Re-Operation after abdominal procedures lessons learnt from our two years experience

Abstract

Objective: The objective of the study are to audit our experience of the management of cases presenting with operative complications requiring acute re operation and to identify the factors resulting in the first operation failure requiring re-exploration. Study Design: A prospective observational/analytical study. Place and duration: Acute re-operative abdominal surgery during two years period 2002-2003 in surgical Unit 1 Allied hospital, Faisalabad. Patient and methods: All the cases which were re-explored after abdominal surgery admitted in surgical unit 1, Allied hospital, Faisalabad are included in the study. Results: The cases fall in three categories, trauma cases (29) 33.71%, non trauma emergency cases (32) 37.25 and elective surgery cases (25) 29.1%. The incidence of our own unit cases subjected to re-operation is 21.9% (24). The presenting pathologies after first operation are in 6 groups; Gastrointestinal fistulas (38 cases) 41.8%, bowel obstruction (7 cases) 8.15%, abdominal abscesses (12 cases) 13.9%, bleeding (18 cases) 20.9%, miscellaneous (biliary and G.U.) (8 cases) 9.35, abdominal wound dehiscence and evisceration (3 cases) 3.6%. Total of 136 complications are in 70 cases. Mortality of 7 cases (8.14) is shared by the semi-trained surgeons, Medical officer operators(6 cases) and the trainee surgeons(1 case).Incidence of mortality in elective surgery cases is 4% in trauma cases 10.34%,non trauma emergency cases 9.4%. Intensive resuscitation including nutritional support, team of senior consultants doing the re-operation, intraoperative and post operative monitoring are the hallmarks of the management. Conclusion: Training and retraining (continuous medical education) of surgeons and regionalization of trauma cases are recommended. The facilities for less invasive procedures blessed with low morbidity and very low mortality will shrink this list of re-operations.