Interphalangeal fixation of the thumb in Moberg's key grip procedure

A follow-up of Moberg's key grip procedure was performed to evaluate the adequacy of interphalangeal joint stabilization of the thumb by means of two methods of percutaneous pin fixation. Five of 16 patients in whom a single, smooth, 2 mm Kirschner wire had been used showed significant complications as a result of distal migration. None of the seven patients who had fixation with a specially designed, 3.2 mm, threaded, slotted pin had any complications.     

Long-term follow-up after the mini-maze procedure

BACKGROUND: Atrial fibrillation (AF) is associated with significant morbidity and mortality. The standard to treat AF surgically is the Cox maze III procedure but owing to its complexity it is not performed on a regular basis. Meanwhile several maze variants have been developed but their long-term results are still not well known. METHODS: From November 1995 until May 2002 a mini-maze procedure was performed upon 77 patients aged 64 +/- 8.7 years with chronic symptomatic AF. Electrophysiological evaluation, magnetic resonance imaging, echocardiography and electrocardiographic evaluations were performed after 3 and 12 months. After a mean follow-up of 50 +/- 2.6 months a standard questionnaire was sent to all patients. RESULTS: Early and late mortality was 1.2% and 9.3% respectively. Actuarial survival was 91%, 90%, and 87% after 1, 3, and 5 years respectively. Left bundle branch block was an independent risk factor for late death (p = 0.02). Patients who were in sinus rhythm at follow-up had significantly better survival rate as compared with the patients still in AF. Seventy-one percent of patients were in sinus rhythm or paced by an atrial pacemaker. Predictors for restoration of sinus rhythm were absence of preoperative mitral insufficiency (p = 0.03) and larger left atrium (p = 0.04). The presence of preoperative tricuspid insufficiency (p = 0.03) and larger right atrium (p = 0.017) were predictors for postoperative pacemaker implantation. CONCLUSIONS: The mini-maze procedure can be carried out with satisfactory early and long-term results regarding mortality and restoration of sinus rhythm. Prophylactic implantation of biventricular pacemakers in patients with left bundle branch block may decrease late mortality. Every effort should be done to cure AF as it affects long-term survival.     

Long-term follow-up of the one-bone forearm procedure

The one-bone forearm procedure can be a successful salvage option for forearm stability in selected patients and is indicated if instability and bone loss are irreparable by other means. We report a case of a dysfunctional arm secondary to radical débridement of the ulna after osteomyelitis treated successfully with a one-bone forearm procedure and followed up for 8 years.     

Long-term follow-up of Lord's procedure for haemorrhoids

86 Patients treated for first or second degree haemorrhoids by Lord's manual dilatation of the anus were followed up for a mean period of 7.2 years. The outcome in the 76 patients traced was satisfactory or good in 76.3%. In only 14.5% was the result unsatisfactory. Lord's anal dilatation is a relatively simple procedure; the results of this study show that it gives good long-lasting results.     

The use of the key grip procedure for improving hand function in quadriplegia

Reconstruction of the quadriplegic hand can give marked functional improvement. In 1975 the key grip procedure was introduced on the Spinal Injuries Unit at Rancho Los Amigos Hospital. Twenty of the first twenty-four cases operated on have obtained a useful improvement, and the reasons for the four failures are readily seen. In correctly cases the key grip procedure is of benefit to the patient and complications are relatively minor.     

Long-term follow-up of the retropubic tension-free vaginal tape procedure

Introduction and hypothesis

Retropubic tension-free vaginal tape (TVT) was introduced in 1996 as a new and innovative surgical approach in the treatment of stress urinary incontinence (SUI). In this study we evaluate the long-term objective and subjective outcomes in a non-selected patient population 10 years after the retropubic TVT procedure.

Methods

All women (603) operated on with retropubic TVT at four gynecological departments from September 1998 through December 2000 were identified, and those still alive (542) were invited to participate in this population-based prospective study. For subjective data a short-form urinary incontinence disease-specific questionnaire was used. For objective evaluation the women underwent a stress test. Data collected were merged with previously stored data in the Norwegian National Incontinence Registry Database.

Results

We included 483 women; 327 attended a clinical follow-up consultation and 156 had a telephone interview. Median duration of follow-up was 129 months. Objective cure rate was 89.9 %, subjective cure rate was 76.1 %, and 82.6 % of the patients stated they were “very satisfied” with their surgery (treatment satisfaction rate). Only 2.3 % of the women had undergone repeat SUI surgery. Subjective voiding difficulties were reported by 22.8 %, the majority describing slow stream or intermittency. De novo urgency incontinence increased significantly from 4.1 % 6–12 months after surgery to 14.9 % at the 10-year follow-up.

Conclusions

Long-term objective and subjective outcome after retropubic TVT is excellent with a low number of re-operations even in a non-selected cohort of patients.     

Long-term follow-up of the modified Delorme procedure for rectal prolapse

HYPOTHESIS: The modified Delorme operation is a safe, effective, and durable treatment for complete rectal prolapse. DESIGN: Retrospective analysis of outcomes in adult patients undergoing the modified Delorme operation. SETTING: Community-based tertiary referral center with a 5-year general surgery residency program. PATIENTS: A total of 52 consecutive patients undergoing surgery for the treatment of complete rectal prolapse during the 26-year period ending December 2001. INTERVENTIONS: Modified Delorme operation.Main Outcomes Measured Method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. RESULTS: In the 52 patients, the mean length of prolapse was 8.2 cm. The mean operating time was 75 minutes. Forty-five patients were administered general anesthesia, 4 were administered spinal anesthesia, and 3 were administered local anesthesia. The mean postoperative stay was 4.9 days for 1975 through 2001 and 2.8 days for 1990 through 2001. No patients died as a result of the procedure. Patients were followed up for 61.4 months. Major medical comorbidities occurred in 40 patients. Preoperative incontinence was present in 12 patients, 10 of whom improved after the procedure, and postoperative incontinence in 8. The recurrent postoperative prolapse rate at 5 years was 6% (3/52) and the recurrent postoperative prolapse rate to the end of the study was 10% (5/52). Two patients (4%) had complications that required operative intervention in the postoperative period. CONCLUSIONS: The modified Delorme operation is a safe and effective surgical treatment for complete rectal prolapse. The risk of recurrent prolapse is low, and the procedure may be safely performed in patients with significant medical comorbidities.     

Long-term follow-up of the Vineberg internal mammary artery implant procedure.

This report describes the 20-year follow-up of a patient who had undergone a double internal mammary implantation for coronary occlusive disease. A lack of similar reports in the literature suggests that such survival is rare, but this case indeed documents the fact that the internal mammary arteries can revascularize the myocardium, and this patient's continued survival appears to depend entirely on this collateral blood flow.     

Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy

Purpose

To assess the long-term results of anterior cervical discectomy and fusion using the Cloward procedure for the treatment of cervical spondylotic myelopathy, and to identify possible clinical outcome predictors.

Methods

A total of 14 cases with a 10-year postoperative follow-up were available (82.4 % of the surviving patients). Patients underwent preoperative and postoperative neurological examination. The symptom severity was graded according to the Nurick scale. MRI measurements were obtained preoperatively. Cervical spine radiographs were obtained preoperatively and at the time of follow-up.

Results

The mean improvement of the clinical status of patients on the Nurick scale was 1.43 ± 0.51 (range 1–2) with respect to the baseline values (p < 0.001), with a 62.5 % recovery rate. A positive association between the improvement of the Nurick scale and the length of follow-up was detected with an age-adjusted univariate analysis (p = 0.042). The Nurick grade improvement was also directly related to preoperative lower limb hyperreflexia (p = 0.039), spasticity (p = 0.017), and bladder dysfunction (p = 0.048). At the time of follow-up, an adjacent discopathy was noted above and below the operated level(s) in eight and six patients, respectively.

Conclusions

The Cloward technique is a safe and effective procedure for the treatment of cervical spondylotic myelopathy. The patients’ preoperative neurological status and the length of follow-up affect the grade of postoperative ambulatory improvement.     

Long-term follow-up study of the Stretta procedure for the treatment of gastroesophageal reflux disease

Background The endoscopic delivery of temperature-controlled radiofrequency energy to the gastroesophageal junction (Stretta procedure) recently has been shown effective for patients with gastroesophageal reflux disease (GERD). However, its effectiveness has been assessed mainly over short periods (6–12 months). This study aimed to evaluate long-term results of the Stretta procedure.Methods All patients undergoing the Stretta procedure since August 2000 were prospectively evaluated under an institutional review board–approved protocol. All patients with a follow-up period longer than 18 months were recruited for a 24-h pH study and mailed a follow-up survey, which included the following: Short Form 12 (SF-12) health status questionnaire, GERD-specific quality-of-life questionnaire (QOLRAD), and queries regarding long-term satisfaction and medication use.Results The Stretta procedure was performed on 82 patients, and 41 patients with a follow-up period longer than 18 months qualified for the study. Follow-up surveys were completed by 36 patients (88%) during a mean follow-up period of 27.1 ± 3.7 months. Of these 36 patients, 30 (83%) were highly satisfied with the procedure and would have it performed again. More than half of the Fifty Stretta patients (56%) had completely discontinued their use of proton pump inhibitors (PPIs), and an additional 31% had reduced their dose significantly. The mean PPI equivalent doses were 37.8 ± 22.2 mg/day before the Stretta procedure and 11.6 ± 14.6 mg/day at 27-month follow-up assessment (p = 0.001). According to the patient outcomes for daily PPI use (yes/no), the patients were divided into two groups: responders (n = 20) and nonresponders (n = 16). The responder group scored higher in QOLRAD score (p = 0.0001), SF-12 physical score (p = 0.038), and SF-12 mental score (p = 0.003). In the 24-hour pH study, the responder group demonstrated a significant decrease in distal esophageal acid exposure time (6.4% ± 1.5% to 3.1% ± 1.4%; p = 0.0001).Conclusion The Stretta procedure results in a statistical significant long-term decrease in GERD symptoms and PPI use. The treatment effect is durable beyond 2 years, and 56% of patients had discontinued their user of all antisecretory drugs.Presented at the European Association for Endoscopic Surgery (EAES) Glasgow 2003, 15–18 June 2003     

Long-term follow-up after endocardial radiofrequency modified Nitta procedure for concomitant atrial fibrillation treatment

In atrial fibrillation (AF) patients, the surgical restoration of sinus rhythm aims at restoring atrial contraction, hence to decrease thromboembolic events. We investigated the long-term outcome of radiofrequency (RF) ablation by a modified Nitta procedure, in patients with AF associated with operative structural heart diseases. Between September 2000 and April 2004, a total of 20 patients (63.7+/-13.34 years) with structural heart diseases due to surgery and chronic AF underwent endocardial RF ablation. Evaluation was achieved at discharge, at 6 months, 12 months and in November 2005. Echocardiography, 12-derivations electrocardiogram and 24-h electrocardiogram were obtained. At the mean follow-up of 43.25+/-13.4 months, 14 out of 20 patients (70%) were in sinus rhythm. Actuarial freedom from AF recurrence was 85% after 6 months, 75% after 12 months and 70% at the follow-up completion. Effective atrial contraction was present in 78.5% of patients with sinus rhythm. No hemodynamic pulmonary edema has been reported during the hospital stay, and no thromboembolic event has been reported during the follow-up period. The Nitta procedure, modified for RF ablation, is an easy procedure when performed in the setting of structural heart disease surgery. Further studies are warranted to evaluate this technique on a larger scale basis.     

Long-term results of the Ross procedure

Aortic valve replacement with a pulmonary autograft (Ross procedure) was pioneered by Donald Ross in 1967. The advantages of the autograft valve include freedom from anticoagulation, hemolysis, and infection, optimal hemodynamic performance, and growth potential. Various materials have been used for the right ventricular outflow tract (RVOT). Currently, a cryopreserved pulmonary allograft is accepted worldwide as a useful material for this procedure. Pulmonary allografts cannot be utilized in Japan, and thus other valves and materials must be used instead. The acceptance of these procedures has been slow because of the technical demands of the operations and the inherent need for reconstruction of the RVOT, thereby placing two valves at risk. In the past 20 years, the Ross procedure has been increasingly considered for pediatric patients with a wide spectrum of congenital abnormalities.     

Long-term follow-up after a distal splenorenal shunt procedure: A clinical and hemodynamic study

Of 26 patients who underwent distal splenorenal shunting 4 or more years ago (1969 to 1978), 10 died 3 to 87 months postoperatively (mean 38.5 months). Six deaths were due to liver failure, two to hemorrhagic peptic ulcer disease (the shunt remained patent in each patient), one to brain hemorrhage, and one to sepsis. Eight of the surviving patients resumed professional activity, one showed transient signs of encephalopathy, one had a single episode of recurrent variceal bleeding that could be managed conservatively, and no patient had ascites. Eight patients were investigated angiographically and endoscopically. Preoperative and postoperative measurements of the portal vein showed a decreased diameter in five patients and no opacification in the other three 29 to 97 months after surgery. At endoscopy four patients had small residual esophageal varices, one patient had none, and the other three had large varicosities with variceal pressures between 30 and 40 cm H₂O in two and above 40 cm H₂O in one. Although the incidence of postoperative encephalopathy and variceal bleeding was low after distal splenorenal shunting, the operation did not prevent a decrease in hepatopetal portal flow and did not always abolish the esophageal varices.     

Effect of elbow position on grip and key pinch strength

Twenty-nine college women participated in a study to investigate the effect of elbow position on grip and key pinch strength evaluations. Standardized instructions and positioning were followed with the exception of the two elbow positions. The elbow was flexed to 90 degrees in one test condition and it was fully extended in the other. The results showed a significantly stronger grip strength measurement in the 90 degree elbow flexed position than in the fully extended position. For evaluation of key pinch strength, both hands were stronger in the elbow flexed position, but only the right hand was significantly stronger. This study supports the use of the elbow flexed position in standardized grip and key pinch evaluations.     

Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis

Background:

Duodenum‐preserving pancreatic head resection according to Beger and the pylorus‐preserving Whipple (ppWhipple) procedure were compared in patients with chronic pancreatitis (CP) in a randomized clinical trial. Perioperative data and short‐term outcome have been reported previously. The present study evaluated long‐term follow‐up.

Methods:

Forty patients were enrolled originally, 20 in each group. Long‐term follow‐up included mortality, morbidity, pain status, occupational rehabilitation, quality of life (QoL), and endocrine and exocrine function at median follow‐up of 7 and 14 years.

Results:

One patient who had a ppWhipple procedure was lost to follow‐up. There were five late deaths in each group. No differences were noted in pain status and exocrine pancreatic function. Loss of appetite was significantly worse in the ppWhipple group at 14 years' follow‐up, but there were no other differences in QoL parameters examined. After 14 years, diabetes mellitus was present in seven of 15 patients who had the Beger procedure and 11 of 14 patients after ppWhipple resection (P = 0·128).

Conclusion:

After long‐term follow‐up of up to 14 years early advantages of the Beger procedure were no longer present. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.