeutic method capable of changing the quality of life of patients with hyperhidrosis. The questionnaire applied has shown these changes.

  19. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: Minimally invasive angiographic techniques as the preferred treatment

    Sucandy Iswanto


    Full Text Available Background: Delayed intra-abdominal bleeding related to hepatic artery pseudoaneurysm is a potentially lethal complication after pancreaticoduodenectomy for pancreatic cancer. Locally advanced tumors, which result in vessel erosion or extensive operative skeletonization, may contribute to weakness of the arterial wall. Reoperation is often technically difficult with high rate of mortality; therefore, alternative less invasive options are ideal. Aims: The study was to present an alternative endovascular treatment of a large hepatic artery pseudoaneurysm after pancreatic resection for locally advanced multicystic adenocarcinoma. Materials and Methods: Transcatheteric mesenteric angiography with deployment of detachable coils in the pseudoaneurysm sac was utilized to manage the hepatic artery pseudoaneurysm. Results: Completion angiography confirmed cessation of contrast enhancement in the pseudoaneurysm sac with preservation of normal antegrade hepatic artery flow. Conclusion: Minimally invasive angiographic technique is the preferred treatment for hepatic artery pseudoaneurysm after pancreatic resections.

  20. The application of computer-aided designated titanium mesh in repairing skull defects

    Lei ZHANG


    Full Text Available Objective To explore the clinical value of repairing skull defects with titanium alloy-mesh of computer-aided design.  Methods A retrospective analysis was done on clinical data of 86 cases with skull defects who underwent repairing using titanium mesh with two-dimensional or three-dimensional computer-aided design.  Results All the incisions achieved primary healing other than one case conducting reoperation due to exposed titanium mesh. Two cases got subcutaneous exudate, one obtained painful mastication and one experienced proliferation of scalp scar.  Conclusions With the computer-aided designated titanium mesh, relevant operation can resume the original state to maximum extent, lower surgical risk, decrease post-operational complications and then obtain satisfying clinical effect. DOI: 10.3969/j.issn.1672-6731.2015.01.015