Second-look surgery is performed after a procedure or course of treatment to determine if the patient is free of disease. If disease is found, additional procedures may or may not be performed at the time of second-look surgery.
Second-look surgery may be performed under numerous circumstances on patients with various medical conditions.
A second-look procedure is sometimes performed to determine if a cancer patient has responded successfully to a particular treatment. Examples of cancers that are assessed during second-look surgery are ovarian cancer and colorectal cancer. In many cases, before a round of chemotherapy and/or radiation therapy is started, a patient will undergo a surgical procedure called cytoreduction to reduce the size of a tumor. This debulking increases the sensitivity of the tumor and decreases the number of necessary treatment cycles. Following cytoreduction and chemotherapy, a second-look procedure may be necessary to determine if the area is cancer-free.
An advantage to second-look surgery following cancer treatment is that if cancer is found, it may be removed during the procedure in some patients. In other cases, if a tumor cannot be entirely removed, the surgeon can debulk the tumor and improve the patient's chances of responding to another cycle of chemotherapy. However, second-look surgery cannot definitively prove that a patient is free of cancer; some microscopic cancer cells can persist and begin to grow in other areas of the body. Even if no cancer is found during second-look surgery, the rate of cancer relapse is approximately 25%.
Second-look surgery may benefit patients suffering from a number of different conditions that affect the pelvic organs. Endometriosis is a condition in which the tissue that lines the uterus grows elsewhere in the body, usually in the abdominal cavity, leading to pain and scarring. Endometrial growths may be surgically removed or treated with medications. A second-look procedure may be performed following the initial surgery or course of medication to determine if treatment was successful in reducing the number of growths. Additional growths may be removed at this time.
Second-look surgery may also be performed following the surgical removal of adhesions (bands of scar tissue that form in the abdomen following surgery or injury) or uterine fibroids (noncancerous growths of the uterus). If the results are positive, an additional procedure may be performed to remove the adhesions or growths. Patients undergoing treatment for infertility may benefit from a second-look procedure to determine if the cause of infertility has been cured before ceasing therapy.
In patients suffering from bleeding from the gastrointestinal (GI) tract, recurrence of bleeding after attempted treatment remains a significant risk; approximately 10–25% of cases do not respond to initial treatment. Second-look surgery following treatment for GI bleeding may be beneficial in determining if bleeding has recurred and treating the cause of the bleeding before it becomes more extensive.
Patients suffering from a partial or complete blockage of the intestine are at risk of developing bowel ischemia (death of intestinal tissue due to a lack of oxygen). Initial surgery is most often necessary to remove the diseased segment of bowel; a second-look procedure is commonly performed to ensure that only healthy tissue remains and that the new intestinal connection (called an anastomosis) is healing properly.
A variety of other conditions can be assessed with second-look surgery. Patients who have undergone surgical repair of torn muscles in the knee might undergo a procedure called second-look arthroscopy to assess how the repair is healing. A physician may use second-look mastoidoscopy to visualize the middle ear after removal of a cholesteatoma (a benign growth in the middle ear). A second endoscopic procedure may be performed on a patient who underwent endoscopic treatment for sinusitis (chronic infection of the sinuses) to evaluate the surgical site and remove debris.
Second-look surgery may be done within hours, days, weeks, or months of the initial procedure or treatment. This time interval depends on the patient's condition and the type of procedure.
A laparotomy is a large incision through the abdominal wall to visualize the structures inside the abdominal cavity. After placing the patient under general anesthesia, the surgeon first makes a large incision through the skin, then through each layer under the skin in the region that the surgeon wishes to explore. The area will be assessed for evidence of remaining disease. For example, in the case of second-look laparotomy following treatment for endometriosis, the abdominal organs will be examined for evidence of endometrial growths. In the case of cancer, a "washing" of the abdominal cavity may be performed; sterile fluid is instilled into the abdominal cavity and washed around the organs, then extracted with a syringe. The fluid is then analyzed for the presence of cancerous cells. Biopsies may also be taken of various abdominal tissues and analyzed.
If the surgeon discovers evidence of disease or a failed surgical repair, additional procedures may be performed to remove the disease or repair the dysfunction. For example, if adhesions are encountered during a second-look procedure on an infertile female patient, the surgeon may remove the adhesions at that time. Upon completion of the procedure, the incision is closed.
Laparoscopy is a surgical technique that permits a view of the internal abdominal organs without an extensive surgical incision. During laparoscopy, a thin lighted tube called a laparoscope is inserted into the abdominal cavity through a tiny incision. Images taken by the laparoscope are seen on a video monitor connected to the scope. The surgeon may then examine the abdominal cavity, albeit with a more limited operative view than with laparotomy. Such procedures as the removal of growths or repair of deformities can be performed by instruments inserted through other small incisions in the abdominal wall. After the procedure is completed, any incisions are closed with stitches.
Depending on the area of the body in question, other procedures may be used to perform second-look surgery. These include:
- Arthroscopy. Arthroscopy uses a thin endoscope to visualize the inner space of a joint such as the knee or elbow. Second-look arthroscopy may be used to determine if previous surgery on the joint is healing properly.
- Percutaneous nephrolithotomy (PNL). This minimally invasive procedure is used to remove kidney stones. Second-look PNL may be used to remove fragments of stones that could not be removed during the initial procedure.
- Hysteroscopy . A hysteroscope is an instrument used to visualize and perform procedures on the inner cavity of the uterus. Second-look hysteroscopy may be used after surgery or medical treatment to treat adhesions or benign growths in the uterus to determine if they have been effectively removed.
- Mastoidectomy. This surgical procedure is used to treat cholesteatoma; a second-look procedure is generally performed to ensure that the entire cholesteatoma was removed during the initial procedure.
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society of surgical oncology. 85 w. algonquin rd., suite 550, arlington heights, il 60005. (847) 427-1400. <http://www.surgonc.org>.
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Stephanie Dionne Sherk
"Second-Look Surgery." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Encyclopedia.com. (May 23, 2018). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/second-look-surgery
"Second-Look Surgery." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Retrieved May 23, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/second-look-surgery
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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.
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.
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.
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.
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.
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.
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"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
"Reoperation." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Encyclopedia.com. (May 23, 2018). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/reoperation
"Reoperation." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Retrieved May 23, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/reoperation