Observational clinical study of indications and outcome of re-exploration laparotomy in 50 patients
DOI:
https://doi.org/10.18203/2349-2902.isj20222937Keywords:
Laprotomy, Re-exploration, Abdominal sepsis, Peritonitis, Outcome of exploration surgeryAbstract
Background: Abdominal surgery that has to be re-done in association with initial surgery (Index surgery), within 60 days of initial surgery, is referred to as re-laparotomy. Redolaparotomies are called, on demand, if laparotomy has to be re-done because of patient condition and planned, if the second laparotomy is decided upon during the course of first surgery itself. Re-laparotomy is associated with increased morbidity and mortality. To find out incidence, indications, morbidity and mortality of re-laparotomy.
Methods: This is a retrospective observational study of 50 cases of re-exploratory laparotomy from 2018 to 2020 done at tertiary care teaching hospital of South Gujarat.
Results: In this study, majority of cases (56%) were seen in the 21-50 age group; males (37) more than females (13) with 3:1 ratio. Index operation was done in emergency in 78% (n=39) and planned in 22% (n=11) of patients. In our study mean duration between 2 laparotomies was 8 days with range of 3-20 days. It is also observed that mean duration of hospital stay among the discharged patients is 30 days with range of 15-60 days. In this study, mortality was 16% (n=8), out of which 5 patients were having co-morbidity. Out of 50 patients 34 (68%) developed local or systemic post-operative complications.
Conclusions: The need for re-laparotomy supersedes risks of severe morbidities and high mortality in view of worsening clinical status of the patient.
References
Koirala R, Shakya VC, Khania S, Adhikary S, Agrawal CS. Redo-laparotomies: reasons, morbidity and outcome. Nepal Med Coll J. 2012;14(2):107-10.
Van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC et al. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA. 2007;298(8):865-72.
Patel H, Patel P, Shah DK. Relaparotomy in general surgery department of tertiary care hospital of Western India. Int Surg J. 2016;4(1):344-7.
Kim JJ, Liang MK, Subramanian A, Balentine CJ, Sansgiry S, Awad SS. Predictors of relaparotomy after non trauma emergency general surgery with initial fascial closure. Am J Surg. 2011;202(5):549-52.
Unalp HR, Kamer E, Kar H, Bal A, Peskersoy M, Onal MA. Urgent abdominal reexplorations. World J Emergency Surg. 2006;1(1):10.
Pusajó JF, Bumaschny E, Doglio GR, Cherjovsky MR, Lipinszki AI, Hernández MS et al. Postoperative intra-abdominal sepsis requiring reoperation: value of a predictive index. Arch Surg. 1993;128(2):218-23.
Girgor'ev SG, Petrov VA, Grigor'eva TS. Relaparotomy. Problems of terminology. Khirurgiia. 2003(6):60-2.
Wain MO, Sykes PA. Emergency abdominal re-exploration in a district general hospital. Ann Royal College Surgeons Eng. 1987;69(4):169.
Ching SS, Muralikrishnan VP, Whiteley GS. Relaparotomy: a five- year review of indications and outcome. International journal of clinical practice. 2003;57(4):333-7
Damas P, Ledoux DI, Nys M, Vrindts YV, De Groote DO, Franchimont P et al. Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg. 1992;215(4):356.
Sautner T, Götzinger P, Redl-Wenzl EM, Dittrich K, Felfernig M, Sporn P et al. Does reoperation for abdominal sepsis enhance the inflammatory host response? Arch Surg. 1997;132(3):250-5.
Haluk RU, Erdinc K, Haldun K, Ahmet B, Mustafa P, Mehmet AO. Urgent abdominal reexplorations. World J Emerg Surg. 2006;1:10.
Nthele M. A one year study of relaparotomies at the University Teaching Hospital, Lusaka. 2012;18.