Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery

Abstract

Relaparotomy may be beneficial in patients developing intraperitoneal sepsis after abdominal procedures. We determined whether joint clinical assessment by intensivist and surgeon (clinician assessment) identified patients with surgically correctable intraperitoneal sepsis. We also assessed the effect of patient age and sex, disease presentation and severity, interval to relaparotomy, and the number of relaparotomies on survival after relaparotomy. Data on clinical, laboratory, and radiologic abnormalities prior to relaparotomy, relaparotomy findings, and in-hospital survival were prospectively collected on a general hospital intensive care unit (ICU) database between January 1997 and January 2002. Altogether, 65 of 1482 (4.4%) patients admitted to the ICU after abdominal surgery underwent relaparotomy at a median of 5 days after the initial procedure. There was an 83% probability of identifying surgically treatable sepsis and 43% in-hospital mortality. Abdominal imaging contributed accurate information in 50% of cases where clinician assessment was uncertain. Patient age and multiorgan failure prior to relaparotomy-but not urgency of initial laparotomy or the acute physiology and chronic health evaluation (APACHE II) score prior to relaparotomy, interval to relaparotomy, or number of relaparotomies-affected the outcome. Clinician assessment after abdominal surgery had a high probability of predicting intraperitoneal sepsis at relaparotomy. The 43% mortality after relaparotomy was unlikely to be greater than with nonoperative treatment of intraabdominal sepsis, but the 78% mortality after relaparotomy in patients older than 75 years of age raised doubts about this approach in the elderly. The identification of intraperitoneal sepsis and performance of relaparotomy earlier after the initial abdominal surgery might reduce the high rate (60%) of multiorgan failure prior to relaparotomy and improve survival after it.

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

“…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.…”

“…One of the study had mean duration between two laparotomies to be 5 days, while another had mean duration to be 6.95 days. 1,6 Duration between laparotomy and relaparotomy depends on surgical technique employed during first surgery, post-operative patient care and patient factors. Even with best possible post-operative care in our institute mortality rate in case of relaparotomy was as high as 34.72%, which is more or less similar to other studies in which mortality rate was in between 26.7% to 37.3%.…”

Management of Peritonitis in the Critically Ill Patient

“…In this study the hospital mortality was 43% and the average time for execution of the relaparotomy was 5 days. Not surprisingly, outcome was highly associated to age and organ dysfunction [89].…”

“…Hutchins and coworkers [89] found that the combined positive predictive value of the clinical assessment made in concert with the input from the laboratory and radiological data as well as the assessment made by the intensivist and the surgeons is close to 83%. In this study the hospital mortality was 43% and the average time for execution of the relaparotomy was 5 days.…”

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

“…Early reoperation before organ failure remains the major concern of the surgeon. After laparotomy, post operative peritonitis is the most common cause 50% -83% of surgical times [6]. We collected 148casesan incidence 10.5 cases per year and a frequency of 0.6 laparotomy ( Table 1).…”