Analysis of early relaparotomy after gastrointestinal surgery

Introduction: The term "relaparotomy" (RL) refers to the laparotomy performed within 60 days of the first operation, while the term "initial RL" refers to the laparotomy performed within 21 days of the first operation. the aim of this retrospective study is to evaluate how many RLs have been performed for complications and to analyze the reasons and results of the RL and the factors that influence the associated mortality rate
Matherials and methods: The study was carried out from January 01.01.1999 to December 31.12.2003 retrospectively consulting 104 patients through the database and the medical records of the AOU Policlino University of Catania. Department of surgical medical specialties II. In the selection of patients subjected to RL. the parameters analyzed were: age, sex and initial diagnosis; pre- and per-operator results; surgical procedures applied during and the complications occurred during the first operation; the results of emergency RLs and not. Mortality rates and the reasons that led to the choice of RL were also studied.
Results: In the period under study, RL interventions were performed in (1.4%) 104 patients out of 8000 cases of abdominal surgery. The number of male and female patients was 73 (70%) and 31 (30%), respectively. Their age was on average 65 (50-80) years. Sixty two (60%) patients were operated in emergency conditions, 23 (20%) had infections, 21 (19%) had tumors and 52 (50%) patients had co-morbidities at the time of the first surgery. (Ischemic heart disease with stent, decompensated diabetes, COPD., cerebral vasculopathies) The surgical interventions performed and examined concerned the gastrointestinal system.
Discussion: The incidence of urgent relaparotomy complications was 1.4% in patients undergoing abdominal / surgical surgery [2, 3, 4, 5, 6, 7, 8]. Consistent with previous studies, the RL-requires the onset of complications that can be classified into 5 groups: (i) haemorrhage in the intestinal canal or abdominal cavity (ii) peritonitis that occurs in the absence or presence of a perforation (iii) mechanical or paralytic postoperative ileus (iv) (v) various complications [2, 9]. The incidence of complications requiring UAR varies depending on the characteristics of the disease of hospitalized patients and the types of surgical interventions they have received [3 On the other hand, a surgery performed earlier than required is not without risk. In our study "Urgent requiring surgery" complications were assessed, no difference was found in terms of mortality between UAR in patients operated for malignant reasons and those in patients operated for benign reasons. Similarly, the sex, the existence of the infection, the execution of surgical interventions in urgent conditions or co-morbidities did not influence the mortality following an RL
Conclusions: There remains the difficulty of the decision when it is necessary to proceed to an RL without the latter aggravating the critical condition of the patient. The precociousness in the implementation of the RL if necessary reduces mortality. The right timing "that varies from patient to patient, depends in our opinion on the experience of the surgeon" is one of the factors that have reduced the mortality rate. Finally the intestinal anastomosis procedure with mechanical sutures reduced the rate of RL.