Retrospective Study on Patients Undergoing Laparotomy to Assess the Risk Factors of Re-Laparotomy

Abstract

INTRODUCTION: A large number of patients undergo various operative procedures every day, out of which laparotomy forms a major proportion. Abdominal surgery that has to be redone in association with initial surgery is referred to as re laparotomy. Relaparotomy is associated with increased morbidity and mortality. Therefore it’s the final choice of surgery. Whenever re laparotomy is necessary, mortality increases to as high as 22% to 51%.3. AIM OF THE STUDY: 1. To find out the incidence of re- laparotomy. 2. To identify the risk factors/ predictors of re laparotomy in patients undergoing general surgery operations. OBJECTIVES: 1. The objective of the study are to find the incidence of revision among laparotomy cases. 2. To identify the predictors of re laparotomy. 3. To develop a scoring system to assess patients at risk for re laparotomy. METHODOLOGY: Study Design: Retrospective Study. Sample size: 100. Duration: 1 ½ Year, 1st Jan 2016 – 1st June 2017. Statistical Analysis: 1. Data analysed using SPSS 22. 2. Results were expressed in percentage. 3. Associations were analysed using chi-square or ‘t’ test depending on outcome variables. Inclusion Criteria: 1. Age more than 18 years. 2. Patients requiring laparotomy. 3. Both general and trauma surgery. Exclusion Criteria: 1. Patient with initial laparostomy, only flank drain placement. 2. Laparotomies during colostomy / ileostomy closure. 3. Initial laparoscopic procedure. 4. Minimal invasive procedure like ultrasound guided drainage etc. RESULTS: The incidence of revision laparotomy in this study was 7% and the incidence of second revision laparotomy was 1%,The indications for relaparotomy wereanastamoticleak 2/7 (20 %) , burst abdomen 2/7 (20%) , pancreatic injury 1/7 (10%), bladder injury 1/7 (10%), negative laparotomy 1/7 (10%), anastamotic leak and burst abdomen , The variables with significant p value are systemic hypertension, COPD, CAD, intra op and post op inotoropic support, wound infection , wound dehiscence and inta abdominal abscess.