Reoperation

Definition

Reoperation is a term used by surgeons for the duplication of a surgical procedure. Repeating surgery may involve surgery at the same site, at another site for the same condition, or to repair a feature from a previous surgery.

Purpose

Success for most surgical procedures depends, in large part, upon the lack of a need to repeat the surgery. However, failure of some feature of a procedure may be only one of many reasons that reoperation is necessary. Reasons for repeat surgery depend upon surgical skills, as well as the reason for the primary surgery. Some diseases and conditions necessitate or make probable repeating the operation.

Cancer

Surgeries for cancer are sometimes repeated because a new tumor or more surrounding tissue has been affected by the original malignancy. This is often the case with breast surgery for cancer that involves breast conservation management. Often it is necessary to re-excise the site of the previously bioped primary cancer. In the case of breast cancer, only 50% of re-excision specimens show residual tumors. If cancer cells are found with the re-excision, this may change the treatment protocol. Colon cancer sometimes involves more surgeries to resect newly affected areas beyond the previous primary site.

Coronary artery surgery

Currently, about 10% of coronary artery procedures are reoperations due to the progression of the disease into native vessels between operations, as well as to treat diseased vein grafts. The mortality associated with reoperation is significantly higher than that of the original bypass procedures. In one study, patients undergoing their first coronary artery bypass graft (CABG) had a mortality rate of 1.7% versus 5.2% for elective reoperation.

Orthropedic surgeries

Arthroplasty—the operative restoration of a joint like the elbow, knee, hip, or shoulder, often involve components that need to be repaired. Infections of the joint may also require reoperation with the complete removal of all prostheses and cement. Re-implantation is repeated after a six-week course of antibiotics. Other bone surgeries that have a high reoperation rate are back surgeries, including spinal surgeries involving discectomy in which discs are fused together to reduce pain. Due to scaring or infection, there may be a need for reoperation. As the frequency of repeat back surgeries increases, the chance of a satisfactory result drops precipitously.

Gastrointestinal surgeries

Crohn's disease surgeries are often repeated. Operations that cut and stitch only the area of obstruction, called strictureplasty, often have repeat operations if the affected area is the small intestine. Another gastrointestinal surgery that often requires reoperation is fundoplication or flap wrapping of the lower part of the esophagus to prevent the reflux of acid from the stomach back into the esophagus. Folding the loose valve that had prevented reflux in such a way as to tighten its ability to close treats a condition known as gastroesophageal reflux disease (GERD). The surgery has a high failure rate of between 30% after five years and 63% after 10 years. Reoperation may be required because of surgical failure, breakdown of tissue, injury to nearby organs, or an excessively wrapped fundus leading to trouble swallowing.

Vasectomy and penile prostheses

These surgeries often have complications that lead to reoperation, largely due to surgical failure.

Normal results

In general, reoperation, or the repeat of a surgical procedure at the same site, is more difficult and involves more risks that the original procedure. It requires more operative time; more blood is lost; and the incidences of infection and clots are higher. Advancements in design and improvements in cementing techniques for component failure in arthroplasty have improved the results of reoperation.

OTHER

"Gastroesophageal Reflux Disease and Heartburn." MD Consult <http://www.MDConsult.com.>.

"Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis)." MD Consult <http://www.MDConsult.com.>.

"Vasectomy and Vasovasotomy: Comprehensive Version." MD Consult <http://www.MDConsult.com.>.

Nancy McKenzie, PhD