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

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

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

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

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

BACKGROUND: The breast reconstruction using implant has been conducted widely. Many studies were presented to analyze the complications, but most of these studies were conducted with patients relatively short term period follow up. The authors studied with patients who were followed up at least five years. METHODS: Among the patients who were underwent breast reconstruction with implant from 1998 to 2007, 37 patients who met were followed up more than 5 years were selected in the study. Relationships between factors such as the operation methods, volume, type of surfaces of the implants, etc. and the complication rate or reoperation rate were analyzed. The level of satisfactory scoring was measured by patients' and 5 plastic surgeons. RESULTS: Complications were developed in 21 patients (65.6%) and 9 of them underwent reoperations. Infection was most common cause of complication. Implant removal was conducted to 7 patients, and 5 of them due to infection. The percentages of patients who received postoperative chemotherapy or radiotherapy in complication group and implant removal group were higher than the whole group whereas such correlation was not statistically significant. Direct Implant insertion has 50% of complication and 80% in permanent expander insertion and 73.7% of expanderimplant exchange. The average value of subjective score at last follow up was 4.2 points and the average value of objective score was 5.74. CONCLUSIONS: The incidence rate of complications was relatively high, and the final followup satisfaction score was low. This study should be helpful not only to select reconstruction methods, but also further studies to compare with other reconstruction methods.
Breast* ; Drug Therapy ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Mammaplasty* ; Methods ; Radiotherapy ; Reoperation ; Tissue Expansion

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

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

OBJECTIVETo analyze the short-term outcomes of redo coronary artery bypass grafting (CABG) using on-pump and off-pump CABG techniques.

METHODSFrom January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique (redo-ONCAB group) and 40 underwent off-pump CABG technique (redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc.

RESULTSThere were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group (all P>0.05), except for incidences of renal dysfunction and pulmonary disease (all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups (P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time (P=0.0045), postoperative ventilation (P=0.0211) and intensive care unit stay (P=0.0400), as well as fewer use of platelet (P=0.0338) and blood transfusion (P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization (P=0.0253) and the use of transmyocardial laser revascularization (P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group (all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups (all P>0.05).

CONCLUSIONRedo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.

Aged ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reoperation

PURPOSE: We reviewed the clinical features of intermittent exotropic patients who experienced recurrence after reoperation for intermittent exotropia, and identified the risk factors and prognoses. METHODS: The incidences, risk factors, treatment modalities, and prognoses of patients with recurrent exotropia were analyzed in 39 patients who underwent reoperation due to a relapse of exotropia after the first intermittent exotropia. RESULTS: Among 39 patients, 24 (61.5%) had recurrent intermittent exotropia and 15 patients had no recurrence with intermittent exotropia. There was no difference in the recurrence of intermittent exotropia with age, deviation, refraction, anisometropia, outward discrepancy, and the vertical deviation before the reoperation. However, when the first operation was performed with bilateral lateral rectus recession and the reoperation was performed with bilateral medial rectus resection or unilateral medial rectus resection, intermittent exotropia tended to recur more than when the first operation was performed with one eye with lateral rectus recession and medial rectus resection, followed by reoperation with the other lateral rectus recession and medial rectus resection (p < 0.05). In addition, an esodeviation <10 prism diopters, orthophoria, or exotropia on the first postoperative day showed a tendency to relapse more than an esodeviation >10 prism diopters (p < 0.05). CONCLUSIONS: The factors affecting recurrence after intermittent exotropia surgery involve surgical factors such as the surgical method and the postoperative overcorrection.
Anisometropia ; Esotropia ; Exotropia* ; Humans ; Incidence ; Methods ; Prognosis ; Recurrence ; Reoperation* ; Risk Factors