Re-Laparotomy for Severe Intra-Abdominal Infections

Mandell, Katherine; Arbabi, Saman

doi:10.1089/sur.2010.023

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…The Ethiopian study demonstrated that neonatal age (< 1 month) was found to be an independent risk factor for death following pediatrics re-laparotomy (p=0.013) (7). This study and many other studies did not show any significant difference in mortality which supports the choice of PRL and ODRL one over the other (3,4,10,12,19). Literatures also reported that ODRL did have a substantial reduction in re-laparotomies, healthcare utilization including ICU, and medical costs (4,19).…”

Section: Discussionsupporting

confidence: 60%

Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Abebe

Geremew²,

Lemmu

et al. 2020

Ethiop J Health Sci

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BACKGROUND: Complications from abdominal surgery may necessitate a second or more surgeries, re-laparotomy. It is associated with significant morbidity and mortality. Data on relaparotomy from the developing nations is limited. This study aims to assess the indications and outcome of patients who had relaparotomyMETHODS: A retrospective review of medical records of all patients who underwent Re-laparotomy at St. Paul’s Hospital Millennium Medical College from January 2016 to December 2017 was done.RESULT: Of 2146 laparotomies, 6.9% (149) needed re-laparotomy and 129 patients were analyzed. Most (123,95.3%) had on-demand re-laparotomy. Patients operated on emergency made 70.5% (91) of the cases making the ratio of emergency to elective surgery 2.4:1. The three most common surgeries that needed re-laparotomy were, Perforated appendicitis (35,27.1%), bowel obstructions (28,21.7%) , and trauma (20,13.4%). The most common indications for relaparotomy were intra-abdominal abscess (57,44.23%), wound dehiscence (17,13.2%) and anastomotic leak (15 ,11.6%). Surgical site infection (128,100%) and malnutrition (58,45%) were the leading complications. The overall mortality rate was 12.8 % (19). There was no statically significant difference in mortality rate between on-demand and planned re-laparotomy (P=0.388), urgency of the primary surgery (P=0.891) and the number of relaparotomy (p=0.629). Re-laparotomy for anastomotic leak(p=0.001) and patients above fifty years of age (P=0.015) had significant associations with mortality.CONCLUSION: Intra-abdominal abscess collection, wound dehiscence and anastomotic leak were the most common indications of re-laparotomies. Age above fifty years and anastomotic leaks were significantly associated with mortality

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Section: Discussionsupporting

confidence: 60%

Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Abebe

Geremew²,

Lemmu

et al. 2020

Ethiop J Health Sci

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“…15,20,21,24,28 The risks and benefits of relaparotomy in the setting of intra-abdominal infections have been well described in the literature evaluating the optimum timing for such intervention. 1,29,30 Early reintervention allows for prompt detection of infectious foci, minimal postoperative adhesions, and early source control. With a negative relaparotomy rate of nearly 30 per cent in ondemand procedures, 1,29,31 risks include exposure to potentially unnecessary surgery and anesthesia, increased adhesions, higher costs, and exaggerated physiological response, which may predispose patients to developing multiorgan failure.…”

Section: Discussionmentioning

confidence: 99%

“…1,29,30 Early reintervention allows for prompt detection of infectious foci, minimal postoperative adhesions, and early source control. With a negative relaparotomy rate of nearly 30 per cent in ondemand procedures, 1,29,31 risks include exposure to potentially unnecessary surgery and anesthesia, increased adhesions, higher costs, and exaggerated physiological response, which may predispose patients to developing multiorgan failure. 1,32 On the other hand, if an abscess can be detected, accessed, and undergo successful percutaneous catheter placement, many of these concerns are avoided.…”

Section: Discussionmentioning

confidence: 99%

“…C RITERIA FOR CONTROL or treatment of intraabdominal infections include early diagnosis, appropriate antibiotics, source control, and supportive care. 1 For primary (spontaneous) peritonitis, antibiotics alone may suffice. For secondary peritonitis in which the infection is caused by contamination from a perforated viscus, source control can be obtained by a variety of methods, including drainage, repair, resection, or diversion.…”

mentioning

confidence: 99%

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Differences in Morbidity and Mortality with Percutaneous versus Open Surgical Drainage of Postoperative Intra-abdominal Infections: A Review of 686 Cases

Politano

Hranjec

Rosenberger

et al. 2011

The American Surgeon™

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Intra-abdominal infections following surgical procedures result from organ-space surgical site infections, visceral perforations, or anastomotic leaks. We hypothesized that open surgical drainage is associated with increased patient morbidity and mortality compared with percutaneous drainage. A single-institution, prospectively collected database over a 13-year period revealed 2776 intra-abdominal infections, 686 of which required an intervention after the index operation. Percutaneous procedures (simple aspiration or catheter placement) were compared with all other open procedures by univariate and multivariate analyses. Analysis revealed 327 infections in 240 patients undergoing open surgical drainage and 359 infections in 260 patients receiving percutaneous drainage. Those undergoing open drainage had significantly higher Acute Physiology Score (APS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores and were more likely to be immunosuppressed, require intensive care unit treatment, and have longer hospital stays. Mortality was higher in the open group: 14.6 versus 4.2 per cent ( P = 0.0001). Variables independently associated with death by multivariate analysis were APACHE II, dialysis, intensive care unit (ICU) care, age, immunosuppression, and drainage method. Open intervention for postsurgical intra-abdominal infections is associated with increased mortality compared with percutaneous drainage even after controlling for severity of illness by multivariate analysis. Although some patients are not candidates for percutaneous drainage, it should be considered the preferential treatment in eligible patients.

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“…Planned relaparotomy consistently generated more costs across the whole range of different courses of disease. Katherine Mandell and Saman Arbabi [29]. The role of relaparotomy in the management of intra-abdominal infection remains controversial.…”

Section: Vmentioning

confidence: 99%

Relaparotomy : Analysis of 50 Cases And Review of Literature

Singh¹

2017

OAJS

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Introduction: Reoperative Abdominal Surgery (Relaparotomy) means an unplanned reintervention carried out during the immediate postoperative period after laparotomy and causally related to first operation. Method:The study had been carried out in upgraded department of General Surgery in SMS Medical College and Hospital. The cases comprises of operated in SMS Hospital and those referred from other surgical centers.Results: Maximum patients 70% needs relaparotomy only one time which had minimum mortality (11.4%). Four patients (8%) were needed relaparotomy 3 times in which 2 patient were expired. Mean while mortality rate of 3rd relaparotomy was 50%. Relaparotomy were done mainly for adhesion obstruction and anastomotic leakage. Adhesion obstruction superwanes anastomotic leakage (40% v/s 28%). 4% patients in which foreign body (sponge in peritoneal cavity at the time of previous surgery) were found both cases operated for caesarian section. 68% patients were refered from some other institution Conclusion: Decision to perform relaparotomy as per patients condition, if taken in time it can improv overall survival and have a positive impact on decrease length of hospital stay, overall cost of treatment and morbidity as well as mortality.

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Re-Laparotomy for Severe Intra-Abdominal Infections

Cited by 9 publications

References 14 publications

Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Indications and Outcome of Patients who had Re-Laparotomy: Two Years’ Experience from a Teaching Hospital in a Developing Nation

Differences in Morbidity and Mortality with Percutaneous versus Open Surgical Drainage of Postoperative Intra-abdominal Infections: A Review of 686 Cases

Relaparotomy : Analysis of 50 Cases And Review of Literature

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