Reoperation In Group Research Articles

Comparative analysis of treatment results in patients with disс herniation of different age groups

Objective. To perform comparative analysis of the results of surgical treatment of patients with intervertebral disc herniation of different age groups. Material and Methods. The results of treatment of 2,448 patients (1,307 men and 1,141 women) with lumbar intervertebral disc herniation were analyzed. Out of them, 393 (16 %) people were elderly and senile patients with a mean age of 66 years. Evaluation of the treatment results in patients with herniated intervertebral discs was carried out in two groups: Group I – young and middle-aged patients; and Group II – elderly and senile patients. Mandatory preoperative evaluation included clinical and neurological examination, radiation diagnostic methods (X-ray, CT, CT-myelography, MRI), and survey using scales and questionnaires (VAS, ODI, CCI). Results. Body mass index (BMI), blood loss, duration of surgery, and length of hospital stay were statistically significantly greater in patients of Group II. In terms of pain, quality of life before and within 5 years after surgical treatment, patients of groups I and II have no statistically significant differences. The total complication rate was 4.9 %, while in patients of Group II complications developed statistically significantly more often (1.7 times) than in patients of Group I (p = 0.02). The most common complication was unintentional durotomy, which occurred in 3.6 % of cases, without statistically significant differences between groups. Epidural hematomas requiring revision intervention were observed in 13 patients, statistically significantly more often in patients of Group II (p = 0.04). The volume of blood loss in patients of Group II is significantly greater (p < 0.001). The cumulative index of reoperations over the 5-year follow-up period in Group I was 11.5 %, in Group II – 13.6 %. During the first year, reoperations in Group I amounted to 6.0 %, in Group II – 8.7 % (p = 0.05), which indicates the possible effect of age on the frequency of repeated operations. Convincing data on the effect of BMI and the comorbidity index on this indicator have not been obtained. The most common cause of reoperation in patients with herniated discs in both groups was hernia recurrence at the operated level, while the relapse rate in Group II was slightly higher – 46 % (n = 37) compared with 36 % (n = 168) in Group I. Conclusion. No difference was found between the clinical outcomes of surgical treatment of herniated intervertebral discs in patients of different age groups during a 5-year follow-up period. Elderly and senile age is a predictor of a higher frequency of early and intraoperative complications, an increase in the surgery duration and in the volume of intraoperative blood loss. Obesity and concomitant somatic pathology do not affect the clinical outcomes of surgical treatment and the cumulative index of repeated operations in patients with herniated discs of the lumbar spine.

Outcome of Postcardiac Surgery Acute Myocardial Infarction and Role of Emergency Percutaneous Coronary Interventions

Background. Cardiac surgery carries a well-known risk of perioperative myocardial infarction (MI), which is associated with high morbidity and both in-hospital and late mortality. The rapid haemodynamics deterioration and presence of myocardial ischemia early after cardiac surgical operations is a complex life-threatening condition where rapid diagnosis and management is of fundamental importance. Objective. To analyse the factors associated with mortality of patients with postcardiotomy MI and to study the role of emergency coronary angiography in management and outcome. Methods. We retrospectively enrolled adult patients diagnosed to have postcardiotomy MI and underwent emergency coronary angiography at our tertiary care hospital between January 2016 and August 2019. Results. Sixty-one patients from consecutive 1869 adult patients who underwent cardiac surgeries were enrolled in our study. The studied patients had a mean age of 49 ± 16.2 years with a mean BMI of 29.5 ± 6.6 and 65.6% of them were males. As compared to the survivors group, the nonsurvivors of perioperative MI had significant preoperative CKD, postoperative AKI, longer CPB time, frequent histories of previous PCI, previous cardiotomies, pre and postoperative ECMO use, higher median troponin I levels, higher peak and 24 hours median lactate levels. Regression analysis revealed that reoperation for revascularization (OR: 23; 95% CI: 8.27–217.06; P=0.034) and hyperlactataemia (OR: 3.21; 95% CI: 1.14–9.04; P=0.027) were independent factors associated with hospital mortality after perioperative MI. Hospital mortality occurred in 25.7% vs 86.7% (P&lt;0.001), AKI occurred in 37.1% vs 93.3% (P&lt;0.001), haemodialysis was used in 28.6% vs 80% (P=0.002), and mediastinal exploration for bleeding was performed in 31.4% vs 80% (P=0.006) in the PCI and reoperation groups, respectively, while there were no significant differences regarding gastrointestinal bleeding, cerebral strokes, or intracerebral bleeding. The median peak troponin level was 795 (IQR 630–1200) vs 4190 (IQR 3700–6300) (P&lt;0.001) in the PCI and reoperation groups, respectively. Absence of significant angiographic findings occurred in 18% of patients. Conclusions. Perioperative MI is associated with significant morbidities and hospital mortality. Reoperation for revascularization and progressive hyperlactataemia are independent predictors of hospital mortality. Emergency coronary angiography is helpful in diagnosis and management of perioperative MI.

Re-operative Parathyroidectomy in Patients With Mild Primary Hyperparathyroidism

BackgroundSurgery is the definitive management of primary hyperparathyroidism and the only curative therapy. However, many surgeons are hesitant to operate on individuals with mild primary hyperparathyroidism, with an even greater reluctance to operate on those who underwent a previous parathyroidectomy. We hypothesize that patients with mild primary hyperparathyroidism who undergo a re-operation have equivalent outcomes compared with those who undergo a first-time (FT) operation. MethodsWe reviewed a prospective database of 459 patients with mild primary hyperparathyroidism who underwent surgery by one endocrine surgeon. Of these patients, 59 had a re-operative (RE-OP) parathyroid surgery. We compared these patients to those with mild primary hyperparathyroidism who had FT surgery (n = 400) using either the Pearson chi-square, Fisher's exact test, or Student's t-test where appropriate. ResultsThe mean age of our cohort was 60 ± 14 y, with 86% females. Patients in the RE-OP group had similar preoperative calcium and parathyroid hormone levels compared with those in the FT group. Most patients who underwent a RE-OP surgery had four gland hyperplasia on pathology (49.2%). Patients in the RE-OP and FT groups both had high and similar cure rates (100% versus 99.8%, P = 0.70). RE-OP patients had a higher rate of recurrent hyperparathyroidism (10.3% versus 3.3%, P = 0.025). ConclusionsIn patients with mild primary hyperparathyroidism, those who undergo RE-OP parathyroidectomy have a high cure rate that is similar to FT surgery. Therefore, we recommend that these patients with recurrence of mild hyperparathyroid disease be considered for parathyroidectomy.

Acetabular Liner Dissociation: A Comparative Study of Two Contemporary Uncemented Acetabular Components.

BackgroundThere are a number of reports of polyethylene liner dissociation of third-generation modular acetabular components. This study compares our experience with 2 contemporary systems to determine whether this is an implant- or class-specific problem.MethodsThis is a single-center retrospective study of 961 primary total hip arthroplasties using 2 third-generation modular cementless acetabular shells: Pinnacle (535) and R3 (426) with a polyethylene liner. Details of all revisions were obtained from local databases and the New Zealand Joint Registry. Kaplan-Meier survival curves were calculated for all-cause revision, acetabular reoperation (including liner exchange), and liner dissociation.ResultsThere were 17 revisions in group 1 (Pinnacle; DePuy Synthes): 17 for recurrent dislocation, 6 for liner dissociations (1.12%), 3 for femoral loosening, and one for deep infection. In group 2 (R3; Smith and Nephew), there were 4 revision procedures: one for infection, 2 for dislocation, and one femoral revision for periprosthetic fracture. There were significantly higher proportions revised in group 1 for all-cause revision, acetabular reoperation, and dissociation (P = .024 to 0.038). The 7-year survival for all-cause revision was 96.1% for Pinnacle and 99.0% for R3 (P = .022), and that in the acetabular reoperation group was 96.9% for Pinnacle and 99.3% for R3 (P = .035).ConclusionsThere was a higher revision rate for the Pinnacle acetabular component than for the R3 at 7 years. This was mainly due to polyethylene liner dissociation that can occur early or late. It appears to be a problem specific to the Pinnacle cup design rather than a feature of similar third-generation acetabular components.

Postoperative urinary extravasation does not impact anterior urethroplasty surgical outcomes: a Latin American large cohort study.

To determine the prevalence of postoperative urinary extravasation (POUE) following anterior urethroplasty, to analyze factors associated with its occurrence, and to study the impact of POUE on surgical success. Retrospective cohort study including all male patients who have undergone a urethroplasty at our center between 2011 and 2018. Subjects with posterior location stricture, those who did not undergo routine radiographic follow-up, or patients with inadequate follow-up were excluded. Urinary extravasation was defined as presence of evident contrast extravasation on the postoperative voiding cystourethrogram (VCUG). Impact was determined as "need-for-reoperation". Uni- and multivariate analysis were performed to determine clinical and demographic variables associated with occurrence of extravasation and postoperative stricture. A total of 783 men underwent a urethroplasty and 630 fulfilled inclusion criteria. Urinary extravasation prevalence was 12.2%, and there was a "need-for-reoperation" in 1.1% of cases. On uni- and multivariate analysis, greatest stricture length (HR: 1.07 (1-1.2), p = 0.05) and penile urethral location (HR: 2.29 (1.1-4.6), p = 0.021) showed to be POUE predictors. POUE did not show to be a risk factor for postoperative stricture (HR: 1.57, 95% CI (0.8-3), p = 0.173). However, reoperation group showed to be a risk factor (HR: 6.6, 95% CI 1.4-31, p = 0.019). Prevalence of POUE was 12.2%. Stricture length and penile urethral strictures were POUE predictors. POUE occurrence with successful conservative management did not appear to have impact on urethroplasty outcomes as it did not predict re-stricture. POUE was reoperation cause in 1.1% of total cases.

Vertebral Bone Quality Score and Postoperative Lumbar Lordosis Associated with Need for Reoperation After Lumbar Fusion

Poor bone quality is a known risk factor for hardware failure and adjacent segment disease after lumbar fusion. One new method of analyzing bone quality is the vertebral bone quality (VBQ) score, which can be obtained from preoperative lumbar magnetic resonance imaging (MRI) scans. We decided to evaluate whether patients' VBQ scores were associated with reoperation after lumbar fusion. We queried records of patients who underwent elective lumbar fusion for degenerative conditions between 2012 and 2017. Patients who required reoperations after lumbar fusions because of symptomatic hardware failure or adjacent segment disease were combined into a case group and compared with a matched control group. Of the 46 patients who underwent elective lumbar fusions and required reoperation, 30 met the inclusion criteria. A 2:1 control group of 60 individually age-, body mass index-, and sex-matched patients who did not require reoperation was then created. The reoperation group had significantly lower degrees of postoperative lumbar lordosis. There were no significant differences regarding other spinopelvic parameters, adjacent Pfirrmann scores, or dual energy x-ray absorptiometry (DXA) T scores. There was, however, a significant difference in VBQ scores between the groups, with the reoperation group having a higher VBQ score. This study found that bone quality, according to the VBQ score rather than the DXA T score, is an important risk factor for reoperation after lumbar fusion surgery. Therefore, this MRI-based tool may be used to assist surgeons in preoperative planning for spine surgeries with the goal of reducing the risk of requiring reoperation.

Reoperation for bleeding following coronary artery bypass surgery with special focus on long-term outcomes

Objectives: We studied the incidence and risk factors of reoperation for bleeding following CABG in a nationwide cohort with focus on long-term complications and survival. Design: A retrospective study on 2060 consecutive, isolated CABG patients operated 2001–2016. Outcome of reoperated patients (n = 130) were compared to non-reoperated ones (n = 1930), including major adverse cardiac and cerebrovascular events (MACCE) and overall survival. Risk factors for reoperation were determined using multivariate logistic regression and a Cox proportional hazards model to assess prognostic factors of long-term survival. Median follow-up was 7.6 years. Results: One hundred thirty patients (6.3%) were reoperated with an annual decrease of 4.1% per year over the study period (p=.04). Major complications (18.5 vs. 9.6%) and 30-day mortality (8.5 vs. 1.9%,) were higher in the reoperation group (p<.001). The use of clopidogrel preoperatively (OR 3.62, 95% CI: 1.90–6.57) and reduced left ventricular ejection fraction (OR 2.23, 95% CI: 1.25–3.77) were the strongest predictors of reoperation, whereas off-pump surgery was associated with a lower reoperation risk (OR 0.44, 95% CI: 0.22–0.85). After exluding patients that died within 30 days postoperatively, no difference in long-term survival or freedom from MACCE was found between groups, and reoperation was not an independent risk factor for long-term mortality in multivariate analysis. Conclusions: The reoperation rate in this study was relatively high but decreased significantly over time. Reoperation was associated with twofold increased risk for major complications and fourfold 30-day mortality, but comparable long-term MACCE and survival rates. This implies that if patients survive the first 30 days following reoperation, their long-term outcome is comparable to non-reoperated patients.

The effectiveness of the system for predicting the results of surgical treatment of patients with lumbar disc herniation

Objective . To evaluate the effectiveness of a multivariate logistic regression model for the predicting surgical treatment results in patients with lumbar disc herniation. Materials and Methods . Study design: monocentric retrospective study. The study included patients operated on for lumbar disc herniation at levels L4–L5, L5–S1, with a 3-year follow-up. Two groups were identified: Group I included 350 patients (their data served as a basis for creation of multivariate logistic regression predicting model), and Group II – 514 patients (in this group, the effectiveness of the model was evaluated). Group II was divided into two subgroups: Subgroup IIa (recurrence probability 50 %) – 17 (3.3 %) patients. Patients in Subgroup IIa underwent microdisectomy, and in Subgroup IIb – spinal fusion. In order to obtain homogeneous pre-operative indicators of both group parameters, the PSM method was used. Statistical calculations were performed in the RStudio program. Results . In Group II, significant differences in indicators in the subgroups were noted for the following parameters (p < 0.05): smoking, disc height index, segmental volume of movement, lumbar lordosis angle, type of intervertebral hernia (except for sequestration), Modic changes, and stage of intervertebral disc degeneration according to Pfirrmann. In Subgroup IIa, 8 (1.6 %) reoperations were performed, in Subgroup IIb – 2 (0.4 %). Using the PSM method, the data of groups I and II were flattened out for significantly different indicators. The sample size was 37 patients in each group. The number of reoperations in the groups differed statistically significantly: Group I – 35 % [22 %; 51 %]; Group II – 5 % [1 %; 18 %]. The risk of reoperation in Group II is 0.13 [0.03; 0.58] times lower than in Group I (p = 0.002). Conclusions . The proposed system for predicting the results of surgical treatment of patients with intervertebral disc hernia can be used as a tool to determine the surgical tactics aimed at reducing the frequency of reoperations.

Incidence, risk factors and management of chylothorax post-oesophagectomy for oesophageal carcinoma in an Australian institution

Background: Chylothorax is a potentially fatal complication of oesophagectomy. This study aims to report the incidence, risk factors and management of chylothorax in patients undergoing oesophagectomy for oesophageal carcinoma. Methods: This study reviewed all patients who underwent oesophagectomy from 2009 to 2018 in an Australian institution. Preoperative, perioperative and postoperative data were collected retrospectively and analysed. Results: Chylothorax occurred in 13 out of 144 patients (9%). Pre-operative albumin [odds ratio (OR) 0.836, P=0.027) and the number of lymph nodes resected (OR 1.141, P=0.001) were significant predictors of chylothorax. Chylothorax was associated with increased reoperation rate (77% vs. 11%, P<0.001) and prolonged hospital stay (29 vs. 15 days, P=0.001), but no increase in short term mortality or other complications. Average chyle leak volume of multiple days were significantly different between the conservative and reoperation groups. Using the cut off value of 1,000 mL/day for average chest drain output of 2, 3, 4 and 5 days following the diagnosis of chylothorax, the sensitivity and specificity for reoperation were 75% and 100%, 75% and 80%, 71% and 100%, 86% and 100% respectively. Conclusions: Chylothorax is associated with increased reoperation rate and prolonged hospital stay. Preoperative albumin and the number of harvested lymph nodes were significant predictors of chylothorax following oesophagectomy. This study suggested that averaged chest drain output of multiple days would be a better representation of chyle leak volume than an isolated chest drain output. Reoperation should be considered when the average chyle leak output, of at least 2 consecutive days following the diagnosis of chylothorax, exceeds 1,000 mL/day.

Risk Factors for Reoperation After Debridement of Acute Pancreatitis

BackgroundAcute pancreatitis (AP) is a common gastrointestinal disorder with a high mortality rate. This study evaluated the incidence of and risk factors for reoperation after debridement of AP. MethodsThis retrospective study included 168 patients diagnosed with AP who had undergone debridement between January 2007 and December 2017 at our hospital. Patients were divided into single-operation and reoperation groups separately. ResultsSixty-eight (40.24%) patients underwent reoperation after AP debridement. The main procedure for reoperation was debridement of necrosis. In univariate analysis, the risk factors for reoperation included younger age; higher admission temperature and heart rate; higher levels of C-reactive protein (CRP), blood urea nitrogen and creatinine; higher Acute Physiology and Chronic Health Evaluation II score and rate of continuous renal replacement therapy; shorter operation interval; lower postoperative albumin level; and high incidence of preoperative and postoperative complications. Multivariate logistic analysis indicated that independent risk factors for reoperation included higher levels of C-reactive protein and creatinine in admission, preoperative percutaneous catheter drainage, and postoperative complications. ConclusionsThe general characteristics and clinical procedures of patients with AP after debridement might affect prognosis and reoperation. The identification of risk factors could help clinicians to provide specific treatment, better ward management, and stratification of reoperation risk.

Outcomes of DIEP Flap and Fluorescent Angiography: A Randomized Controlled Clinical Trial.

Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap can be associated with complications such as fat necrosis. The authors' objective was to assess the safety and efficacy of fluorescent angiography with indocyanine green to reduce fat necrosis. The authors designed a parallel, randomized, controlled clinical trial for unilateral breast reconstruction. The poorly vascularized tissues of the DIEP flap were removed based on a clinical evaluation in group 1 and based on angiographic criteria in group 2. The authors recorded the flap dimensions, perfusion in terms of fluorescence intensity, complications, reoperations, and BREAST-Q questionnaire scores for both groups. The study included a total of 51 patients. The flaps showed no size differences after the tissue was excised. The flaps of group 2 presented higher perfusion rates (p = 0.001). The incidence of fat necrosis was 59.3 percent in group 1 and 8.3 percent in group 2 (p = 0.001). Four cases of partial necrosis were recorded in group 1 (18.2 percent) compared with none in group 2 (0 percent) (p = 0.131). Four patients underwent reoperation in group 1 (14.8 percent) compared with none in group 2 (0 percent) (p = 0.113). The patients in group 2 reported higher scores in all domains of the BREAST-Q. Fluorescent angiography with indocyanine green significantly reduced the incidence of fat necrosis without diminishing the flaps' dimensions. The perfusion rates were significantly higher and the patients reported significantly greater satisfaction and quality of life. Fluorescent angiography with indocyanine green may be considered a safe and effective tool to enhance the outcomes of breast reconstruction with the DIEP flap. Therapeutic, I.

Early reoperation after adult living-donor liver transplantation is associated with poor survival.

BackgroundPatients who undergo reoperation after living-donor liver transplantation (LDLT) have poor outcomes. However, the specific outcomes of patients undergoing reoperation due to gastrointestinal (GI) tract-related complications following adult LDLT are relatively unknown. In the present study, we investigated the relationship between the causes and outcomes of reoperation after LDLT and classified the risk groups.MethodsWe performed a retrospective analysis of 506 patients who underwent LDLT at Samsung Medical Center in Seoul between 2010 and 2016.ResultsAmong 506 adult LDLT recipients, 98 (19.4%) underwent reoperation. The causes for reoperation included bleeding (n=39, 39.8%), vascular complications (n=26, 26.5%), wound complications (n=12, 12.2%), bile leakage (n=7, 7.1%), GI tract complications (n=6, 6.1%), and others (n=8, 8.1%). Based on a multivariate analysis, we identified prolonged operation time, hospitalization days, and a history of previous hepatocellular carcinoma-related operation as independent risk factors for reoperation. Patient survival after 3 months, 1 year, 3 years, and 5 years was 96.3%, 90.6%, 82.5%, and 79.4% in the non-reoperation group and 95.9%, 82.7%, 72.8% and 69.3% in the reoperation group, respectively. Patient survival in the reoperation group was significantly lower than that in the non-reoperation group (P=0.018). In the reoperation group, the survival rates of patients with GI tract-related complications—including bile leakage and GI tract complications—were significantly worse than those of patients with non-GI tract-related complications such as bleeding, vascular complications, and wound complications (P<0.001).ConclusionsOur results showed that patient outcomes are poor after early reoperation after LDLT and that patients with GI tract-related complications have a higher risk of mortality.

Mitigating the Risk: Transfusion or Reoperation for Bleeding After Cardiac Surgery

Several studies have established morbidity associated with bleeding after cardiac surgery. Although reoperation has been implicated as the marker for this morbidity, there remains limited understanding regarding relative morbidities of reoperation and substantial transfusion. The Society of Thoracic Surgeons (STS) Maryland Adult Cardiac Surgery Database (July 2011-September 2018) was reviewed (N = 23,240). Substantial transfusion was defined as requiring greater than the reoperation group median red blood cells (5 units) and non-red blood cells (4 units). Patients were stratified into4subgroups: group 1, no reoperation without substantial transfusion (n= 22,365); group 2, reoperation without substantial transfusion (n= 351); group 3, no reoperation with substantial transfusion (n= 350); andgroup 4, reoperation with substantial transfusion (n= 167). Operative morbidity and mortality were compared. Reoperation patients were older with a higher STS predicted risk of mortality (1.8% vs 1.2%, P < .001). Multivariable analysis demonstrated that group 4 increased the odds of renal failure (odds ratio [OR] 7.36, P < .001), stroke (OR 3.24, P= .002), and operative mortality (OR 8.68, P < .001) compared with group 1. Both group 2 and group 3 increased the odds of mortality and renal failure compared with group 1. However, group 3 had greater risk for renal failure (OR 3.48, P < .001) and mortality (OR 2.91, P < .001) than group2. Although reoperation for bleeding is associated with morbidity after cardiac surgery, substantial transfusion without reoperation appears to increase morbidity compared with a limited-transfusion reoperative approach. Better timing for reoperation and guided transfusion approaches may mitigate morbidity compared with substantial transfusion alone.

Treatment Results for Recurrent Glioblastoma and Alteration of Programmed Death-Ligand 1 Expression After Recurrence

This study was designed to analyze the results of recurrent glioblastoma (GBM) treatment, investigate the changes in molecular expression on paired primary and recurrent tumor specimens of GBM, and evaluate the effect of these changes on patient survival. A total of 170 adult patients were diagnosed with recurrent GBM at a single institution between 2005 and 2015. Patients were divided into the reoperation and nonoperation groups. In addition, we evaluated the expression of immunologic markers of 43 paired surgical specimens from the first and second operations. The median overall survival (OS) after recurrence in the reoperation group was significantly longer than that in the nonoperation group (median, 9.1 months vs. 5.6 months; P= 0.024). The groups differed in characteristics such as age, performance scale, and progression-free survival. In the reoperation group, higher performance scale at recurrence, better extent of resection, and adjuvant treatment were related to longer overall survival. Among 43 paired surgical specimens, programmed death-ligand 1 (PD-L1) was positively expressed in 17 (39.5%) and 6 (13.9%) patients after the first and second operations, respectively. PD-L1 expression after recurrence showed an increase, decrease, and no change in 6 (13.9%), 14 (32.5%), and 23 (53.4%) patients, respectively. Changes in PD-L1 expression after recurrence did not affect survival after recurrence during progression. The extent of resection and adjuvant treatment was important for prolonged survival. Reoperation without adjuvant treatment was not effective for prolonged survival. Initial and follow-up PD-L1 expression from both operations did not influence patient survival.

Outcomes and Quality of Life After Ross Reintervention: Would You Make the Same Choice Again?

The Ross procedure was introduced as a long-term if not definitive solution for aortic pathology. However, the rate of reoperation is not negligible. This single-center prospective study assessed the general outcome of Ross reoperation and patients' perceived quality of life compared with 2 control groups (Ross non-reoperation and mechanical aortic valve replacement). Patient's preference regarding the choice between mechanical aortic valve and Ross procedure was investigated in a subgroup that could theoretically have been directed to either of the 2 procedures. Between 2005 and 2017, 64 consecutive patients underwent reoperation after Ross. Median age was 31 years. Median freedom from reoperation after the Ross procedure was 136 months. An autograft reoperation was required in 49, and 25 had homograft failure. No in-hospital death was recorded. Mean follow-up was 77 months (range, 6-164 months). Quality of life was assessed with the 36-Item Short Form Health Survey questionnaire. The Ross reoperation group showed a lower score involving psychological concerns compared with the other groups. In the reoperated-on patients group, 52 had adequate aortic annulus dimensions to receive a prosthetic valve instead of a Ross procedure. When asked whether they would make the same choice, only 31% confirmed the preference. Reoperations after Ross procedure have low mortality and morbidity. Long-term follow-up showed a high quality of life, even after reoperations. However, owing to psychological concerns after the redo operation, when choosing a Ross procedure, it is our duty to thoroughly explain to patients that a high level of disillusion is predictable in case of reoperations.

Long term motor and sensory outcome after surgery for infantile esotropia and risk factors for residual and consecutive deviations

ABSTRACTPurpose: To present long-term motor and sensory outcomes after surgery for infantile esotropia and assess risk factors for residual and consecutive deviations.Methods: Data of infantile esotropia patients operated between 2002 and 2016 with minimum follow-up of 2 years were retrospectively reviewed.Results: Among a total of 62 patients, 35 had a successful motor outcome (alignment within 10 PD from orthotropia) after one surgery (Group A), while 27 required horizontal reoperation (Group B). Patients with residual esotropia had larger preoperative angle of deviation (P = .005) and younger age at first surgery (P = .01), while consecutive exotropia was associated with longer follow-up (P = .03) and higher rate of DVD (P = .003) compared to patients in Group A. Stereopsis was present in 30.3% of patients in Group A and associated with younger age at first surgery (P = .03).Conclusions: Successful motor alignment may be obtained with single surgery in infantile esotropia; however, reoperations are common. Younger age at first surgery may be associated with both higher rate of stereopsis and risk of reoperation. Careful preoperative assessment and surgical timing, with long-term postoperative follow-up is required to achieve satisfactory outcome.

Prognostic Value of Initial Aneurysmal Sac Regression after EVAR

The objective of the study was to evaluate the impact of initial aneurysmal sacreduction after endovascular aneurysm repair on the evolution of aneurysmal sac over follow-up. A retrospective cohort study was made of patients subjected to elective treatment between January 2005 and December 2014, with a minimum follow-up of 18months. An analysis was made of the evolution of the aneurysmal sac according to its condition one year after surgery, defining of two groups: A (sac reduction) and B (stable sac). Follow-up by computed tomography (CT) angiography was made after one month and then every 6months or annually, depending on the presence of endoleak. A total of 128 patients were included. Fifty-one patients (39.8%) showed a significant decrease in diameter during the first year (group A), whereas 77 patients (60.2%) showed no initial decrease (group B). Preoperative CT angiography showed the patients in group A to have larger aneurysms (63.5mm vs. 59.25; P=0.048), a greater presence of posterior thrombus (68.6% vs. 30.7%; P<0.001), and fewer patent lumbar vessels (56.9% vs. 83.1%; P=0.001). The prevalence of endoleak at some point during follow-up was lower in group A (31.4% vs. 74% in group B; P<0.001), and 100% of all aneurysmal growths were associated to the presence of endoleak. After 5years, significant differences were observed in the growth-free rate (96.9% in group A vs. 85.2% in group B; hazard ratio [HR] 4.8 [1.1-21.4; P=0.036]) and in the reintervention-free rate (95,7% vs. 84.6%; HR 6.6 [0.8-52.4; P=0.07]). No reoperation in group A was due to type II endoleak. The aneurysmal sac can be expected to take a favorable course in those cases characterized by initial aneurysmal sac reduction. These findings may imply a change in the follow-up protocol, even in cases with type II endoleak.

Adnexal lesions after hysterectomy: A retrospective observational study

Objective:To characterize adnexal lesions detected in patients who had undergone previous hysterectomy with one or both ovaries conserved, and to define the clinical, pathologic, and surgical characteristics of the adnexal lesions in these patients.Material and Methods:A retrospective observational study was conducted on patients who had undergone a previous abdominal hysterectomy with one or both adnexa preserved and who had subsequently presented with an adnexal lesion. Characteristics of lesions, operative, and pathologic findings in patients who required a re-operation were noted.Results:One hundred thirty-seven patients presented with an adnexal lesion after hysterectomy. Of the 137 patients, 71 (51.8%) had undergone a re-operation (re-operated group), the rest of the patients (n=66, 48.1%) remained on follow-up (follow-up group) in whom the lesion disappeared during follow-up period. Adnexal lesions that were re-operated were significantly larger (p<0.001), more complicated (p=0.04), and had more septations (p=0.01) than in the follow-up group. The origin of the adnexal lesion was confirmed as the ovary in 59 (83%) patients, and as the peritoneum in 8 (11.2%) patients during surgery. All of the adnexal lesions arising after hysterectomy and required a re-operation were confirmed to be benign.Conclusion:Almost half of the lesions detected after hysterectomy disappeared during the follow-up period. The adnexal lesions that were re-operated were more symptomatic, larger, and had more complicated lesions. All lesions that were re-operated were found to be benign, mostly originating from the ovary.

Parenteral Nutrition Instead of Early Reoperation in the Management of Early Postoperative Small Bowel Obstruction

BackgroundIn majority of patients, early postoperative small bowel obstruction (EPSBO) resolves with nasogastric decompression and bowel rest alone, while in some patients, symptoms persist without urgent indications for surgery. The purpose of this study was the evaluation of home parenteral nutrition (HPN) instead of elective surgery as an initial approach to persistent EPSBO. MethodsPatients developing EPSBO prescribed HPN without reoperation within 6 weeks after index intestinal surgery were identified from an institutional HPN registry and retrospectively compared with patients undergoing reoperation for EPSBO within the same time period. ResultsThirty-four patients for the HPN group and 27 patients in elective reoperative (REOP) group met the inclusion criteria. In the HPN group, mean interval between surgery and PN initiation was 11 days. HPN duration ranged from 17 to 244 days with a median of 60 days. Thirty-one patients (91%) successfully recovered bowel function and resumed enteral nutrition without reoperation, while 3 patients required reoperation > 6 weeks after index surgery due to HPN failure. In the REOP group, mean interval between index surgery and reoperation was 17 days. At reoperation, 12 patients required bowel resection, 5 having incidental enterotomies, and 3 required new stoma creation. Postoperatively, 2 patients developed enterocutaneous fistulas, 1 experienced an anastomotic leak, and another had fascial dehiscence. ConclusionHPN is a safe alternative to elective surgery in clinically stable patients with persistent EPSBO. This approach avoids hazardous reoperation during the recovery phase when adhesions are at their worst.

Determinants of reoperation after decompressive craniectomy in patients with traumatic brain injury: A comparative study

Objectives: Reoperation after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) remains a dilemma and the risk factors are to be identified. The aim of the current study was to determine the determinants and risk factors of reoperation after DC in patients with TBI.Patients and methods: This retrospective case-controlled study was conducted during a 4-year period from September 2013 to October 2017 in a level I trauma center affiliated with Shiraz University of Medical Sciences in southern Iran. We included all the adult (≥18 years) patients with TBI who underwent primary or secondary DC in our center during the study period. Those who underwent reoperation were compared to those who underwent DC only regarding the demographic findings, clinical features and neuroimaging findings. A univariate and multivariate logistic regression analysis was performed to determine the determining factors of reoperation.Results: Overall we included 371 patients with mean age of 36.45 ± 14.18 years. Among the patients there were 325 (87.6%) men and 46 (12.4%) women. The reoperation in patients undergoing DC due to TBI was associated with primary DC (p = 0.039) and higher Marshall grade (p = 0.027). Those who underwent reoperation after DC for TBI had significantly higher ICU (p = 0.007) and hospital LOS (p = 0.001) and lower 6-month GOSE (p = 0.010). Age (p < 0.001), GCS (p < 0.001) and pupils (p = 0.027) were predictors of outcome in reoperation group. Reoperation in primary DC group was associated with pupil reactivity (p = 0.002) and number of episodes with INR above 1.5 (p = 0.037)Conclusion: Reoperation after DC for TBI is associated with primary DC, and Marshall grade. The reoperation after DC is associated with worse outcome and longer ICU and hospital stay. The age, GCS and pupil reactivity are the main predictors of outcome in those with reoperation after DC for TBI.