Reoperation In Group Research Articles

Diagnosis and treatment of postoperative bleeding in patients after gastrectomy: a retrospective case series study.

There are significant differences in terms of the pathophysiology and clinical manifestations between intra- and extra-luminal bleeding, and it is also difficult to determine the reasonable management of the bleeding. This study is to analyze the clinical characteristics of postoperative bleeding in gastric cancer, and to explore the management of postoperative intra-intestinal and extra-intestinal bleeding. We collected the clinical data of 2,978 patients with gastric cancer from the Department of Surgery, Fujian Cancer Hospital, from May 2014 to September 2019. A total gastrectomy or a distal or proximal subtotal gastrectomy with regional lymph node dissection (D1+ or D2) was included. The clinic data and management of both early (postoperative days ≤6 d) and delayed (postoperative days ≥7 d) post-operative hemorrhage were explored. This retrospective study is to compare the clinical characteristics and treatment of intra-intestinal and extra-intestinal hemorrhage. The incidence of postoperative bleeding in gastric cancer was 2.85% (n=85), and the bleeding-related mortality was 4.7% (4/85). There were 67 men and 18 women, and four patients died, with a bleeding-related mortality rate of 4.7%. There were 46 cases of intra-intestinal hemorrhage and 39 cases of extra-intestinal hemorrhage. The reoperation rate in the extraneous bleeding group was higher than that in the intra-intestinal bleeding group (66.67% vs. 19.57%, P<0.001), and the incidence of delayed bleeding in the extra-intestinal bleeding group was higher than that in the intra-intestinal bleeding group (46.15% vs. 8.70%, P<0.001). In the delayed phase, 11 patients underwent reoperation to stop the bleeding, and three patients died due to bleeding-related complications. Hemostasis was successfully achieved in four patients by transcatheter arterial embolization (TAE). In the reoperation group, 72.73% (8/11) suffered hemodynamic instability and 63.64% (7/11) had an abdominal infection, while in the TAE group, 25% (1/4) had hemodynamic instability and 50% (2/4) had an abdominal infection. A greater number of gastric cancer patients with intra-intestinal hemorrhage are treated conservatively, while more patients with extra-intestinal hemorrhage are treated by reoperation. External bleeding is more likely to occur in the delayed period of bleeding. TAE is a safe and effective means of hemostasis if the hemodynamics is stable.

Risk Factors and Outcomes of Reoperative Surgical Aortic Valve Replacement in the United Kingdom

BackgroundMortality after reoperative aortic valve surgery continues to decline but remains high compared with primary isolated replacement. We sought to examine temporal trends, morbidity, and mortality among patients undergoing isolated first-time reoperative aortic valve surgery. MethodsThe study included all patients undergoing reoperative aortic valve surgery in the United Kingdom between January 2007 and March 2019. Patients undergoing isolated reoperative aortic valve replacement (AVR) were compared with a propensity matched cohort of patients undergoing isolated primary AVR. Outcomes measured included inhospital mortality, neurologic dysfunction, postoperative dialysis, deep sternal wound infections, and hospital length of stay. ResultsDuring the study period, 40,858 primary isolated AVRs and 3015 first-time isolated reoperative AVRs were carried out in the United Kingdom. In the propensity matched reoperative group, median age of participants was 69.8 years (60.8-76.2) with median duration between the initial surgery and the reoperation being 7.69 years. Overall mortality was 3.1% (94) for reoperative AVR compared with 1.9% (56) for primary AVR. Mortality of both primary and reoperative AVR declined during the study period. Reoperation, age, New York Heart Association class, and chronic kidney disease were independently associated with early mortality. ConclusionsReoperative isolated AVR can be performed with acceptable inhospital mortality and provides a benchmark against which alternative strategies should be compared.

Failure factors in pediatric deep neck space abscess surgical management.

Deep neck space infections (DNSI) in pediatric otolaryngology are a common occurrence in the inpatient setting. A subset of DNSI patients will fail medical and surgical management. It is difficult to predict which patients will fail. There are no studies that effectively evaluate variables associated with readmission and reoperation for DNSI abscesses. The purpose of this study was to evaluate the specific perioperative decisions that may lead to combined therapy failure and necessitate reoperation. A case-control study was performed at a single center academic tertiary care hospital. Patients <18 years old treated from January 2015 to April 2020 with a surgically treated DNSI were reviewed. The single incision and drainage group (SOp) and reoperation group (ReOp) were evaluated with reoperation performed within a 30-day period. Intravenous antibiotic administration timing, drain management and type (gauze or latex), diagnostic, and postoperative factors were evaluated. The SOp group consisted of 275 patients and the ReOp group of 21 patients. The average preoperative intravenous antibiotic time showed no statistical difference (p=0.884) and no increased risk for reoperation (p=0.470; OR=0.993). Timing of drain removal showed a significant difference (p<0.005; 41.1 SOp vs 46.5h ReOp). Abscess location (p=0.855) and complications rate did not vary (p=0.450). Gauze drains were used in 131 (44.3%), latex in 80 (27%), and no drain in 84 (28.4%) with no difference regarding reoperation (p=0.124). Length of stay was longer in the ReOp group (8 vs 4 days; p<0.001). The average measured dimension for each group did not significantly vary (p=0.633). The duration of antibiotics in the preoperative period showed no statistical role in the need for reoperation in DNSI abscess patients. Drain type and duration also had a potentially clinically relevant association with the need for reoperation. Extensive unknown abscess pockets or inadequate technique may be the main contributors to the need for reoperation.

The impact of prior cardiac surgery on patients undergoing surgical repair for acute type A aortic dissection.

To determine the impact of reoperative versus first-time sternotomy for emergent open repair of acute Type A aortic dissection (ATAAD). This was an observational study of consecutive aortic surgeries from 2007 to 2021. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed to assess the impact of reoperative versus first-time sternotomy upon survival after ATAAD repair. A total of 601 patients with ATAAD were identified, of which 72 (12%) underwent reoperative sternotomy. The reoperative group had a higher prevalence of baseline comorbidities, including hypertension, diabetes, peripheral vascular disease, atrial fibrillation, and coronary artery disease. Central cannulation of the aorta was achieved at a similar rate across each group (81.9% vs. 81.5%, p = .923), and cardiopulmonary bypass (CPB) time was similar across each group (204 ± 84.8 vs. 203 ± 72.4 min, p = .923). Postoperative outcomes were similar across both groups, including in-hospital mortality, stroke, pulmonary complications, renal failure, and reexploration for excessive bleeding. Five-year survival was 74.5% (70.5, 78.3) for the first-time group and was 71.6% (60.0, 81.9) for the reoperative group. After multivariable Cox regression, reoperative sternotomy was not significantly associated with an increased hazard of death compared to first-time sternotomy (hazards ratio: 0.90, 95% confidence interval: 0.56, 1.43, p = .642). These findings suggest that re-sternotomy can be safely performed with similar outcomes as first-time sternotomy. Central initiation of CPB after sternal reentry limits CPB time and may therefore represent a protective strategy that enhances outcomes for patients presenting with ATAAD and prior cardiac surgery.

Mid-Term Functional Outcomes Following Reoperation after Total Ankle Arthroplasty: A Case- Control Study

Category: Ankle Arthritis; Ankle Introduction/Purpose: A relatively frequent need for secondary surgery is an important consideration when treating end-stage ankle arthritis with total ankle arthroplasty (TAA). Despite a significant reported rate of non-revision reoperation after TAA, it is uncertain if these subsequent procedures have an impact on the longer term outcomes. It is imperative to know whether patients undergoing reoperation after TAA would have comparable functional ability compared to those with uncomplicated TAA in order to optimize patient outcomes when faced with complications after TAA. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation. Methods: Seventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 to 2014 were allocated into two groups based on presence (n=16) or absence of reoperation (n=60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs. A subgroup analysis was performed to compare clinical and radiographic outcomes of gutter impingement patients to those of uncomplicated group. Results: The most common cause of reoperation was gutter impingement (n=11), followed by stress fracture of the medial malleolus (n=2), tarsal tunnel syndrome (n=1), periprosthetic cyst (n=1), and infection (n=1). In comparison to the non- reoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p&lt;0.05, Figure 1). There were no statistical differences in the radiographic parameters between both groups. In a subgroup analysis, all FAOS subscales at final follow-up were significantly lower in the gutter debridement patient group. There was significantly less improvement in the Pain, Symptoms, and QoL subscales in the gutter debridement patient group compared to the non-reoperation group (p&lt;0.05 in all three subscales). Postoperative radiograph showed no differences between groups. Conclusion: Patients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. At the time of the primary TAA, an emphasis should be placed on carefully examining and preventing possible causes of reoperation to achieve favorable patient outcomes. Additionally, when faced with performing a reoperation following TAA, a thorough evaluation to determine the underlying cause of the reoperation should be performed to guide treatment.

Analysis of risk factors for re-operation due to postoperative haemorrhage following coblation-assisted tonsillectomy

Objective:To investigate the risk factors for re-operation due to postoperative haemorrhage following coblation-assisted tonsillectomy. Methods:The clinical data of 135 patients with haemorrhage after coblation-assisted tonsillectomy in our hospital from January 2015 to May 2022 were collected, According to the patients received reoperation after tonsillectomy or not, all patients were divided into the reoperation group （n=43） and non-reoperation group （n=92）,clinical data were compared between the two groups. Results:Univariate analysis showed that there was no significant difference in gender, age, postoperative intravenous glucocorticoid use, diabetes and hypertension between the two groups（P>0.05）, Univariate and multivariate factor analyses showed that early haemorrhage, obvious hemorrhage points were independent risk factors for re-operation due to postoperative haemorrhage（P<0.05）. Conclusion:Early haemorrhage and obvious hemorrhage points are independent risk factors for re-operation due to postoperative haemorrhage following coblation-assisted tonsillectomy.

Mid-term functional outcomes following reoperation after total ankle arthroplasty: A retrospective cohort study

BackgroundDespite a significant reported rate of non-revision reoperation after total ankle arthroplasty (TAA), it is uncertain if these subsequent procedures have an impact on the longer term outcomes. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation. MethodsSeventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 and 2014 were allocated into two groups based on presence (n = 16) or absence of reoperation (n = 60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs. ResultsThe most common cause of reoperation was gutter impingement (n = 11), followed by stress fracture of the medial malleolus (n = 2), tarsal tunnel syndrome (n = 1), periprosthetic cyst (n = 1), and infection (n = 1). In comparison to the non-reoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p < 0.05). There were no statistical differences in the radiographic parameters between both groups. ConclusionsPatients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. An emphasis should be placed on preventing possible causes of reoperations to achieve favorable patient outcomes. Additionally, if a reoperation is deemed necessary, a thorough evaluation and surgical correction of underlying causes should be achieved.

Thyroid lobectomy is sufficient for differentiated thyroid cancer with upgraded risk after surgery.

BackgroundIt is difficult to reliably distinguish between American Thyroid Association (ATA) low-risk and intermediate-risk differentiated thyroid cancer (DTC) before surgery. Therefore, physicians are faced with a dilemma regarding the necessity and timing of completion total thyroidectomy (CT) after thyroid lobectomy (TL). We evaluated proper surgical methods by analyzing oncologic outcomes of TL in patients with DTC whose risk had been upgraded after surgery.MethodsWe retrospectively reviewed the medical records of 1,702 patients with DTC who underwent TL and ipsilateral central lymph node (LN) dissection between January 2006 and December 2011. The patients were classified into Group A (n=1,159; low risk; ≤5 central LN metastases or the absence of pathologic microscopic capsular invasion) and Group B (n=543; upgraded intermediate risk after surgery; >5 central LN metastases or the presence of pathologic microscopic capsular invasion). We analyzed their clinicopathological characteristics and recurrence-free survival.ResultsAll 32 patients who experienced recurrence underwent CT. After the first operation, the duration until reoperation in Groups A and B were 8.00±2.74 (range, 3.42–12.17) and 5.10±3.09 (range, 1.25–11.67) years, respectively. There was no significant difference in recurrence rates, disease-related mortality rates, or 10-year recurrence-free survival rates between the two groups. The mean follow-up durations in Groups A and B were 10.22±1.58 and 10.13±1.47 years, respectively. Univariate analysis showed that sex, age, tumor size, multifocality, extrathyroidal extension (ETE), and number of central LN metastases were not associated with recurrence after TL, although the rate of central LN metastases was. Multivariate analysis showed that sex, age, tumor size, multifocality, ETE, central LN metastases, and the number of central LN metastases were not associated with recurrence after TL, although multifocality was.ConclusionsTL with prophylactic central compartment neck dissection (CCND) is sufficient for patients with DTC whose risk is upgraded after surgery because they have a good prognosis at long-term follow-up. Larger-scale randomized clinical trials are required to confirm our findings.

Hardware complications and reoperations following precontoured plate fixation of the olecranon: a population-based study.

Several fixation techniques have been described to treat acute olecranon fractures. Plate fixation is often used because of its superior mechanical properties. The reported rates of reoperation after olecranon plate fixation have been quite heterogeneous. The purpose of this study was to establish an updated reoperation rate based on modern precontoured plate constructs. This retrospective cohort study used population-level administrative data to identify all surgically treated adult patients with olecranon fractures at 4 hospitals in Edmonton, AB, Canada, between 2010 and 2015. Radiographic review was conducted to identify patients who underwent precontoured olecranon plate fixation. Fracture characteristics including Mayo fracture classification and other concomitant upper-extremity injuries were identified. Chart reviews were performed to determine patient characteristics and patients who required reoperation. The primary reason for and type of reoperation were determined. Six hundred patients were surgically treated for olecranon fractures. Precontoured plate fixation was used in 321 patients. The average age of included patients was 56 years (standard deviation [SD],19.4 years), and there were 173 female patients (53.9%). Reoperation was required in 90 patients (28%). For 50 patients, implant-related irritation was the primary reason for reoperation, representing 55.6% of the patients who underwent reoperation (50 of 90) and 15.6% of the total cohort (50 of 321). Other reasons for reoperation included hardware failure in 17 patients (5.3%), infection in 9 (2.8%), and contracture in 9 (2.8%). Patients who required reoperation were significantly younger (52.9 years [SD,18.1 years] vs. 57.7 years [SD,19.4 years]; P=.048) and had significantly higher rates of type III olecranon fractures (17.8% [16 of 90] vs. 8.2% [19 of 231]; P=.04) and Monteggia fractures (13.3% [12 of 90] vs. 4.8% [11 of 231]; P=.008). A multivariate logistic regression model also demonstrated increased odds ratios (ORs) for overall reoperation in patients with Monteggia fractures (OR, 2.99 [95% confidence interval, 1.25-7.17]; P=.014) and for reoperation due to implant-related irritation in younger patients (OR, 0.98 [95% confidence interval, 0.96-0.996]; P=.018). No discerning factors were identified for the 50 patients who underwent hardware removal for implant-related irritation compared with the whole reoperation group (n=90). This study found that patients with olecranon fractures treated with precontoured plates experienced a hardware removal rate of 15.6% for implant-related irritation. Patients who sustained more complex fractures, such as Monteggia injuries, demonstrated higher rates of reoperation. Increasing age may be associated with lower rates of reoperation. In patients who required reoperation, there were no identifiable radiographic or clinical characteristics that were associated with implant-related irritation as their primary reason for reoperation.

91. Reoperation rates following minimally invasive lumbar fusion compared to open fusion: a survivorship analysis with a minimum of five-year follow up

<h3>BACKGROUND CONTEXT</h3> Both traditional open and less-invasive techniques such as minimally invasive (MIS) lumbar fusion have been shown to be effective for degenerative lumbar pathology. One of the critical measures of success following surgery is the reoperation rate, as well as the duration of reoperation from the index procedure. It is known that fusion of one or more segments alters the biomechanics of the adjacent level(s) and may cause accelerated degeneration of the adjacent segment(s). The clinical significance of muscle and musculotendinous preservation offered by MIS fusion and whether it offsets some of the altered biomechanics of fusion, and thus the reoperation rates for adjacent segment degeneration, are unclear. Current studies suggest that MIS fusion may demonstrate a lower long-term reoperation rate. However, evidence in this regard is very limited and conflicting. <h3>PURPOSE</h3> The primary objective of this study is to assess the long-term reoperation rate of 1- to 2-level MIS vs open lumbar instrumented fusion with a minimum of 5-year follow-up. <h3>STUDY DESIGN/SETTING</h3> Obervational study. <h3>PATIENT SAMPLE</h3> Adults with degenerative lumbar disease who underwent 1- to 2-level open and MIS fusion at our institution from January 2006 to December 2016. <h3>OUTCOME MEASURES</h3> Rate of reoperation for MIS vs open lumbar fusion. <h3>METHODS</h3> Retrospective study of all consecutive cases of operatively managed patients with lumbar degenerative disease who underwent 1- to 2-level lumbar fusion between January 2006 to December 2016 performed by two experienced surgeons from a single academic center. One surgeon exclusively uses an MIS tubular retractor fusion technique for all scheduled 1- to 2-level fusions, and the other surgeon only utilizes a midline open posterior approach. The patients were divided into an MIS fusion group and an open surgery group based on the surgical technique performed. The two groups were compared for baseline demographic features, surgical variables and diagnosis at index surgery. Reoperation rates defined as any operation on the same or adjacent levels were assessed. Levels of reoperation were assessed as (1) cranial, (2) caudal, (3) same level of index surgery and (4) both levels. Descriptive and comparative statistics were utilized for between-group comparison and Kaplan-Meier survivorship plots were generated. <h3>RESULTS</h3> A total of 370 patients were included, with range of follow-up (5-14 years). Fusion involved 1 level in 67.5 % of cases and 2 levels in 32.4 %. There was no significant difference between the two groups in age, sex (p = 0.34) or number of levels of fusion (p= 0.214). The overall rate of reoperation was 25.9 %, with incidence of 21.8 % in the MIS fusion group (n=42/192) and 30.3 % (n=54/178) in the open fusion group (p = 0.149). The mean time to reoperation was 4.45 years in the MIS group while in the open group it is 4.24 years. Adjacent segment degenerative pathology was the main reason for reoperation in both groups (69% [n=29/42] for MIS fusion and 76% [n=41/55] for open fusion [p=0.161]). Additionally, for MIS vs open fusions, instrumentation-related reoperations were 19% vs 3.7% (p=0.344); 9.5% vs 14.5% (p=0.376) for pseudoarthrosis; 2.4% vs 3.6% (p=0.468) for infection and 1 revision case for LIV fracture in open group. <h3>CONCLUSIONS</h3> While there seems to be a trend for a higher adjacent segment degeneration reoperation rate in open vs MIS fusion, this effect is offset by a higher rate of instrumentation-related re-operation in the MIS group. The overall reoperation rate did not statistically differ between MIS and open 1- to 2-level lumbar fusion at minimum of 5-year follow-up. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Perioperative Risk Factors Associated With Unplanned Reoperation Following Vascularized Free Flaps Reconstruction of the Oral Squamous Cell Carcinoma.

To find out the occurrence rate and risk factors of unplanned reoperation (any unscheduled surgery within 30d after the initial surgery) in patients who have received oral squamous cell carcinoma (OSCC) surgery and vascularized free flap reconstruction. We organized a retrospective study of 1058 patients who underwent OSCC resection and reconstruction with vascularized free flaps from 2011 to 2019. Clinical characteristics, reasons for unplanned reoperation, flap types, and previous treatment were compared between the unplanned reoperation group and the control group. Univariate and multivariate analyses were performed to identify perioperative risk factors for unplanned reoperation. The related perioperative factors that may influence perioperative infusion were included in propensity score matching to investigate the independent contribution of intraoperative colloid infusion on unplanned reoperation. The overall rate of unplanned reoperation in OSCC patients was 11% (n=115). Flap necrosis and bleeding were the most common causes. Higher American Society of Anesthesiologists (ASA) grade [odds ratio (OR)=1.709, P=0.009], postoperative anemia (OR=0.983, P=0.011) and excessive intraoperative colloid input (OR=1.55, P=0.037) were identified as risk factors for unplanned reoperation. Propensity score matching was applied, and the difference of unplanned reoperation incidence between the matched groups was statistically significant (14.59% versus 8.54%; P=0.025). The multivariate analyses after propensity score matching confirmed that the intraoperative rate of colloid infusion of more than 2.3mL/kg/h (OR=1.756, P=0.042) and prior radiotherapy (OR=2.78, P=0.001) are independent risk factors for unplanned reoperation. High intraoperative colloid infusion rate and prior radiotherapy may increase the risk of unplanned reoperation in patients who underwent OSCC surgery and vascularized free flap reconstruction.

Fluoroscopic lumbar transforaminal epidural steroid injections for recurrent herniated intervertebral disc after discectomy: Effectiveness and outcome predictors.

BackgroundDespite transforaminal epidural steroid injection (ESI) being the first choice in patient with recurrent herniated intervertebral disc (HIVD), efficacy of ESI in those patients are not well established. Herein, we evaluate the effectiveness and outcome predictors of fluoroscopic transforaminal ESI for recurrent HIVD.MethodsSeventy-seven patients (48 male; mean age, 51.3 years) with recurrent lumbar HIVD were included and divided into three groups according to initial treatment: conservative treatment, transforaminal ESI, and immediate surgery. ESI effectiveness was evaluated by operation rates, injection numbers in 6 months, and pain reduction (visual analog scale (VAS) scores). Clinical and MRI variables were analyzed as possible outcome predictors. Each subject in the transforaminal ESI group was individually matched to two patients with initial HIVD (control group).ResultsIn the transforaminal ESI group (n = 37), 20 patients (54.1%) did not undergo reoperation. The initial and follow-up VAS scores were significantly higher in the reoperation group (p = 0.014, p = 0.019, respectively). Patients with either paresthesia or motor weakness (12/19, 63.2%) had a significantly higher reoperation rate than patients with only pain (5/18, 27.8%; p = 0.031). Extruded disc ratios ≥2.0 were significantly higher in the reoperation group (10/17, 58.8%; p = 0.048). The reoperation rate in the transforaminal ESI group (17/37, 45.9%) was higher than the operation rate in the control group (6/73, 8.2%; p<0.001).ConclusionTransforaminal ESI was effective in reducing radicular pain in patients with recurrent HIVD. Approximately 54% of patients did not undergo reoperation. An extruded disc ratio ≥2.0 and paresthesia or motor weakness were poor outcome predictors.

Reoperations After Repair for Atrioventricular Septal Defects: >25 Years Experience at a Single Center

Our aim was to evaluate the total burden of reoperations after previous repair for atrioventricular septal defects, including long-term survival and identify risk factors for reoperation. All patients with surgical correction for atrioventricular septal defect (AVSD) 1993- 2020 underwent a follow-up in October 2020. Clinical data were obtained by retrospective review and evaluated with Kaplan-Meier and competing risk analysis. Of 477 patients who underwent initial repair, 53 patients (11.1%) underwent a total of 82 reoperations. The perioperative mortality at reoperation was 3.8% (2/53). There were no late deaths (0/51) during follow-up. In patients requiring reoperation for left atrioventricular valve regurgitation, a re-repair was performed in 90% (26/29) at first attempt. Estimated overall survival was 96.2 ± 2.6% (95% CI 91.2-100) in the Any reoperation group and 96.7 ± 0.9% (95% CI 94.9-98.5) in the No reoperation group at 20 years (P=0.80). The cumulative incidence function of Any reoperation (with death as competing risk) was 13.0% (95% CI 9.4-16.5) at 20 years. Independent risk factors for Any reoperation included severe mitral regurgitation after primary repair (HR 40.7; 95% CI 14.9-111; P < 0.001). The risk of perioperative mortality in AVSD patients undergoing reoperation was low in the present study. Long-term survival was very good and not significantly different when compared to patients who did not need reoperation. Re-repair for left atrioventricular valve regurgitation was possible in most cases and showed long-term durability. Our data suggest that reoperations after primary repair of AVSD have very good long-term outcomes when performed at a high-volume pediatric cardiac surgery center.

Evaluating the safety and efficacy of microwave ablation in treatment of cervical metastatic lymph nodes of papillary thyroid carcinoma compared to repeat surgery

Objective To evaluate the safety and efficacy of microwave ablation (MWA) versus repeat surgery for treating metastatic lymph nodes (MLNs) in papillary thyroid carcinoma (PTC). Methods Between July 2017 and October 2020, 67 patients were enrolled in this retrospective study. 19 and 48 patients underwent MWA and repeat surgery, respectively. The primary and secondary endpoints were recurrence-free survival and complication rates, respectively. The largest diameter, volume and volume reduction ratio (VRR) were analyzed before and after MWA. The effects of different ablation powers on the largest diameter, volume and VRR were investigated. Pre and posttreatment variables (e.g., baseline characteristics, serum thyroglobulin [Tg] levels, hospitalization time, treatment costs, recurrence-free survival and complication rates) were compared between groups. Results The largest diameter and volume postablation at each follow-up were smaller than the preablation levels (p < 0.05), except at the 1-month follow-up (p > 0.05). The largest diameter, volume, and VRR among the different ablation powers were not significantly different (p > 0.05). The mean serum Tg levels and biochemical remission rates were not significantly different between the groups (p > 0.05). Compared to reoperation, MWA had a shorter hospitalization time and lower treatment cost (p < 0.001). Total and minor complications were higher in the reoperation group (p < 0.05), but major complications were comparable (p > 0.05). The recurrence-free survival rate between groups was not significantly different (p = 0.401). The 1- and 3-year recurrence-free survival rates were comparable between the groups. Conclusions MWA may be a safe and effective alternative to repeat surgery for treating MLNs of PTC in select patients.

Larger Than Larger: Huge Amounts of Recession-Resection Surgery for Third Nerve Palsy.

To describe the characteristics and management outcomes of strabismus surgery in patients with third cranial nerve palsy and identify factors associated with long-term outcomes. A 10-year retrospective study of patients with third cranial nerve palsy who underwent strabismus surgery was performed at Zhongshan Ophthalmic Center, Sun Yat-sen University, China, between August 2010 and January 2021. Clinical characteristics and factors associated with long-term outcomes were evaluated. Success of surgery was defined as esotropia of 15 prism diopters (PD) or less at postoperative day 1 (POD1) or any deviation of 10 PD or less at postoperative month 2 (POM2) or later. A total of 91 patients were included, with a mean age of 24.02 ± 15.38 years (range: 2 to 64 years). Forty-one patients (45.1%) were diagnosed as having complete palsy. Congenital palsy accounted for 40.7% (n = 37). Mean follow-up time was 2.50 ± 1.78 years (range: 8 months to 8 years). One-step surgery was performed in 78.0% of cases (n = 71), a staging procedure in 7.7% (n = 7), and reoperations in 14.3% (n = 13). Most patients had supra-maximal recession and resection of the horizontal rectus muscle with additional techniques, including horizontal rectus transposition, superior oblique transposition, traction sutures, and fixation of the globe. The mean surgical dosage performed on the horizontal rectus muscle was 18.52 ± 5.69 mm (range: 8 to 35 mm). Success rates at postoperative month 8 (POM8) were 69.0% (49 of 71) in the one-step surgery group, 57.1% (4 of 7) in the staging surgery group, and 46.2% (6 of 13) in the reoperation group. Preoperative horizontal deviation (odds ratio [OR]: 1.07, 95% CI: 1.02 to 1.13, P = .011), horizontal deviation at POD1 (OR: 0.86, 95% CI: 0.76 to 0.97, P = .016), and horizontal deviation at POM2 (OR: 1.53, 95% CI: 1.18 to 1.98, P = .001) were associated with the outcomes at POM8. Patients with partial palsy had a higher success rate than those with complete palsy (76.0% vs 51.2%, P = .014). Supra-maximal recession and resection with additional techniques yields satisfying surgical results in patients with third nerve palsy when a larger surgical dose is performed for an initial overcorrection for 15 to 25 PD at POD1. The cases with complete palsy showing a larger deviation were prone to failure. [J Pediatr Ophthalmol Strabismus. 2023;60(3):184-194.].

Analysis of the Outcome of Reoperative Face Lifts Using Sub-SMAS Techniques

Reoperative face lift can be technically more demanding than primary face lift because of altered anatomy and scarred tissue plane. This study was carried out to analyze the outcome of reoperative face lift using sub-superficial musculoaponeurotic system (SMAS) techniques, including facial nerve injury. Seventy reoperative face lifts using sub-SMAS techniques were studied. Data analysis includes the patients' demographic information, the interval between the previous face lift and the reoperative face lift, intraoperative findings of the SMAS-platysma anatomy, complications, and rate of revision. A separate group of 180 primary face lifts using sub-SMAS techniques during the same period was analyzed for the incidence of facial nerve injury only. Intraoperative findings in the reoperative group consist of anatomical changes in the SMAS-platysma in 82.9 percent of the cases, including increased fibrosis, changes in thickness, limited movement, and increased adhesion on the undersurface. Sub-SMAS dissection was completed in 137 hemifaces. Complication consists of seroma (1.4 percent), delayed healing (1.4 percent), and temporary facial nerve injury (7.1 percent), which was not correlated with increased fibrosis or adhesion under the SMAS-platysma. The rate of revision within 18 months was 11.4 percent. There was a 2.2 percent incidence of temporary facial nerve injury in the primary face-lift group. Sub-SMAS techniques, with few exceptions, were successfully used in a series of reoperative face lifts. Temporary facial nerve injury was the most frequent complication. Satisfactory outcome was obtained in all the cases. The incidence of facial nerve injury was higher than in primary face lift using sub-SMAS techniques. Therapeutic, IV.

Risk factors and risk nomogram model of reoperation for hemorrhages after severe traumatic brain injury craniotomy.

This study aimed to explore the risk factors associated with reoperation for postoperative hemorrhages after severe traumatic brain injury (sTBI) craniotomy and establish a risk nomogram model. A retrospective case-control study was performed. Overall, 367 patients who were diagnosed with sTBI and fulfilled the inclusion criteria were enrolled from the Department of Neurosurgery of the Affiliated Hospital of Zunyi Medical University between January 2015 and December 2020. They were divided into a reoperation group and a non-reoperation group according to whether they underwent reoperation for hemorrhages. Using univariate binary logistic regression analysis, the possible risk factors were screened. Subsequently, the independent risk factors of reoperation for postoperative hemorrhages were screened using the forward step method of multivariate binary logistic regression analysis, and a corresponding nomogram model was constructed. The receiver operative characteristic (ROC) curve was used to evaluate the reliability of the model. Finally, 30% of the data were randomly selected for internal verification of the model. The reoperation rate for hemorrhage after sTBI emergency craniotomy was 14.71% (54/367); multivariate logistic regression analysis showed that multiple hemorrhages (odds ratio [OR] = 4.38, 95% confidence interval [CI]: 1.815-10.587, p = 0.001), day or night surgery (OR = 0.26, 95% CI: 0.119-0.547, p < 0.001), operation duration (OR = 0.74, 95% CI: 0.119-0.547, p < 0.025), and abnormal intraoperative blood pressure fluctuation (OR = 4.15, 95% CI: 2.090-8.245, p < 0.001) were statistically significant. The sensitivity and specificity of the nomogram model were 0.815 and 0.661, respectively, and the area under ROC curve was 0.76 (95% CI: 0.705-0.833). Internal verification showed that the area under the ROC curve was 0.783 (95% CI: 0.683-0.883). Taken together, the results of our study reveal that multiple preoperative intracranial hemorrhages, day and night operation, operation duration, and abnormal fluctuation of intraoperative blood pressure were independent risk factors for postoperative bleeding and reoperation for sTBI. Through the analysis of the influencing factors, a prediction model for the risk of bleeding and reoperation after craniocerebral trauma was developed. Compared with other relevant studies, this prediction model has good prediction efficiency and can be used to predict the occurrence of bleeding and reoperation after sTBI in patients.

Application analysis of omental flap isolation and modified pancreaticojejunostomy in pancreaticoduodenectomy (175 cases)

BackgroundTo explore the application value of free omental wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD).MethodsThe clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analysed. In total, 86 cases were divided into Group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases were divided into Group B (control group). The incidences of postoperative pancreatic fistula and other complications were compared between the two groups, and univariate and multivariate logistic regression analyses were used to determine the potential risk factors for postoperative pancreatic fistula. Risk factors associated with postoperative overall survival were identified using Cox regression.ResultsThe incidences of grade B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in Group A were lower than those in Group B, and the differences were statistically significant (P < 0.05). Group A had an earlier drainage tube extubation time, earlier return to normal diet time and shorter postoperative hospital stay than the control group (P < 0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) inflammatory factors 1, 3 and 7 days after surgery also showed significant. Univariate and multivariate logistic regression analyses showed that a body mass index (BMI) ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P < 0.05). Cox regression analysis showed that age ≥ 65 years old, body mass index ≥ 24, pancreatic duct diameter less than 3 mm, no isolation of the greater omental flap isolation and modified pancreaticojejunostomy, and malignant postoperative pathology were independent risk factors associated with postoperative overall survival (P < 0.05).ConclusionsWrapping and isolating the modified pancreaticojejunostomy with free greater omentum can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and favourably affect prognosis.

Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study

BackgroundOpen reduction and internal fixation (ORIF) for unstable ankle fractures (AF) are relatively predictable with excellent outcomes. Rehabilitation strategies are still being debated after surgical intervention for AF: non-weight bearing and cast immobilization for six weeks after the surgical repair of unstable AF or early functional treatment with partial weight bearing. This study aimed to compare early weight bearing and functional outcomes and complications. MethodsBetween April 2014 and March 2019, 1421 patients with AF underwent ORIF at 11 institutions (TRON group). The patients were divided into two groups: Group E started weight bearing within six weeks after surgery, and group L started weightbearing for more than six weeks after. To adjust for baseline difference between groups, a propensity score-matched algorithm was used to match Group E with Group L in a 1:1 ratio of 294 cases each. We compared the American Orthopedic Foot and Ankle Society (AOFAS) score as the functional outcome, the rate of wound dehiscence, superficial and deep infections, blistering, nonunion, neurapraxia, and reoperation at 3, 6, and 12 months after surgery. ResultsThe mean period of non-weight bearing was significantly shorter in group E (3.68 ± 1.02 vs. 6.67 ± 1.43; P < 0.001). The mean period of cast immobilization term were shorter in group E (1.84 ± 1.35 vs. 2.65 ± 1.51; P < 0.001). There were no differences in the AOFAS score at any period. The rates of deep infection and reoperation in Group E were significantly lower than those in Group L (1.7% vs. 6.1%; P = 0.009, 2.0% vs. 7.8%; P = 0.002, respectively). There were no significant differences in superficial infection (9 vs. 15; P = 0.297), nonunion (9 vs. 15 P = 0.30), blistering (4 vs. 3; P = 1.00), neurapraxia (2 vs. 1; P = 1.00), and wound dehiscence (15 vs. 18; P = 0.72). ConclusionsAlthough functional outcome was similar depending on whether early weight bearing was allowed, the rates of deep infection and reoperation decreased in patients with early weight bearing. We recommend early postoperative weight bearing in patients with a surgically treated AF.

Reoperation rate of ductal carcinoma in situ: impact of tomosynthesis (3D) and spot magnification.

Surgical planning depends on precise preoperative assessment of the radiological extent of ductal carcinoma in situ (DCIS). Despite different modalities used, reoperation rates for DCIS due to involved margins are high. To evaluate the impact of additional imaging views (spot magnification, tomosynthesis) on surgical reoperation rate of DCIS. The retrospective single institute study includes 157 patients with biopsy-proven pure DCIS seen on mammogram as microcalcifications and treated with breast-conserving surgery. Patients have been divided into three groups according to additional imaging performed: spot magnification, tomosynthesis, and none. All breast images (mammograms, spot magnification, tomosynthesis) were reviewed and the maximum extent of pathological microcalcifications was recorded. Radiological size was compared to final histopathological size. Reoperation rate due to inadequate margins was recorded. Reoperation rates (25%) due to inadequate margins were as follows: spot (18%), tomosynthesis (27%), none (31%); P = 0.488. Spot magnification, tomosynthesis, and digital zoom of full-field digital mammography predicted similarly the final histopathological size. Reoperation group had a significantly greater preoperative radiological median size (26 mm vs. 20 mm; P = 0.014) as well as median size of disease on final histopathological report (29 mm vs. 14 mm; P < 0.001). Discrepancy between radiological and final histopathological size became greater with increasing DCIS extent. The main factors for reoperations are DCIS size and discordance between radiological and histopathological sizes. The use of additional imaging views (spot magnification, tomosynthesis) did not reduce reoperation rate.