DOI: http://dx.doi.org/10.18203/2349-2902.isj20204677

Evaluation of relaparotomy in surgery and obstetrics and gynecology patients in tertiary care hospital in India: reason, morbidity, mortality: a case controlled study

Pooja Shah, Dilip Choksi, Arun R., Sahdev Chauhan, Ronak Kadia

Abstract


Background: Many laparotomy may require relaparotomy due to post-operative complication as life-saving procedure. Incidence of relaparotomy and post-operative outcome defers from patient to patient. The objectives of our study were to evaluate the indication of relaparotomy, outcome of the relaparotomy and factors affecting mortality.

Methods: Data was collected between March 2017 and November 2019 in SSG hospital, Vadodara. Patient’s demographics, indication and intra-operative findings of initial surgery and relaparotomy with morbidity and mortality were studied. Patients from department general surgery and obstetrics and gynecology were included. Consent was taken in a pre-validated form.

Results: Out of total 5684 laparotomy performed, 146 (2.58%) patients underwent relaparotomy. Male to female ratio was 1.5:1. Incidence was highest in 31-40 years age group (median age: 37 years). Dirty wound in initial laparotomy had highest conversion rate (3.21%) to relaparotomy. Mean interval between initial laparotomy and relaparotomy was 8.57±5.62 days. The major indication of relaparotomy was burst abdomen (39.52%) followed by leak from previously sutured site (24.65%). 50.68% patients were shifted to ICU following relaparotomy. Average days of ICU admission were 4.16±2.25 days. Mortality rate was 23.29%. Maximum mortality was noted in case of leak from anastomotic or perforation site. 14 (38.88%) deaths occurred during postoperative day second to fourth with mean hospital stay of 21.85±8.65 days.

Conclusions: Although relaparotomy is life-saving procedure, it has high mortality rate. The possibility of efficiently lowering relaparotomy depends on success of the first laparotomy, patient’s status, early re-exploration with proper surgical techniques and thorough postoperative care.


Keywords


Anastomotic-leak, Burst abdomen, Complication, ICU admission, Morbidity, Relaparotomy

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References


Hasan KC, Abdul Aemmah AK. A 5 year study of re laparotomies, planned and unplanned, in Al Hillah Teaching General Hospital. Med J Babylon. 2018;15(1):25-7.

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.

Haluk RU, Erdinc K, Haldun K, Ahmet B, Mustafa P, Mehmet AO. Urgent abdominal re-explorations. World J Emerg Surg. 2006;1:10.

Krivitskii DI, Shuliarenko VA, Babin IA. Indications for relaparotomy. KlinKhir. 1990;1:18-21.

Koirala R, Mehta N, Varma V, Kapoor S, Kumaran V, Nundy S. Urgent redo-laparotomies: patterns and outcome a single centre experience. Indian J Surg. 2015;77(3):195-9.

Ching SS, Muralikrishnan VP, Whiteley GS. Relaparotomy: a five year review of indications and outcome. Int J Clin Pract. 2003;57:333-7.

Kriger AG, Shurkalin BK, Glushkov PS, Andreĭtsev IL. Diagnosis and treatment of postoperative intraabdominal complications. Khirurgiia. 2003(8):19-23.

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.

Sak ME, Turgut A, Evsen MS, Soydinc HE, Ozler A, Sak S, et al. Relaparotomy after initial surgery in obstetric and gynecologic operations: analysis of 113 cases. Ginekol Pol. 2012;83(6):429-32.

Hutchins RR, Gunning MP, Lucas DN, Mersh TG, Soni NC. Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery. World J Surg. 2004;28(2):137-41.

Sridhar M, Susmitha C. Incidence and causes of relaparotomy after an obstetric and gynaecological operation. Int Surg J. 2016;3(1):301-4.

Thombarapu U, Kodey PD, Koneru GR. Retrospective study of relaparotomy in department of obstretrics, gynaecology and family planning in, rural tertiary care hospital, Andhra Pradesh, India. Int J Med Res Health Sci. 2015;4(3):582-6.

Rygachev GP, Nekhaev AN. Relaparotomy in the treatment of generalized postoperative peritonitis. Khirurgiia. 1997(1):45-8.

Wain MO, Sykes PA. Emergency abdominal re- exploration in a district general hospital. Ann R Coll Surg Engl. 1987;69:169-74.

Unalp H, Kamer E, Onal M. Analysis of early relaparotomy after lower gastrointestinal system surgery. Surg Today. 2008;38:323-8.

Zavernyi LG, Poida AI, Bondarenko ND, Tarasov AA, Nadeev SS, Stepanik V. Prognosis in the outcome of relaparotomy. Klinicheskaiakhirurgiia. 1992(8):12-6.

Desiaterik VI, Krivitskiĭ I, Mikhno SP, Ageenko AP, Polishchuk ON, Shapovaliuk VV. Relaparotomy: clinical, strategic and organizational aspects. Klinichnakhirurhiia. 2000;(7):35-8.

Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638-52.

Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on sepsis-related problems of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-800

Bunt TJ. Urgent relaparotomy: the high-risk, no-choice operation. Surgery. 1985;98(3):555-60.

Zer M, Dux S, Dintsman M. The timing of relaparotomy and its influence on prognosis. Am J Surg. 1980;139:338-43.

Harbrecht PJ, Garrison RN, Fry DE. Early urgent relaparotomy. Arch Surg. 1984;119:369-74.

Hinsdale JG, Jaffe BM. Reoperation for intra-abdominal sepsis: Indication and results in a modern critical setting. Ann Surg. 1984;199:31-6.

Butler JA, Huang J, Wilson SE. Repeated laparotomy for postoperative intra-abdominal sepsis- an analysis of outcome predictors. Arch Surg. 1987;122:702-6.

Pusajo JF, Bumaschny E, Doglio R, Cherjovsky MR, Lipinszki AI, Hernandez MS, et al. Postoperative intra-abdominal sepsis requiring reoperation- value of a predictive index. Arch Surg. 1993;128:218-23.

Koperna T, Schulz F. Relaparotomy in peritonitis: Prognosis and treatment of patients with persisting intra-abdominal infection. World J Surg. 2000;24:32-7.

Krause R. Reintervention in abdominal surgery. World J Surg. 1987;11:226-32.

Velmahos GC, Degiannis E, Souter I. Relaparotomies for abdominal sepsis- why, when, how? A collective review. S Afr J Surg. 1998;36(2):52-6.