When a revision surgery related with removal of failed interbody cage is required, going through the previous passage can lead to a higher risk of neurological deficits or incidental dural injuries. Recently, the lateral approach has become a popular method instead of the conventional anterior or posterior approaches. The lateral approach is also useful method to remove failed interbody cage previously placed and re-do interbody fusion with lower risks compared to revision surgery via previous passage. However, there is still some difficulty in retrieving the interbody cage from the intervertebral space because of no spacious passage, subsidence, and uncontrolled movable cage. In this study, we introduce our experience that we removed failed interbody cage more easily with only the simple additional steps of making a taphole and fixing the cage using a thread-tipped stick.
Device Removal ; Methods ; Reoperation

For undercorrected esotropia after bilateral medial rectus(MR) recession, we performed unilateral or bilateral MR rerecession, unilateral rerecession or marginal myotomy of the recessed medial rectus muscle combined with lateral rectus(LR) resection, or unilateral LR resection. The correction of deviation was 15 delta in unilateral 2.0mm MR rerecession. Bilateral 2.0mm MR rerecession corrected 20 to 25 delta of esodeviation, but undercorrection was noted in one case. With unilateral 2.0mm rerecession or marginal myotomy of the recessed medial rectus muscle combined with 5.5mm or 8.0mm LR resection, the correction of deviation was 26 to 29 delta, and there was no under- or overcorrection. The corrective effect of this procedure was therefore greater and more stable than that of bilateral 2.0mm MR rerecession. Unilateral 8.0mm LR resection performed 3 months after bilateral MR recession showed correction of 15 delta, whereas the same procedure performed 3 weeks after bilateral MR rerecession showed correction of 24 delta. Unilateral LR resection procedure seems to be more efficacious for residual esotropia if performed as soos as possible within 3 months after sufficient bilateral MR recession or rerecession.
Esotropia* ; Methods ; Reoperation

Over the past several decades, liver transplantation has experienced remarkable advances in surgical techniques, including venovenous bypass, piggyback method without venovenous bypass, piggyback method with cavaplasty, living-related liver transplantation, splitting liver transplantation, cluster organ transplantation, and liver retransplantation. Based on his experience on 582 case of liver transplantation, the author reviews these techniques and discusses their advantages and disadvantages.
Humans ; Liver Transplantation ; methods ; trends ; Living Donors ; Reoperation

We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.
Cadaver ; Kidney Transplantation/*methods ; Postoperative Complications ; Reoperation ; Replantation ; Ureter/*surgery

BACKGROUNDSevere acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.

METHODSThis study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky IIC, 6 were IIIA, and 4 were IIIB. The mean age at the time of surgery was 63.0 years (range, 46 - 78 years). During revision surgery, a reinforcement ring was implanted in 6 patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9 - 71 months).

RESULTSThe average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit. The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes, debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification, aseptic loosening, or infection.

CONCLUSIONReconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.

Acetabulum ; surgery ; Aged ; Bone Transplantation ; methods ; Female ; Hip ; surgery ; Humans ; Male ; Middle Aged ; Reoperation ; methods

OBJECTIVETo summarize the experience of liver retransplantation for patients with poor graft function.

METHODSThe clinical data of 9 patients undergone liver retransplantation at our center from April 1993 to April 2005 were retrospectively analyzed. The main indications for liver retransplantation at our center were early hepatic artery thrombosis (2/9), early portal vein thrombosis (1/9), and biliary tract complication (6/9). Of the 9 patients received liver retransplantation with cadaveric allografts, 3 received classic orthotopic liver transplantation, and 6 piggyback liver transplantation. Roux-en-Y biliary tract reconstruction was performed in 6 patients, Donor spleen vein was used as a conduit between donor portal vein and recipient portal vein in 1, and donor spleen artery as a conduit between donor hepatic artery and recipient aorta in 1.

RESULTSNo perioperative mortality occurred. Of them, 5 had no complications after the operation, 1 had stricture in anastomotic stoma of portal vein, and 3 died in 6 months after the operation.

CONCLUSIONSPoor graft function due to biliary tract complications and vessel complications after primary liver transplantation are the chief indications of liver retransplantation. Liver retransplantation is the only suitable treatment of poor graft function.

Adult ; Female ; Humans ; Liver Transplantation ; methods ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Time Factors ; Transplantation, Homologous

OBJECTIVEAugmentation rhinoplasty is a commonly procedure in clinical work for a plastic surgeon. Autologous costal cartilage is widely used in aesthetic rhinoplasy because of the abundant in quality. However, the cartilage may warp, and it is not easy-handling for inexperienced plastic surgeons. We-used diced cartilage combined with thin strips as columellar struts, which can be easily shaped, and reduce the warping incidence.

METHODSFrom July 2012 to March 2014, 61 patients were performed diced costal cartilage for nasal augmentation via endonasal approach. Standardized photographs are obtained before and after surgery. Postoperative outcome is graded by patient's self-evaluation of the nasal appearance with a satisfaction scale.

RESULTSAmong the 61 cases, 25 were revision cases. The follow-up time was no less than 6 months, with an average time of 10.9 months. 28 patients reported improved or better nasal appearance. One patient required revision surgery because of overcorrection. Supratip step-off was observed in one patient and corrected by external reshaping. No warping, infection, irregularity, absorption, airway obstruction, or donor-site morbidity were observed. All patients were satisfied with the final appearance.

CONCLUSIONSDiced costal cartilage is a reliable option for nasal augmentation and revision rhinoplasty. Good outcomes can be achieved postoperatively, with aesthetically pleasing appearance and simple procedure.

Costal Cartilage ; transplantation ; Esthetics ; Humans ; Nasal Septum ; Reoperation ; Retrospective Studies ; Rhinoplasty ; methods

The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Classification ; Hip ; Hip Prosthesis ; Life Expectancy ; Methods ; Reoperation ; Transplants

PURPOSE: The purpose of this study is to evaluate the efficacy of the trochanter reattachment device (TRD) as a firm internal fixation method for bipolar hemiarthroplasty in unstable intertrochanteric femur fracture for elderly patients over 65 years old. MATERIALS AND METHODS: From September 2010 to April 2011, 19 patients (M/F: 1/18) over 65 years old were treated with bipolar hemiarthroplasty using the TRD as a fixation method for intertrochanteric femur fracture with above Evans-Jensen classification 2nd (above AO/OTA A1.3). They were followed up for more than 12 months(12-29 months). RESULTS: Out of 19 patients, only one had loosening of the TRD plate and reoperation was performed. There was no dislocation after surgery. Complete fracture union was observed in 19 patients with follow up of more than 12 months. CONCLUSION: In bipolar hemiarthroplasty for intertrochanteric femur fracture, TRD produced easy and firm fixation. Additional fixation with TRD restoring abduction force by union of greater trochanter can be a good choice of surgery for avoidance of dislocation and chronic pain due to trochanteric nonunion after arthroplasty.
Aged* ; Arthroplasty* ; Chronic Pain ; Classification ; Dislocations ; Femur* ; Follow-Up Studies ; Hemiarthroplasty ; Hip Dislocation ; Humans ; Methods ; Reoperation

BACKGROUND: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. METHODS: In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. RESULTS: The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). CONCLUSION: The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.
Brachial Plexus ; Hemothorax ; Humans ; Intraoperative Complications ; Methods ; Pneumothorax ; Prevalence ; Reoperation ; Retrospective Studies ; Thoracic Outlet Syndrome*