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

Manuel Lim,Jinsoo Rhu,Sang Jin Kim,Seohee Lee,Gyu Seong Choi,Jae Won Joh 대한이식학회 2019 Korean Journal of Transplantation Vol.33 No.4

Background: Patients 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. Methods: We performed a retrospective analysis of 506 patients who underwent LDLT at Samsung Medical Center in Seoul between 2010 and 2016. Results: Among 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). Conclusions: Our 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.

요도하열 재수술 환자에서 Tubularized Incised Plate 요도성형술의 성적 및 영향 인자들

하홍구,이상돈 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.1

Purpose: We retrospectively evaluated the outcome and risk factors of tubularized incised plate(TIP) urethroplasty in patients with reoperative hypospadias repairs. Materials and Methods: Thirty-nine patients with reoperative hypospadias repairs by the TIP method were evaluated. The meatal location, interval between prior urethroplasty and reoperation, length from meatus to penile tip, coexistence of chordee, type of prior urethroplasty, shape of glans, scarring on urethral plate, times of prior urethroplasty, and complications were reviewed. We also evaluated the outcome of reoperative hypospadias repairs and the relationships between these factors and outcomes. Results: The mean age of the patients was 47.7±77.9 months(range: 5-384 months) at prior urethroplasty and 92.7±115.6 months(12-480 months) at reoperative urethroplasty, and the mean follow-up duration was 54.2±90.5 months(6-443 months). Complications at prior urethroplasty included urethrocutaneous fistula in 18 patients, wound dehiscence in 9, meatal stenosis in 5, persistent chordee in 5, and urethral diverticulum in 3. Complications at TIP reoperation were urethrocutaneous fistula and wound dehiscence in 11 and 4 patients, respectively(complication rate: 38.5%). Older age at the time of the repeat urethroplasty, long urethral defect, and scarring in the urethral plate at reoperation were related with poor outcomes in reoperative urethroplasty. Conclusions: TIP urethroplasty for reoperative hypospadias repair can result in good cosmetic and functional outcomes. However, caution is necessary in patients of old age or with a long urethral defect and scarring at the urethral plate at reoperation. Purpose: We retrospectively evaluated the outcome and risk factors of tubularized incised plate(TIP) urethroplasty in patients with reoperative hypospadias repairs. Materials and Methods: Thirty-nine patients with reoperative hypospadias repairs by the TIP method were evaluated. The meatal location, interval between prior urethroplasty and reoperation, length from meatus to penile tip, coexistence of chordee, type of prior urethroplasty, shape of glans, scarring on urethral plate, times of prior urethroplasty, and complications were reviewed. We also evaluated the outcome of reoperative hypospadias repairs and the relationships between these factors and outcomes. Results: The mean age of the patients was 47.7±77.9 months(range: 5-384 months) at prior urethroplasty and 92.7±115.6 months(12-480 months) at reoperative urethroplasty, and the mean follow-up duration was 54.2±90.5 months(6-443 months). Complications at prior urethroplasty included urethrocutaneous fistula in 18 patients, wound dehiscence in 9, meatal stenosis in 5, persistent chordee in 5, and urethral diverticulum in 3. Complications at TIP reoperation were urethrocutaneous fistula and wound dehiscence in 11 and 4 patients, respectively(complication rate: 38.5%). Older age at the time of the repeat urethroplasty, long urethral defect, and scarring in the urethral plate at reoperation were related with poor outcomes in reoperative urethroplasty. Conclusions: TIP urethroplasty for reoperative hypospadias repair can result in good cosmetic and functional outcomes. However, caution is necessary in patients of old age or with a long urethral defect and scarring at the urethral plate at reoperation.

The impact of unplanned reoperations in head and neck cancer surgery on survival

Choi, Nayeon,Park, Song I,Kim, Hyeseung,Sohn, Insuk,Jeong, Han-Sin Elsevier 2018 Oral oncology Vol.83 No.-

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>Unplanned reoperation causes physical and psychological stress in patients and it costs more in terms of medical, economic and social resource. The purpose of the study was to evaluate the incidence, risk factors and clinical significance of unplanned reoperation (any unscheduled surgery within 30 days from the initial surgery) in patients who had undergone head and neck cancer (HNC) surgery.</P> <P><B>Materials and methods</B></P> <P>A total of 574 consecutive patients who had received surgery for HNC with or without flap reconstruction from 2010 to 2015 were analyzed. Clinical and biochemical characteristics, cause of unplanned reoperation, cancer subsites, and previous treatment history were compared between unplanned reoperation group (n = 60) and control group (n = 514). Multivariable analyses were performed to identify risk factors for unplanned reoperation. Clinical significance was evaluated by multivariable survival analyses using Cox proportional hazard model.</P> <P><B>Results</B></P> <P>Overall rate of unplanned reoperation was 10.5%. Flap complication (40.0%) was the most common cause, followed by infection (16.7%), necrosis (11.7%), and bleeding (8.3%). Higher N (N2) classification, long operation time and previous treatment before surgery were identified as risk factors for unplanned reoperation. Based on multivariable survival analyses, recurrence-free survival was significantly decreased in unplanned reoperation group (Hazard ratio = 1.85, 95% confidence interval [1.23–2.80]), but not overall survival.</P> <P><B>Conclusion</B></P> <P>Unplanned reoperation significantly decreased recurrence-free survival in patients with HNC surgery. Thus, careful surgical/ perioperative management is needed to reduce unplanned reoperation in HNC patients with advanced nodal disease, long operation time or previous treatment history.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Unplanned reoperation (UR) causes physical and psychological stress in patients. </LI> <LI> Advanced nodal disease was a risk factor for UR in head & neck cancer (HNC) surgery. </LI> <LI> Long operation and previous treatment also increased risk for UR in HNC surgery. </LI> <LI> UR in HNC surgery itself resulted in worse recurrence-free survival in HNC patients. </LI> <LI> Thus, careful management is needed to reduce UR in HNC patients with risk factors. </LI> </UL> </P>

인공 심장판막의 재치환술 -수술 위험인자와 수술 결과의 분석-

김관민 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.1

From January 1985 to December 1992, of 1257 patients who underwent a heart valve replacement 210 [16.8% underwent reoperation on prosthetic heart valves, and 6 of them had a second valve reoperation. The indications for reoperation were structural deterioration [176 cases, 81.5% , prosthetic valve endocarditis [25 cases, 11.6% , paravalvular leak [12 cases, 5.6% , valve thrombosis [2 cases, 0.9% and ascending aortic aneurysm [1 case, 0.4% . Prosthetic valve failure developed most frequently in mitral position [57.9% and prosthetic valve endocarditis and paravalvular leak developed significantly in the aortic valve [40%, 75% [P<0.02 . Mean intervals between the primary valve operation and reoperation were 105.3$\pm$28.4 months in the case of prosthetic valve failure, 61.5$\pm$38.5 months in prosthetic valve endocarditis, 26.8$\pm$31.2 months in paravalvualr leak, and 25.0$\pm$7.0 months in valve thrombosis. In bioprostheses, the intervals were in 102.0$\pm$23.9 months in the aortic valve, and 103.6$\pm$30.8 months in the mitral valve. The overall hospital mortality rate was 7.9% [17/26 : 15% in aortic valve reoperation [6/40 , 6.5% in reoperation on the mitral prostheses [9/135 and 5.7% in multiple valve replacement [2.35 . Low cardiac output syndrome was the most common cause of death [70.6% . Advanced New York Heart Association class [P=0.00298 , explant period [P=0.0031 , aortic cross-clamp time [P=0.0070 , prosthetic valve endocarditis [P=0.0101 , paravalvularr leak [P=0.0096 , and second reoperation [P=0.00036 were the independent risk factors, but age, sex, valve position and multiple valve replacement did not have any influence on operative mortality. Mean follow up period was 38.6$\pm$24.5 months and total patient follow up period was 633.3 patient year. Actuarial survival at 8 year was 97.3$\pm$3.0% and 5 year event-free survival was 80.0$\pm$13.7%. The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, so reoperation before severe hemodynamic impairment occurs is recommended.

Complications Leading Reoperation after Gastrectomy in Patients with Gastric Cancer: Frequency, Type, and Potential Causes

이하우,김성,김수미,김상현,심정호,최민규,이준호,노재형,손태성,배재문 대한위암학회 2013 Journal of gastric cancer Vol.13 No.4

Purpose: Reoperations after gastrectomy for gastric cancer are performed for many types of complications. Unexpected reoperations may cause mental, physical, and financial problems for patients. The aim of the present study was to evaluate the causes of reoperations and to develop a strategic decision-making process for these reoperations.Materials and Methods: From September 2002 through August 2010, 6,131 patients underwent open conventional gastrectomy operationsat Samsung Medical Center. Of these, 129 patients (2.1%) required reoperation because of postoperative complications. We performed a retrospective analysis of the patients using an electronic medical record review. Statistical data were analyzed to compare age, sex, stage, type of gastrectomy, length of operation, size of tumor, and number of lymph node metastasis between patients who had been operated and those who had not.Results: The variables of age, sex, tumor stage, type of gastrectomy, length of operation, and number of lymph node metastases did not differ between the 2 groups. However, the mean tumor size in the reoperation group was greater than that in the non-reoperation group (5.0±3.7 [standard deviation] versus 4.1±2.9, P=0.007). The leading cause of reoperation was surgical-site infection (n=49, 0.79%). Patients with intra-abdominal bleeding were operated on again in the shortest period after the initial gastrectomy (6.3±4.2 days). Patientswith incisional hernia were not reoperated on until after 208.3±81.0 days, the longest postoperative period.Conclusions: Tumor size was the major variable leading to reoperation after gastrectomy for gastric cancer. The most common complicationrequiring the reoperation was a surgical site-related complication.

담도계 재수술의 임상고찰 - 담석증을 중심으로 -

박용현(Yong Hyun Park),김선회(Sun Whe Kim),장이찬(Lee Chan Jang),허윤석(Yoon Seok Hur) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3

N/A Biliary tree has anatomical and pathophysiological features liable to reoperation. The reoperative rate has been reported 4,1% to 25%, which is higher cornpared to that of Western countries. It has been suggested that the high reoperative rate in our country is related to the high incidence of intrahepatic duct stones, pigment stones and parasites. To investigate clinical features of the reopertive biliary surgery, we reviewed the patients who underwent reoperation on biliary tree for benign diseases especially gallstone disease. The results are as follows; Among the 1,018 biliary operation cases, 130 reoperations (12.8%) were performed from January 1987 to December 1991. The reasons of reoperation were recurrent stone 54.6%, remant stone 32.3% and stricture 4.6%. The mean interval between first operation and reoperation was 7 years and 17 cases received 3 operations, 3 cases 4 operations, 1 case 5 operations. The ratio of reoperation according to the site of the stone in first operation were 9. 1%, 22.9% and 61.7% for GB stone, CRD stone and IHD stone respectively. The patients who underwent reoperative biliary surgery, recieved first biliary operation at younger age, had more female predominance, and higher proportion of pigment and IHD stone, compared to those who did not need reoperation. Reoperative biliary surgery is related to prolonged operativc time, larger amount of transfusion and higher operative morbidity. In conclusion, since reoperative biliary surgery is related to high morbidity, we should try to lower the rate of residual stone and find the measures to prevent recurrent stone and avoid operative injury possibly causing biliary stricture.

Complications Leading Reoperation after Gastrectomy in Patients with Gastric Cancer: Frequency, Type, and Potential Causes

Yi, Ha Woo,Kim, Su Mi,Kim, Sang Hyun,Shim, Jung Ho,Choi, Min Gew,Lee, Jun Ho,Noh, Jae Hyung,Sohn, Tae Sung,Bae, Jae Moon,Kim, Sung The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.4

Purpose: Reoperations after gastrectomy for gastric cancer are performed for many types of complications. Unexpected reoperations may cause mental, physical, and financial problems for patients. The aim of the present study was to evaluate the causes of reoperations and to develop a strategic decision-making process for these reoperations. Materials and Methods: From September 2002 through August 2010, 6,131 patients underwent open conventional gastrectomy operations at Samsung Medical Center. Of these, 129 patients (2.1%) required reoperation because of postoperative complications. We performed a retrospective analysis of the patients using an electronic medical record review. Statistical data were analyzed to compare age, sex, stage, type of gastrectomy, length of operation, size of tumor, and number of lymph node metastasis between patients who had been operated and those who had not. Results: The variables of age, sex, tumor stage, type of gastrectomy, length of operation, and number of lymph node metastases did not differ between the 2 groups. However, the mean tumor size in the reoperation group was greater than that in the non-reoperation group ($5.0{\pm}3.7$ [standard deviation] versus $4.1{\pm}2.9$, P=0.007). The leading cause of reoperation was surgical-site infection (n=49, 0.79%). Patients with intra-abdominal bleeding were operated on again in the shortest period after the initial gastrectomy ($6.3{\pm}4.2$ days). Patients with incisional hernia were not reoperated on until after $208.3{\pm}81.0$ days, the longest postoperative period. Conclusions: Tumor size was the major variable leading to reoperation after gastrectomy for gastric cancer. The most common complication requiring the reoperation was a surgical site-related complication.

Frequency of reoperation in patients who underwent breast reconstruction using Allergan implants after an interview about breast implant-associated anaplastic large cell lymphoma

이재우,김승현,김민욱,정대균,배성환,김현율,정윤주,주기석,남경진,남수봉 대한미용성형외과학회 2022 Archives of Aesthetic Plastic Surgery Vol.28 No.2

Background In recent years, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has emerged as an important concern. At our institution, patients who received breast reconstruction using Allergan implants were informed individually about BIA-ALCL. The present study analyzed correlations between patients’ level of satisfaction with their breast shape and whether they chose to undergo reoperation (implant removal or replacement). Methods Breast reconstruction with Allergan implants was performed between December 2014 and April 2018. In total, 107 patients were interviewed, excluding those who had died, were unreachable, or had already undergone reoperation. The mean follow-up period was 53 months (range, 26–73 months). Results After the interviews, 68 patients postponed reoperation, 29 had their implant replaced, and 10 had their implant removed. Nearly one-fifth (18.9%) of patients who were satisfied with their breast shape (13 out of 69) underwent reoperation due to anxiety over ALCL. Meanwhile, 68.4% of patients who were not satisfied due to capsular contracture or scar contracture (26 out of 38) underwent reoperation. Sixteen of the 30 patients who received postoperative radiotherapy (53.3%) chose to undergo reoperation. Conclusions Satisfaction with the cosmetic outcomes of implant placement played a meaningful role in patients’ decisions to undergo reoperation. This tendency may be linked to postoperative radiotherapy, which is a major contributor to complications such as contracture. Nonetheless, a substantial proportion of patients who were satisfied with the outcomes chose to undergo reoperation due to concerns regarding ALCL.

소아시기에 사시수술을 받은 후 재수술한 환자의 임상 분석

김연희,최미영,Youn Hui Kim,M,D,Mi Young Choi,M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.6

Purpose: To report the clinical characteristics of patients undergoing reoperation after strabismus surgery during childhood. Methods: Sixty-one patients who had undergone strabismus surgery in childhood and later reoperation were included. Age, visual acuity, type of strabismus at the first and second operations and postoperative angle of deviation were analyzed. The causes of reoperation were classified into recurrent, consecutive, or newly developed strabismus. Recurrent strabismus was defined as strabismus developed in the same direction after correction within 10 prism diopters (PD). Consecutive strabismus was defined as strabismus developed in the opposite direction after surgical overcorrection. Results: The mean duration between the first operation and reoperation was 5.6 years. Recurrent exotropia was the most common cause of reoperation. The incidence of vertical strabismus was higher in reoperations than in first operations (4.9 vs 26.2%, P=0.020). Most incidences of vertical strabismus in the reoperation were newly developed after first operation for horizontal strabismus. At the last follow-up, 63.9% had ocular alignment within 10PD in the horizontal plane and within 8PD in the vertical plane. The frequency of amblyopia was 16.4%. Conclusions: Recurrent exotropia was the most common cause of reoperation for strabismus. The incidence of vertical strabismus was higher in reoperations than in first operations.

Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-α Antibody Use: 35 Years of Experience at a Single Institute in Korea

이상목,한언철,유승범,오흥권,최은경,문상희,김주성,정현채,박규주 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.4

Purpose: Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-α (anti-TNF-α) antibody use, and long-term follow-up results. Methods: We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors. Results: The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-α antibody use did not affect the reoperation rate (P = 0.767). Conclusion: We showed a high reoperation rate regardless of treatment with anti-TNF-α antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.