Retrospective study of relaparotomy in department of obstetrics, gynaecology and family planning in, rural tertiary care hospital, Andhra Pradesh, India

Thombarapu, Uma; Kodey, Prabha Devi; Koneru, GangadharaRao

doi:10.5958/2319-5886.2015.00112.5

Cited by 7 publications

(9 citation 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: 94%

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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: 94%

“…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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“…Khan et al reported a case fatality rate of 18.5% [17]. A rate of 12.76% and 15.38% were reported in two studies from India [18,19], while no deaths were encountered in the study done by Lurie et al [20]. This wide variation in incidence of maternal mortality reported in different studies is due to variable availability of safe procedure, skilled personnel, adequate blood components, facilities for rapid transfer of complicated cases, close monitoring and timely decision for intervention.…”

Section: Limitation Of the Studymentioning

confidence: 98%

Re-Laparotomy after Caesarean Section at a Tertiary Hospital in Egypt: Cross Sectional Study

Elkhateeb¹,

Mahran²,

Sanad³

et al. 2017

Gynecol Obstet

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Objective: To identify the risk factors and complications associated with re-laparotomy after caesarean section (CS) at Mina Maternity university Hospital in Egypt.Methods: Cross sectional study including thirty two women that underwent re-laparotomy after CS at Minia Maternity university Hospital during the period from April 2015 and March 2016 whether the primary operation was done at the hospital or patients were referred from other hospitals or private centres.Results: Repeated Cs was the most common indication for CS followed by re-laparotomy (37.5%). The second most common indication was morbidly adherent placenta (MAP) (15.6%). Intra-peritoneal collection was the indication for re-laparotomy in 50% of cases. CS was done by junior obstetricians in 56.3%, of cases. Fifteen cases were haemodynamically unstable at the time of re-laparotomy (46.9%) and 20 cases (62.5%) were admitted to ICU postoperatively. The main surgical procedure performed during re-laparotomy was hysterectomy (15 cases). The most common complication was massive blood transfusion. Maternal mortality occurs in eight cases (25%). The cause for maternal deaths was irreversible shock in four cases, multiple organ failure in two cases, disseminated intravascular coagulopathy (DIC) in one case and sepsis in one case. Conclusion:Re-laparotomy after CS is associated with high maternal morbidity and mortality. Efforts should be directed to reduce the rate of CS as repeated CS was identified as the main indication for CS followed by relaparotomy.

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“…6 Another study from tertiary care in Andhra Pradesh, India shows incidence of obstetric relaparotomy to be 0.11%. 7 Another study from tertiary care urban hospital has shown incidence of relap to be 0.22%. 4 In this study, obstructed labour was the commonest indication for primary cesarean similar to study by Seal SL et al 6 Second stage cesarean is technically difficult with increased chances of extension of uterine incision of fragile and edematous lower uterine segment.…”

Section: Figure 1: Maternal Mortalitymentioning

confidence: 99%

An analysis of relaparotomy in operative obstetrics

Kumari

Vidyarthi

2020

Int J Reprod Contracept Obstet Gynecol

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Background: Relaparotomy in obstetrics following caesarean section or laparotomy is associated with high morbidity and mortality and hence, considered as maternal near miss. Selection of patient for the same is crucial. This study was done to know the incidence, indications, the risk factors, intraoperative procedures and mortality rates of relaparotomy. Methods: A retrospective analysis of relaparotomy after primary obstetric surgery over a period of two and half years (Results: During study period 28 cases of relaparotomy (18 inhouse and 10 referred cases) were identified. The incidence of relaparotomy was 0.24%. Intraperitoneal hemorrhage (39.2%) was commonest indication of reoperations followed by PPH (17.8%), rectus sheath hematoma (14.8%) and burst abdomen (10.7%). Obstructed labor (32.1%) was commonest indication of primary cesarean. Hysterectomy was required in 8 cases (25.7%), evacuation of blood for hemoperitoneum was required in another 8 cases. Most cases of hemorrhage were reopened within 24 hours, whereas most case of the rectus sheath hematoma, burst abdomen, and broad ligament hematoma were reopened between 5-9 days. Conclusions: Relaparotomy is often a lifesaving procedure. Decision to perform and manage relaparotomy should always be done by senior obstetricians. Meticulous surgical techniques to secure hemostasis at time of primary surgery should be adopted. Strict postoperative vigilance, is of utmost importance for early detection of intraperitoneal hemorrhage and other complications requiring relaparotomy as timely intervention.

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Retrospective study of relaparotomy in department of obstetrics, gynaecology and family planning in, rural tertiary care hospital, Andhra Pradesh, India

Cited by 7 publications

References 0 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

Re-Laparotomy after Caesarean Section at a Tertiary Hospital in Egypt: Cross Sectional Study

An analysis of relaparotomy in operative obstetrics

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