Relaparotomy—the Surgeons Nightmare
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The term relaparotomy (RL) refers to operations performed within 60 days of an initial laparotomy, for complications arising following the primary surgery. Our study aims to determine the incidence, indications, and outcome of RLs and identify factors affecting outcomes of RLs in Indian population. A prospective nonrandomized observational study was conducted at a tertiary care Medical College Hospital. Planned elective RL, those undergoing index laparotomy in other hospital were excluded. Demographic features, nutritional status, initial diagnoses, elective/emergency initial surgery, postoperative complications leading to RL, presence of diffuse peritonitis, average interval to RL, associated co morbidity, duration of hospital stay, outcome, and factors associated with outcome of RL were analyzed. Of 622 laparotomies in the study period, 30 underwent RL with incidence of 4.8%. The mean age was 52.2 years. RL was more common in emergency surgeries (80% vs 20%). The mean hospital stay among patients undergoing RL was 25.8 days. The mean interval between first laparotomy and RL was 12.3 days and the average gap between the time of detection of the complication and RL was 3.96 days. The mortality rate in the study was 20%. Five of the six mortality patients had underwent emergency primary surgery. The mean serum albumin level was 3.4 g/dL while that associated with mortality was 3.01 g/dL. All laparotomies have potential for RL. RL is associated with high morbidity and mortality. Careful surgical techniques and patient optimization help reduce RL rate. Intensive postoperative monitoring and early RL when indicated reduce mortality associated with RL.
KeywordsRelaparotomy Index laparotomy Postoperative complications Wound dehiscence Post-operative hemorrhage Re-exploration
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 3.Girgor’ev SG, Petrov VA, Grigor’eva TS (2003) Relaparotomy. Problems of terminology. Khirurgiia 6:60–62Google Scholar
- 4.Brasel K, Hameed M, Sarr M (2009) Comparison of on-demand and planned relaparotomy for secondary peritonitis. J Can Chir 52:1Google Scholar
- 5.Ching SS, Muralikrishnan VP, Whiteley GS (2003) Relaparotomy: a five year review of indications and outcome. Int J Clin Pract 57:333–337Google Scholar
- 6.Desiaterik VI, Krivitskii IUM, Mikhno SP, Ageenko AP, Polishchuk ON, Shapovaliuk VV (2000) Relaparotomy: clinical, strategic and organizational aspects. Klin Khir 7:35–38Google Scholar
- 8.Kononov AG, Sotnicenko BA, Makarov VI (1990) Relaparotomy for intra-abdominal hemorrhage. Acta Chir Iugosl 37:65–73Google Scholar
- 12.Tera H, Aberg C (1975) Relaparotomy. A ten-year series. Acta Chir Scand 141:637–644Google Scholar
- 13.Kriger AG, Shurkalin BK, Glushkov PS, Andreitsev IL (2003) Diagnosis and treatment of postoperative intraabdominal complications. Khirurgiia 8:19–23Google Scholar
- 14.Zavernyi LG, Poida AI, Tarasov AA, Mel’nik VM, Nadeev SS (1992) Indications for relaparotomy in acute postoperative intestinal obstruction. Klin Khir 4:4–7Google Scholar
- 16.Holzheimer RG, Gathof B (2003) Re-operation for complicated secondary peritonitis – how to identify patients at risk for persistent sepsis. Eur J Med Res 8:125–134Google Scholar