Réinterventions de chirurgie abdominale en milieu défavorisé : indications et suites opératoires (238 cas)

Abstract

We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.