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Objective: Management of patients after failed epilepsy surgery is still challenging. Advanced diagnostic and intraoperative tools including magneto-encephalography (MEG) as well as neuronavigation and intraoperative magnetic resonance imaging (iopMRI) may contribute to a better postoperative seizure outcome in this patient group. Methods: We retrospectively analyzed consecutive patients after reoperation of failed epilepsy surgery for medically refractory epilepsy at the University of Erlangen between 1988 and 2017. Inclusion criteria for patients were available MEG, neuronavigation and iopMRI data. The Engel scale was used to categorize seizure outcome. Results: We report on 27 consecutive patients (13 female/14 male mean age at first surgery 29.4 years) who had operative revision of the first resection after failed epilepsy surgery. An improved seizure outcome postoperatively was observed in 78% of patients (p < 0.001) with 55% seizure free (Engel I) patients after a mean follow-up time of 4.9 years. In detail, 80% of lesional cases were seizure free compared to 59% of MRI negative patients. Localizing MEG spike activity in the vicinity of the first resection cavity was present in 12 of 27 patients (44%) corresponding to 83% (10/12) of MEG localizing spike patients having advanced seizure outcome after operative revision. Conclusion: Re-operation after failed surgery in refractory epilepsy may lead to a better seizure outcome in the majority of patients. Preoperative MEG may support the decision for surgery and may facilitate targeting epileptogenic tissue for re-resection by employing navigation and iopMR imaging.

Objective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication. Маterials and methods. The results of treatment of the adult patients, suffering abdominal sepsis in 2009 – 2019 yrs, excluding an acute cholecystitis cases, were analyzed. The patients were divided retrospectively and prospectively in accordance to the Sepsis–3 classification. Of them 130 have suffered peritoneal sepsis, 33 – intestinal one, and 38 – pancreatogenic abdominal. The results estimation was compared with application of modern systems: APACHE–II, Mannheim іndex of peritonitis (MPI), MODS and SOFA. The indices were estimated on the 1st, 2nd, 3rd and 4th postoperative days before subsequent outcomes of a primary operation. Results. The prognosis systems with a square under the ROC–curve (AUC) > 0.8 have included MPI only for determination of indications for reoperations: the ROC–curves value for the first subgroup (the closed treatment) have constituted 0.73, for the second subgroup (reoperations in accordance to indications) – 0.91, and for the third – 0.84 (the programmed reoperations). But in the patients of first subgroup this index have constituted 0,73, indicating its application restricting the decision making process, concerning the reoperations efficacy in patients with absence of the septic shock signs. Conclusion. Calculations of the occurrence possibility for postoperative complications and mortality in patients, depending on their preoperative state severity permits to select a most rational tactics of treatment. Most optimal approach for the rate reduction of postoperative complications occurrence and mortality in patients with abdominal sepsis and septic shock is performance of reoperations in accordance to indications to control the infection source, if it is possible.

Introduction and hypothesis: We evaluate intraoperative and short-term postoperative (≤ 3 months) complications and long-term re-operations (up to 6 years) after tension-free vaginal tape (TVT) operation in women with stress urinary incontinence (SUI). Methods: Data from 446 women undergoing TVT operation between 2012 and 2016 at a tertiary referral center was retrospectively collected. Data included patient baseline demographics, information from the TVT operation and the following postoperative period, and scores from patient questionnaires [the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Patient Global Impression of Improvement (PGI-I)]. Collected data were investigated for incidence of complications and re-operations, postoperative improvement in patient questionnaires, and association between complications and baseline patient demographics. Results: The only intraoperative complication was bladder perforation (2.0%). Postoperative complications included: infection (0.7%), hematoma (0.9%), bleeding (0.2%), pain (0.9%), erosion of the vaginal mucosa (1.1%), persistent SUI (0.7%), and voiding dysfunction > 24 h (10.3%). Re-operations included: operation due to infections (0.4%), incontinence surgery for persistent SUI (0.4%), revision for tape erosion (1.1%), tape mobilization (3.6%), and tape division (0.2%). A significant reduction in urinary incontinence symptoms was observed in the ICIQ-UI SF and PGI-I. The reduction in ICIQ-UI SF did not vary significantly between patients with and without complications. No association between complications and baseline patient demographics was found. Conclusion: This study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications.

This paper reviews reoperations rates for short- and long-term complications following secondary bariatric procedures and need for further bariatric surgery. The search revealed 28 papers (1317 secondary cases) following at least 75 % of patients for 12 months or more. For adjustable gastric banding (AGB), rebanding had higher re-revisional rates than conversions into other procedures. Conversion of AGB to Roux-en-Y gastric bypass had the highest number of short- (10.7 %) and long-term (22.0 %) complications. We estimated 194 additional reoperations per 1000 patients having a secondary procedure, 8.8 % needing tertiary surgery. Despite being poorly reported, risks of reoperations for long-term complications and tertiary bariatric surgery are higher than usually reported risks of short-term complications and should be taken into account when choosing a secondary bariatric procedure and for economic evaluations.

The authors studied the causes of development of recurrent chronic purulent frontal sinusitis after Belogolovov frontal sinus opening in 26 patients at the period of 2010–2016. The article discusses the specific features of formation of frontal ostium using demineralized bone grafts and polytetrafluoroethylene, describing the disadvantages of each of the materials. It was decided to return to the previously suggested original method of formation of frontal ostium using a combined drain tube consisting of a rigid tubular fragment and a homotissue component (femoral artery), which is the natural fluid conductor in the human body.

We investigated if patient-reported outcomes (PROMs) one year after total hip replacement (THR) can predict the risk of re-operation using data from the Swedish Hip Arthroplasty Register. A total of 75,899 patients with THR due to osteoarthritis operated in 2002–2014 were included. We used Kaplan-Meier and Cox regression to investigate the relationship between one-year post-operative PROMs and risk of re-operation (all types of further hip surgery). The predictive power of the model and post-operative PROMs were evaluated by concordance index (C). Kaplan-Meier estimates for not being re-operated at eight years was 95.5% (95%CI; 95.3–95.8). Cox regression analyses showed that all PROMs, except for EQ-VAS, were associated with re-operation. The full model had a concordance index of 0.68. Satisfaction (C = 0.65) and pain (C = 0.65) in isolation had the highest predictive power. Worse PROMs predicted higher risk of re-operation. Therefore, we believe PROMs may be helpful in identifying patients at risk for re-operation and timely address their problems.

Complications, which led to the need of re-operations in the patients with previously correction of congenital septal defects, are analyzed in this paper. Indications for re-operations, their immediate and long term results are considered. Approaches to the problem of the choice of tactics in the case of different complications after initial correction of congenital septal defect of the heart are considered as well. Having diagnosed re-canalization of septal defect requires not always need to re-intervention. The presence of a severe deficiency on the mitral or aortic valve (in particular, the existence of fenestration of the valves of the aortic valve) is almost always an indication for re-operation. Infective endocarditis as one of the significant causes for re-operations is considered in this paper. At the same time, this investigation didn’t reveal a single case of re-operation concerning any severe arhythmias, which required surgical operation. The investigation demonstrates the good immediate and long term results of re-operations in given group of patients. The complications required re-operation after correction of septal defects for more than 15 years didn’t note. This was the result of analysis of mistakes made, and also "the surgeon is an independent" complications.

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.

While an increasing amount of arthroplasty articles report comorbidity measures, none have been validated for outcomes. In this study, we compared commonly used International Classification of Diseases-based comorbidity measures with re-operation rates after total hip replacement (THR). Scores used included the Charlson, the Royal College of Surgeons Charlson, and the Elixhauser comorbidity score. We identified a nationwide cohort of 134 423 THRs from the Swedish Hip Arthroplasty Register. Re-operations were registered post-operatively for up to 12 years. The hazard ratio was estimated by Cox’s proportional hazards regression, and we used C-statistics to assess each measure’s ability to predict re-operation. Confounding variables were age, gender, type of implant fixation, hospital category, hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant relationship with increased risk of re-operation, with increased scores for both one to two and three or more comorbidities. However, the predictive C-statistic in this period for the Elixhauser score was poor (0.52). None of the measures proved to be of any value between two and 12 years. They might be of value in large cohort or registry studies, but not for the individual patient. Cite this article: Bone Joint J 2013;95-B:1184–91.

Summary Objective To determine and compare failure, re-operation, and complication rates of all generations and techniques of autologous chondrocyte implantation (ACI). Methods A systematic review of multiple medical databases was performed according to PRISMA guidelines. Levels I–IV evidence were included. Generations of ACI and complications after ACI were explicitly defined. All subject and defect demographic data were analyzed. Modified Coleman Methodology Scores (MCMSs) were calculated for all studies. Results 82 studies were identified for inclusion (5276 subjects were analyzed; 6080 defects). Ninety percent of the studies in this review were rated poor according to the MCMS. There were 305 failures overall (5.8% subjects; mean time to failure 22 months). Failure rate was highest with periosteal ACI (PACI). Failure rates after PACI, collagen-membrane cover ACI (CACI), second generation, and all-arthroscopic, second-generation ACI were 7.7%, 1.5%, 3.3%, and 0.83%, respectively. The failure rate of arthrotomy-based ACI was 6.1% vs 0.83% for all-arthroscopic ACI. Overall rate of re-operation was 33%. Re-operation rate after PACI, CACI, and second-generation ACI was 36%, 40%, and 18%, respectively. However, upon exclusion of planned second-look arthroscopy, re-operation rate was highest after PACI. Unplanned re-operation rates after PACI, CACI, second-generation, and all-arthroscopic second-generation ACI were 27%, 5%, 5%, and 1.4%, respectively. Low numbers of patients undergoing third-generation ACI precluded comparative analysis of this group. Conclusions Failure rate after all ACI generations is low (1.5–7.7%). Failure rate is highest with PACI, and lower with CACI and second-generation techniques. One out of three ACI patients underwent a re-operation. Unplanned re-operations are seen most often following PACI. Hypertrophy and delamination is most commonly seen after PACI. Arthrofibrosis is most commonly seen after arthrotomy-based ACI. Use of a collagen-membrane cover, second-generation techniques, and all-arthroscopic, second-generation approaches have reduced the failure, complication, and re-operation rate after ACI.

Objective(s) To study the incidence, indications and outcome of reoperations done within 7 days of primary gynecological and obstetrical surgery in a teaching institution in last five years.

Category: Ankle Arthritis Introduction/Purpose: The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years. Methods: Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded. Results: The ten year survival rate was (def. 1) 94% (CI 82- 98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28). Conclusion: The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis.

Strabismus surgery with adjustable sutures of absorbable material was performed in 19 patients, aged 8-69 years, who had paralytic strabismus and/or were re-operated. The ocular alignment was assessed at 1 week and 3-12 months post-operatively. In 12 of the patients eye position was stable during that period. Eleven of them had good or moderate binocular vision. However, eye position changed over the follow-up period in about half of the patients with poor binocular vision. No evidence was found for any muscle repositioning by mechanical stress during suture absorption.

one hundred and thirteen re-operations necessitated by loosening of the prosthesis shaft were analyzed with regard to surgical stress, technique and results. Of these operations to replace the prosthesis shaft, the surgical technique employed depended on the individual situation in 94 cases. In some, the implant and cement cone were removed, in some the medullary space was foragad, and in others single or multiple fenestration was performed. The surgical investment in these 94 operations proved to be especially high. The main disadvantage of individually oriented, partly improvised procedures is that granular tissue remains in the former contact zone between cement cone and bone. Uncovering of the shaft of the femur in a planned procedure employing the fenestration/chiseling method (19 patients) represents a way of cleaning the medullary cavity completely prior to fitting the replacement implant, with a low level of surgical stress. Implants whose shape corresponds as closely of the shaft are preferred to the so-called long-shaft implants. The authors see a considerable improvement in the departure from individually oriented and partially improvised procedures in replacement interventions: the surgical stress imposed by the operation is easier to assess and the safety of the implant renders the chances of success greater.

BACKGROUND Many operations are currently used for morbid obesity, and every procedure appears to have advantages, drawbacks and failures. Re-operation is a part of bariatric surgery practice that is necessary in the event of failure. We analyzed the reasons for failure in the bariatric re-operation group. METHODS From June 1998 to April 2000, 17 morbidly obese patients had a bariatric re-operation. Of 203 bariatric operations performed in our institution, 12 patients had a re-operation (5.9%), and 5 patients had their primary procedure performed elsewhere. Mean age was 36.5 +/- 11 years, mean original weight 151.3 +/- 44.3 kg, mean BMI 58.4 +/- 16.9 kg/m2 and mean excess body weight (EBW) 94.4 +/- 43.5 kg. Mean height was 161 +/- 7.7 cm, and 15 patients were female (88.2%). The primary bariatric operation was vertical banded gastroplasty (VBG) in 15 patients (88.2%), Roux-en-Y gastric bypass (RYGBP) in 1 patient (5.9%), and gastric banding in 1 patient (5.9%). Duration since the primary surgery was a mean of 15.6 months (range 1-72 months). RESULTS Reasons for re-operation were inadequate weight loss (47%) or food intolerance (53%). 11 patients had VBG converted to RYGBP, 1 patient had a gastric banding converted to a BPD, 4 patients had their VBG converted to a gastro-gastrostomy, and 1 patient had a RYGBP staple dehiscence re-stapled. CONCLUSION Incidence of bariatric re-operations may be decreased if super-obese patients, older patients, and sweets-consuming individuals undergo RYGBP or BPD as the primary operation rather than VBG or gastric banding. The use of staplers transecting and separating the gastric pouch from the remaining stomach can decrease staple dehiscence.

We asked whether patients under long-term warfarin and managed with current guidelines regarding bridging therapy have a higher complications rate within ninety days following total knee arthroplasty. We retrospectively identified 38 patients under long-term warfarin. They were match-paired with 76 control patients. Our results showed a significant increased rate of complications (42.1% vs. 6.9%, P < 0.001) and re-operation (21.1% vs. 5.2%, P < 0.001) in the warfarin group. The difference was related to the number of hematomas requiring surgical evacuation. The warfarin group had a significantly higher rate of blood loss, blood transfusion, and length of hospital stay. Our data suggest that current guidelines for preoperative warfarin management are associated with a high rate of bleeding complications and reoperations following TKA.

To define the risk factors of complications which are followed by re-operations in patients with cardiac and pericardial wounds and to prevent these complications.Retrospective and prospective analysis of 1072 victims with cardiac and pericardial injuries for 35 years was performed. Overall mortality was 17.2%. 98 patients died during surgery. Postoperative bleeding was observed in 38 (3.9%) cases.In 28 cases re-operations were performed for bleeding-related complications. Indications for re-thoracotomy were one-time drainage from pleural cavity over 500 ml or bleeding rate over 100 ml per hour for 4 hours. Prevention of postoperative bleeding in case of cardiac and pericardial wounds was developed on basis of analysis of these observations.Risk factors of complications requiring re-operation are cardiomyopathy of different etiology, technical and tactical errors during primary intervention and hypocoagulation with massive blood loss. Prevention of these complications includes careful heart wound closure, comprehensive intraoperative control, correction of hemostatic system.Цель исследования - выявление факторов, способствующих развитию осложнений, требующих выполнения повторных оперативных вмешательств при ранениях сердца и перикарда, определение мер профилактики этих осложнений. Материал и методы. Проведен ретроспективный и проспективный анализ 1072 наблюдений ранений сердца и перикарда за 35 лет. Общая летальность составила 17,2%. В момент выполнения оперативного вмешательства умерли 98 раненых. Послеоперационные кровотечения наблюдали у 38 (3,9%) пострадавших, перенесших операцию. Результаты. Выполнения повторных хирургических вмешательств в 28 наблюдениях потребовали осложнения, связанные с кровотечением. Показанием к реторакотомии считали одномоментное поступление по дренажам плевральной полости крови в объеме 500 мл и более или кровотечение с темпом более 100 мл в час в течение 4 ч. На основании анализа этих наблюдений сформулированы меры профилактики послеоперационных кровотечений при ранениях сердца и перикарда. Вывод. Факторами, способствующими развитию осложнений, которые требуют выполнения повторных оперативных вмешательств при ранениях сердца и перикарда, являются кардиомиопатия различной этиологии, технические и тактические ошибки в ходе первичного вмешательства, а также гипокоагуляция при массивной кровопотере. Профилактика этих осложнений заключается в тщательном соблюдении техники ушивания ран сердца, полноценной интраоперационной ревизии, коррекции системы гемостаза.

Aims: Cardiac surgery patients are prone to bleeding postoperatively owing to the extensive sternotomy wound, multiple vessel and heart sutures, and disorders of hemostasis. In this study we retrospectively analyzed the outcomes for all patients in our department who were re-operated for bleeding, over a 5 year period. Methods: A total of 4297 patients underwent heart surgery between February 2002 and January 2007, of which 98 (2.3 %) were emergency reoperations for bleeding. We analyzed the process of indication for repeat surgery, possible source of bleeding, and postoperative complications. Results: Most (85.7 %) of the reoperated patients had undergone their first operation as an elective cardiac procedure. The mean blood loss before the reoperation was 1557 ml. The studied group was characterized by increased mortality (11.2 %), longer ventilation period (35.1 hours) and ICU (4.5 days) and hospital (13.3 days) stays. The postoperative outcomes did not differ significantly between patients with TEG-detected coagulation disorder and the rest of the patients, or between patients treated with antilysin and those who did not receive antifibrinolytics. Conclusions: It is vital for the indication process leading to reoperation of the bleeding patient to be as short as possible so as to minimize the delay to repeat surgery. Echocardiography including ultrasound of both pleural spaces, and TEG could shorten that time delay, and should always be included when evaluating patients. Platelets should be administered more often, with the use of antifibrinolytics reserved for cases with confirmed fibrinolysis.

To optimize the outcomes of reoperations for postoperative complications in patients with thoracic diseases and injuries.The study enrolled 1258 patients with different thoracic diseases and injuries. Postoperatively 58 (4.6%) patients underwent re-thoracotomy and 15 (1.1%) patients - video-assisted interventions for any complications. Indications for re-operations were intrapleural bleeding, bronchial stump failure, esophagogastrostomy insufficiency, prolonged air leak through the drains due to unsealed lung parenchyma, clotted hemothorax. Postoperative complications were observed in 16 patients after re-thoracotomy (including 14 deaths), while only 1 patient died after VATS surgery.Early diagnosis and rational surgical approach are key for successful surgical treatment of early postoperative complications in thoracic surgery.Цель исследования - оптимизация выполнения повторных вмешательств у больных с заболеваниями и травмами органов грудной полости (ГП) в случае возникновения послеоперационных осложнений. Материал и методы. Проведен анализ результатов лечения 1258 больных с различными заболеваниями и повреждениями органов ГП. В послеоперационном периоде ввиду возникших осложнений у 58 (4,6%) больных выполнена реторакотомия, а в 15 (1,1%) случаях - применены видеоторакоскопические технологии. Показаниями к повторным операциям были: внутриплевральное кровотечение, несостоятельность культи бронха, несостоятельность эзофагогастроанастомоза, длительное просачивание воздуха по дренажам вследствие негерметичности легочной паренхимы, свернувшийся гемоторакс. После выполнения реторакотомии послеоперационные осложнения отмечены у 16 больных (в том числе у 14 - с летальными исходами), тогда как после видеоторакоскопических вмешательств скончался 1 пациент. Вывод. Залогом успешного оперативного устранения ранних послеоперационных осложнений в хирургии органов ГП являются ранняя диагностика и выбор рационального хирургического доступа.Цель исследования - оптимизация выполнения повторных вмешательств у больных с заболеваниями и травмами органов грудной полости (ГП) в случае возникновения послеоперационных осложнений. Материал и методы. Проведен анализ результатов лечения 1258 больных с различными заболеваниями и повреждениями органов ГП. В послеоперационном периоде ввиду возникших осложнений у 58 (4,6%) больных выполнена реторакотомия, а в 15 (1,1%) случаях - применены видеоторакоскопические технологии. Показаниями к повторным операциям были: внутриплевральное кровотечение, несостоятельность культи бронха, несостоятельность эзофагогастроанастомоза, длительное просачивание воздуха по дренажам вследствие негерметичности легочной паренхимы, свернувшийся гемоторакс. После выполнения реторакотомии послеоперационные осложнения отмечены у 16 больных (в том числе у 14 - с летальными исходами), тогда как после видеоторакоскопических вмешательств скончался 1 пациент. Вывод. Залогом успешного оперативного устранения ранних послеоперационных осложнений в хирургии органов ГП являются ранняя диагностика и выбор рационального хирургического доступа.

Roux-en-Y gastric bypass (RYGBP) has been demonstrated to be an effective treatment for weight loss in the morbidly obese. Numerous variations of the RYGBP have been performed, including placing a ring proximal to the gastric outlet. This ring in RYGBP is intended to decrease pouch dilation and limit weight regain. We reviewed our experience in laparoscopic re-operation after open banded RYGBP. All charts of patients who underwent laparoscopic revisional bariatric surgery were reviewed. Patients who had laparoscopic removal of the band following the open banded RYGBP were reviewed in this study. There were 4 patients who had laparoscopic removal of the band. The indication in all patients was dysphagia and emesis. The ring removed was a silicone band (1) and a large braided non-absorbable suture (3). After the laparoscopic reoperation, there was immediate relief. There has been an average of 5.8 kg weight regain at average followup of 30 months. This complication after open banded RYGBP may require operative intervention. Laparoscopic removal of a band is feasible and safe.

To examine the efficacy of amniotic membrane transplantation (AMT) and/or botulinum toxin type A-induced ptosis (Dysport) in the treatment of corneal ulcerations of different entities.Retrospective evaluation of 137 cases of corneal ulcers which have been treated with AMT, botulinum toxin type A and perforating keratoplasty (pKP). Regarding corneal ulcerations the patients were divided into three groups: group A, patients initially having received an AMT (92 eyes eventually followed by AMT or pKP as a second intervention); group B, patients initially having received an AMT (32 eyes followed by botulinum toxin type A injection in the upper lid as a second intervention); group C, patients initially treated only by botulinum toxin type A injection (13 eyes followed occasionally by AMT or pKP or additional botulinum toxin type A injection). Additionally, we analysed the complete epithelialisation rate of the ocular surface in respect to different ocular and systemic diseases and compared the frequency of re-operations in each group.The overall follow-up was 14.2 (+/-14.7 months; range from 1 to 60 months). The total frequency of re-operations was 45.3% (overall time until complete epithelialisation 12.7 (+/-6.1) days). If the patient was initially treated with an AMT (group A), the re-operation rate was 44.6%. Treating affected eyes in this group with a subsequent amniotic membrane resulted in a reduction of re-operation rate to 30.4%. In cases with induced ptosis by injecting botulinum toxin type A in the M. levator palpebrae (group B), the re-operation frequency could be reduced to 34.4% with similar times of epithelialisation [group A: 12.0 (+/-6.5) days and group B: 11.7 (+/-5.5) days]. In group C, with botulinum toxin type A alone initially, the re-operation rate of 69.2% was the highest one compared with groups A and B; this rate could be drastically reduced by a following AMT to 23.1%. Surprisingly, in the few successful cases with botulinum toxin type A alone a quite low epithelialisation time of 6.5 (+/-1.3) days was achieved, but turned out to be similar after additional interventions if compared with the other groups (botulinum toxin type A + AMT: 15.7 (+/-4.9) day).AMT alone and combined with botulinum toxin type A-induced ptosis is an effective surgical approach for managing severe corneal ulcerations by promoting wound healing and stabilizing ocular surface homeostasis.

The widespread use of meshes for the repair of incisional hernia is currently followed by an increasing number of re-operations. The incidence of incisional hernia recurrence after mesh repair varies between 3 and 32%. The problem of mesh failure and options for another surgical intervention seem rather unattended. We present our experience of 77 re-operations after previous mesh repair that were performed between 1995 and 2004 out of a total of 1,070 operations for incisional hernia. The retrospective analysis focused on recurrence in relation to location, material of the previous mesh repair and the surgical procedure to resolve the problem. The locations of the preceding meshes were epifascial as onlays (n=23), retromuscular as sublays (n=46), within the defect as inlays (n=6) or intraperitoneally (n=2). The direction of the incision was vertical medial (n=41) or horizontal crossing the linea semilunaris (n=36). Recurrences after median incisional hernia mesh repair mainly occurred at the cranial border of the mesh subxiphoidal. Except for two patients, all recurrences manifested at the margin of the enclosed mesh. Re-operation after previous mesh repair is a surgical challenge. The type of revision procedure has to consider the position and material of the previous mesh. In our clinic recurrences, heavyweight polypropylene meshes were mostly treated with mesh exchange and lightweight polypropylene meshes could be treated by extension with a second mesh. In contrast to suture techniques, deficient mesh repairs are more evidently related to technical problems.

Back ground Repair of truncus arteriosus represents a surgical challenge. Many technical modifications were added to improve the surgical outcome, decrease complications and decrease the incidence of re operations especially regarding the RV to PA connections with the consideration of absence or limited number of valved biological conduits in most of our centers in Egypt. Patients and methods Over the last six months 4 patients with TA type 1underwent total surgical repair with window like technique (without separation of the short main pulmonary trunk from the main trunk) and valveless RV to PA connection except one that was done using contegra due to severe PH as the patient was 6 months old. Results Early results of this limited number of patients’ reveals satisfactory results with no in hospital mortality, acceptable ICU and hospital stay and early post-operative echocardiographic study apart from clinically tolerated moderate PR. Conclusion Window like repair of TA and valveless RV to PA connection reveals satisfactory early outcome and considered as good alternatives for the classic techniques utilizing valved biological conduits especially when limited resources are obstacles for repair of this category of complex lesions.

The Austin Moore prosthesis is commonly used for displaced femoral neck fractures. In this study the rate of re-operation following Austin Moore hemiarthroplasty was studied. Ten out of 88 cases (11.36%) were re-operated on within the first year following the original operations. The indications for re-operation were infection (4.5%), dislocation (3.4%) and loose prosthesis (3.4%). The rate of infection found in this study was higher than other published series and could be attributed to the lack of laminar flow ventilation system and the use of cotton drapes and surgical gowns while performing these operations. We recommend that Austin Moore hemiarthroplasty should be carried out in theatres equipped with a laminar flow ventilation system and to use waterproof gowns and drapes to limit the number of deep infections and therefore lower the re-operation rate.

Comment in Journal of Oral and Maxillofacial Surgery Feb 2010, v. 68 n. 2, p. 442-446; Author's reply on 2011, v. 68 n. 11, p. 2925-2926

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Abstract #1014 Back ground :OSNA method, One-step Nucleic Acid Amplification(OSNA) method is a new method for rapid detection of axillary lymph node metastases of breast cancer using PCR to detect cytokeratin 19's mRNA and different from conventional hsitopathological examination. It can be automated and can detect the axillary lymph node metastases quickly and precisely during operation. No cost effectiveness studies are conducted for this method. Materials and Method: We conducted the cost effectiveness analysis for this method comparing with conventional hsitopathological method using Markov models. We adopted the societal perspectives and the time horizon for fives years. We used TreeAge Pro 2005 (TreeAge Software Inc, Williamsontown, MA) to conduct Markov simulations. One way sensitivities analysis were conducted for all parameters. Cost and utilities data were collected from the studies and clinical trials for OSNA and conventional methods. Results: When the cost of OSNA is assumed as the same as intra-operative lymph node diagnosis by histopathology, the Markov model has shown the cost saving of $11,527/QALY by OSNA method. When the sensitivity analysis was performed by changing the cost of OSNA, the result has shown that OSNA can still show cost saving until the cost of OSNA method is $1,094 higher than the hsitopathological examination. Discussion: Our results clearly revealed OSNA methods is cost saving compared with convention intraoperative hsitopathological examinations. Result is robust for all parameters included in the model. Since OSNA method can avoid unnecessary re operations for axillary lymphadenectomy, this method can improve the quality of life for breast cancer patients. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1014.

Over a period of 5 years, 55 re-operations with internal fixation were performed on 51 patients. The re-operations constituted 9.2 per cent of all operations employing internal fixation for subcapital fractures of the femur during that period. The indications for re-nailing were penetration of the nail through the femoral head, or slipping of the nail, with or without dislocation of the fracture. Only 26 per cent of the re-nailed fractures healed. Seventy-three per cent showed avascular necrosis and 61 per cent non-union.

Objective The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery. Background Hemorrhage is a significant complication after major gastrointestinal and abdominal surgery. Clinically significant bleeding can lead to shock, transfusion of blood products, and re-operation. Recent reports suggest that activated rfVIIa may be effective in correcting coagulopathy and decreasing the need for re-operation. Methods This study was a retrospective review over a 4-year period of 17 consecutive bleeding postoperative patients who received rfVIIa to control hemorrhage and avoid re-operation. Outcome measures were blood and clotting factor transfusions, deaths, thromboembolic complications, and number of re-operations for bleeding. Results Seventeen patients with postoperative hemorrhage following major abdominal gastrointestinal surgery (nine pancreas, four sarcoma, two gastric, one carcinoid, and one fistula) were treated with rfVIIa. In these 17 patients, rfVIIa was administered for 18 episodes of bleeding (dose 2,400-9,600 mcg, 29.8-100.8 mcg/kg). Transfusion requirement of pRBC and FFP were each significantly less than pre-rfVIIa. Out of the 18 episodes, bleeding was controlled in 17 (94%) without surgery, and only one patient returned to the operating room for hemorrhage. There were no deaths and two thrombotic complications. Coagulopathy was corrected by rfVIIa from 1.37 to 0.96 (p

As a rule, a patient who is not free of symptoms or who even complains of an aggravation of his condition after he has been operated on for a prolapse in the lumbar region will seek neurosurgical advice at a relatively early date. What is the prognosis if it is decided to perform a re-operation?

This communication reviews the surgical experience with re-operations performed for correction of extrahepatic biliary atresia upon 22 patients at the Children's Hospital National Medical Center between 1972 and 1978.