Incidence and causes of relaparotomy after an obstetric and gynaecological operation

Sridhar, Monica; Susmitha, Chillamherla

doi:10.18203/2349-2902.isj20160247

Cited by 7 publications

(7 citation statements)

References 9 publications

(9 reference statements)

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“…Various studies have found different incidence rates of relaparotomy in various scenarios as low as 0.34% to as high as 3.5% to 4.4%. 1,[5][6][7][8] Incidence is on higher side when compared to similar study in general surgery department.…”

Section: Discussionmentioning

confidence: 98%

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

Patel

Patel²,

Shah³

2016

Int Surg J

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INTRODUCTIONMany patients develop complications following elective or emergency laparotomy. Some of these patients have to undergo relaparotomy for correction of these complications.Relaparotomy means operations performed with in hospitalization period which is related to initial surgery. Relaparotomy can be classified as early or late, radical or palliative, planned or unplanned depending on time, its goal and nature of urgency. 1Certain predisposing factors play important role in occurrence of surgical complications leading to re laparotomy. Some of the important indications of relaparotomy are anastomotic leakage, septic peritonitis, intestinal obstruction, burst abdomen, intestinal perforation and haemorrhage.1-3 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 ABSTRACT Background: Relaparotomy has to be performed in case of certain post-operative complications. Incidence of relaparotomy differs according to hospital setup as well as patient characteristics and initial surgery. It also depends on post-operative care given to patient following first surgery and incidence of post-operative sepsis. This study was carried out to know the incidence of relaparotomy and indications of it, so that in the future this factors can be modified and incidence can be further lowered. Methods: This is an observational study in which 75 relaparotomy cases reported during the period of May 2008 to September 2010 were included. All patients irrespective of age and sex, who have undergone re exploration of the abdomen during the period of hospitalization after the first operation and discharge of patients. All the gynaecological and obstetrical laparotomies were excluded. Data were recorded in pre-validated case record form. Results: Incidence of relaparotomy was 2.84%. It was most common in age group of 31 to 40 years; with mean age of 39.25 years. The most common indication of relaparotomy was leak (34 patients); from an anastomotic site (29 patients) or from perforation (5 patients). The mean duration between first Laparotomy and relaparotomy was 6.85 days. The mortality was 34.72% (25 patients). Mean number of days stay in ICU or the patient requires continuous close monitoring was 4.01 days; mean days of hospitalization was 25.72 days. Conclusions: Relaparotomy is lifesaving procedure for patients. Incidence of relaparotomy depends on expertise in primary surgery, proper surgical technique and prevention of post-operative infection.

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Section: Discussionmentioning

confidence: 98%

“…7,8 This much low incidence rate might be because, these studies are carried out in obstetrics and gynaecology department. Patient characteristics as well as indications of relaparotomy are different in general surgery department.…”

Section: Discussionmentioning

confidence: 99%

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

Patel

Patel²,

Shah³

2016

Int Surg J

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“…[1][2][3]5,7 Overall the most common indication for the relaparotomy is post-operative haemorrhage. 6,7,9,11 In other studies the most common indication for relaparotomy were leak from anastomotic site and abdominal sepsis. 1,2 Early diagnosis and immediate surgery to rectify the cause might decrease the mortality.…”

Section: Discussionmentioning

confidence: 92%

“…Various studies have different incidence rates of relaparotomy (range: 0.76%-3.4%). 6,11 Incidence is on higher side when compared in general surgery department and lower when carried out exclusively in obstetrics and gynecology department. [2][3][4]11,12 Gender wise distribution of relaparotomy was higher in male patients (1.5:1) which is comparable to similar studies.…”

Section: Discussionmentioning

confidence: 98%

“…6,11 Incidence is on higher side when compared in general surgery department and lower when carried out exclusively in obstetrics and gynecology department. [2][3][4]11,12 Gender wise distribution of relaparotomy was higher in male patients (1.5:1) which is comparable to similar studies. [1][2][3]6,7 Incidence of relaparotomy was highest in 31-40 years age group (3.22%) and lowest in >70 years age group only 1.34% patients had relaparotomy.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2020

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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.

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Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study

Girma

Negesso

Tadese

et al. 2021

International Journal of Surgery Open

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Background: Intestinal obstruction is the most common surgical emergency worldwide. Intestinal obstruction continues to remain a challenge to surgeons despite advances in the field of medicine, surgical technique and accounts for high mortality ranges from 3% to 30% all over the world. Objective: The study aimed to assess management outcome and its associated factors among surgically treated intestinal obstruction cases, at Dilla University Referral Hospital 2020 GC. Method: Hospital-based cross-sectional study was conducted on all cases surgically managed for intestinal obstruction, at Dilla University Referral Hospital from November, 1/2016 up to November, 30/2019. Data were collected using a structured questionnaire by trained data collectors. The collected data was checked for its completeness and entered into epidata version 3.1 then exported to SPSS version 26 for cleaning and analysis. The odds ratio along with 95%CI was estimated to measure the strength of the association. Statistical significance was declared at p-value < 0.05. Result: 258 cases were included in this study. From these, 223 (86.4%) cases have favorable surgical management outcomes of intestinal obstruction. Of 35 cases with unfavorable outcome, the most common postoperative complication occurred was surgical site Infection followed by post-operative pneumonia. A total of 4.7% of postoperative deaths were documented as unfavorable surgical management outcomes. Fever, length of illness, comorbidity, intraoperative bowel condition, bowel resection was done and length of hospital stay after operation were independent significantly associated factors with the surgical management outcome of intestinal obstruction. Conclusion: The unfavorable management outcome of patients with IO who treated surgically at the study area was high. Assessing co-morbidity, fluid resuscitation, administration of prophylactic antibiotics before operation and properly applying infection prevention protocol are some of the activities that need emphasis in intestinal obstruction management. Highlights

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Incidence and causes of relaparotomy after an obstetric and gynaecological operation

Cited by 7 publications

References 9 publications

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

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

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

Management outcome and its associated factors among surgically treated intestinal obstruction cases in Dilla University Referral Hospital, Southern Ethiopia. A cross-sectional study

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