H Assmus1, T Dombert, F Staub. 1. Neurochirurgische Gemeinschaftspraxis Dossenheim. assmusdombert@t-online.de
Abstract
BACKGROUND: With an increasing number of operative procedures for CTS, the number of reoperations is increasing too. These procedures are not in general performed because of recurrence, other reasons may play a role for the failure of the initial operation or recurrent symptoms. METHODS AND CLINICAL MATERIAL: Revision procedures performed in 57 patients in the practice for peripheral neurosurgery from January to September 2004 were analyzed for incision, intraoperative findings, method of operation, electrophysiological findings, and revised diagnosis. Moreover, the data were compared with 185 revision procedures performed in the years from 1986 up to 1994. RESULTS: 2.4 % of all CTS operations were revision procedures (in the former time period 1.5 %). In 59 % of revision operations (former 50 %) an incomplete release of the transverse ligament was found, in 27 % (former 31 %) typical recurrence, in 5 % (former 6 %) nerve lesions, and in 9 % (former 13 %) no abnormalities so that other reasons for complaints of mainly radicular lesions must be assumed. In cases of incomplete release of the transverse ligament, only in 16 % of the patients were normal skin incisions seen, but in 56.3 % there were small incisions (i.e., short or mini-incisions). Typical CTS recurrence occurred mainly in hemodialysis patients, nerve lesions were seen mainly when endoscopic procedures were performed. CONCLUSION: Diagnostic problems because of incomplete or misinterpreted ENG findings may lead to delayed or useless primary as well as revision operations. Too small incisions but also endoscopic procedures used by less experienced surgeons are accompanied with an increased risk for avoidable revisions and nerve lesions. Not only for forensic reasons but also in view of quality management, procedures for correction (of operative failure) should be distinguished from those for recurrence.
BACKGROUND: With an increasing number of operative procedures for CTS, the number of reoperations is increasing too. These procedures are not in general performed because of recurrence, other reasons may play a role for the failure of the initial operation or recurrent symptoms. METHODS AND CLINICAL MATERIAL: Revision procedures performed in 57 patients in the practice for peripheral neurosurgery from January to September 2004 were analyzed for incision, intraoperative findings, method of operation, electrophysiological findings, and revised diagnosis. Moreover, the data were compared with 185 revision procedures performed in the years from 1986 up to 1994. RESULTS: 2.4 % of all CTS operations were revision procedures (in the former time period 1.5 %). In 59 % of revision operations (former 50 %) an incomplete release of the transverse ligament was found, in 27 % (former 31 %) typical recurrence, in 5 % (former 6 %) nerve lesions, and in 9 % (former 13 %) no abnormalities so that other reasons for complaints of mainly radicular lesions must be assumed. In cases of incomplete release of the transverse ligament, only in 16 % of the patients were normal skin incisions seen, but in 56.3 % there were small incisions (i.e., short or mini-incisions). Typical CTS recurrence occurred mainly in hemodialysis patients, nerve lesions were seen mainly when endoscopic procedures were performed. CONCLUSION: Diagnostic problems because of incomplete or misinterpreted ENG findings may lead to delayed or useless primary as well as revision operations. Too small incisions but also endoscopic procedures used by less experienced surgeons are accompanied with an increased risk for avoidable revisions and nerve lesions. Not only for forensic reasons but also in view of quality management, procedures for correction (of operative failure) should be distinguished from those for recurrence.
Authors: Jerzy Kopeć; Artur Gadek; Maciej Drozdz; Krzysztof Miśkowiec; Julian Dutka; Antoni Sydor; Eve Chowaniec; Władysław Sułowicz Journal: Med Sci Monit Date: 2011-09