Urgent Redo-Laparotomies: Patterns and Outcome—A Single Centre Experience

Abstract

A proportion of the operations performed in a surgical gastroenterology department are unplanned repeat laparotomies for complications of the original procedure. We examined why, in our department, these 'redo' laparotomies were performed and what was their outcome. We retrospectively analyzed 6530 patients operated between September 1996 - December 2010, of these 257 redo laparotomies were performed in 193(2.5 %) patients. There were 138 males and 55 females who had a mean age of 42 years (range 7-68 years). Eighty one (42 %) of the index surgeries were elective and 112 (58 %) performed in the emergency situation. Pancreas was the commonest organ for the index operation {50 (25.9 %)}, followed by the colon and rectum {45 (23.3 %)} and the small bowel {36 (18.7 %)}. Postoperative bleeding was the most common cause for re-exploration 66 (34.2 %) followed by an abscess or fluid collection that required surgical drainage 57 (29.6 %). The mortality rate after redo laparotomies was 33.2 % with sepsis and multi-organ failure being the commonest cause of death. Urgent redo-laparotomies that are performed following complicated abdominal operations have a high mortality rate. Postoperative bleeding, intrabdominal abscess and peritonitis are the commonest cause for redo-laparotomy. Multiple redolaparotomies and associated co-morbid conditions are significant predictors of mortality.

Evaluation of factors that affecting mortality in urgent redo-laparotomies

“…In a study evaluating UARLs, the mortality rate was found to be 33% (2). It was reported to be 37.03% in the study of Unalp et al (1). In our study, the mortality rate was 27%.…”

“…UARLs are still the most important step of the treatment for these patients (1,3). The mortality rates vary between 50 and 100% in cases with peritonitis that cannot be taken under control, namely those with spesis and multiple system organ failure (4,5).…”

Relaparotomy in general surgery department of tertiary care hospital of Western India

“…Majority of relaparotomy were performed due to leak from anastomotic site in all the studies. [1][2][3][4] Mean duration between first laparotomy and relaparotomy was 6.85 days in our study. One of the study had mean duration between two laparotomies to be 5 days, while another had mean duration to be 6.95 days.…”

“…Some of the important indications of relaparotomy are anastomotic leakage, septic peritonitis, intestinal obstruction, burst abdomen, intestinal perforation and haemorrhage. [1][2][3] Measures which can be carried out to reduce the incidence of relaparotomy are proper pre-operative work up, use of newer anaesthetic techniques, newer antibiotics and proper antiseptics, better post-operative fluid and electrolyte balance, proper Incidence of relaparotomy can be decreased by proper understanding of predisposing factors and by taking appropriate measures. Emergency, sepsis, primary suppurating disease, these are some factors, because of which incidence of relaparotomy cannot be brought down further.…”

“…Factors associated with high mortality are elderly patients, peritonitis at the initial surgery and multi organ failure. [1][2][3][4] Majority of patients who have to undergo relaparotomy have to be cared in intensive care unit. Incidence of relaparotomy is also found to be higher in hospital setup associated training facility.…”