Risk Of Relaparotomy Research Articles

Laparoscopic Repair Modality of Perforated Peptic Ulcer: Less Is More?

Perforation, per se, presents the most serious complication of peptic ulcer disease with a mortality rate that cannot be underestimated. Surgery is the only treatment option, which can be performed laparoscopically or via conventional laparotomy. The present study aimed to compare the short-term outcomes of laparoscopy and laparotomy techniques in the surgical treatment of peptic ulcer perforation. A retrospective study design was structured to compare the perioperative and short-term postoperative outcomes of 102 patients who had undergone laparoscopic and conventional repair of the perforated peptic ulcer over a six-year interval (January 1, 2016, to December 31, 2021). Of these, 44 (43.1%) had undergone laparoscopic repair while 58 (56.9%) had surgical repair via conventional laparotomy. The operative time and length of hospital stay were comparable in both subgroups (p=0.984 and p =0.585). Nevertheless, 30-day postoperative morbidity was significantly higher in the open surgery subgroup (75.9% vs. 59.1%, p= 0.032). The risk of relaparotomy was similar in both study subgroups; however, suture dehiscence as a reason for surgical revision was significantly more frequent in the laparoscopic subgroup (13.6% vs 3.4%). Of note, the mortality rate in the laparoscopic group of patients was 13.6%, and in the laparotomy group 41.4%. The laparoscopic approach to peptic ulcer perforation is the procedure of choice for low-risk patients. Conventional surgery seems to be associated with a significantly higher incidence of severe postoperative complications and mortality. However, the higher mortality in these patients is probably related to their worse initial clinical condition.

Relaparotomy post-cesarean delivery: characteristics and risk factors.

Relaparotomy following cesarean delivery (CD) is performed at a rate of 0.2-1% of CD. The objective of the present study was to identify risk factors for relaparotomy following CD, and to examine whether there is a difference in the risk of relaparotomy between CD performed during different hours of the day. A retrospective study on all CD over 10years compared pregnancies that underwent laparotomy within 1week following CD to those that did not. Sixty-four patients underwent relaparotomy out of 24,239 CDs (0.26%). In univariate analysis, relaparotomy was significantly associated with pregnancies following assisted-reproductive-technologies odds ratio (OR) 95% confidence interval (CI) 3.15 (1.90-5.22), hypertensive disorders of pregnancy OR 3.05 (1.62-5.72), twin pregnancies OR 95% CI 3.78 (2.21-6.48), preterm deliveries OR 95% CI 2.44 (1.46-4.10), placenta previa OR 95% CI 6.41(2.55-16.09) and urgent CD 1.74 (1.06-2.86), especially during the second-stage of labor OR 95% CI 2.73 (1.34-5.54). The time of day of CD did not influence the rate of relaparotomy. In a multivariable-regression analysis, the adjusted odds ratio for relaparotomy was 10.24 in CD due to placenta previa, and 5.28 in CD performed at the second-stage of delivery. At relaparotomy, active bleeding was found in 50 patients (78.1%), nearly half received packed cells, 12.5% developed consumptive coagulopathy, and 17.2% needed hospitalization in the intensive care unit. 6.3% underwent a second relaparotomy, mainly due to bleeding. Placenta previa, and urgent CDs mainly those performed at the second stage of labor are risk factors for relaparotomy after CD.

Impact of albumin levels on clinical outcomes in children underwent abdominal surgery

Background Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications. The prognostic role of albumin levels in children with abdominal surgery remains unclear.
 Objective To investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery.
 Methods This was a retrospective cohort study on children aged 29 days to 18 years, who underwent abdominal surgery, had serum albumin levels measured at pre-operative and within 48 hours post-operatively, and hospitalized in Paediatric Intensive Care Unit of Dr. Cipto Mangunkusumo Hospital, Indonesia. The primary outcomes were post-operative complications (sepsis, surgical site infection, shock), length of stay in PICU, dehiscence, relaparotomy, and postoperative mortality.
 Results This study recruited a total of 201 children. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were found in 15.4% and 51.2%, respectively. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were associated with higher risk of post-operative sepsis (RR 3.4; 95%CI 1.54 to 7.51) and relaparotomy (RR 3.84; 95%CI 1.28 to 1.49). The median of length of PICU stay was 4 days longer in children with pre-operative serum albumin levels ≤ 3.00 g/dL (P<0.001).
 Conclusions Hypoalbuminemia condition in children undergo abdominal surgery is associated with increased risk of post-operative sepsis, longer length of stay in PICU, and risk of relaparotomy.

Impact of albumin levels on clinical outcomes in children underwent abdominal surgery

Background Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications. The prognostic role of albumin levels in children with abdominal surgery remains unclear.
 Objective To investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery.
 Methods This was a retrospective cohort study on children aged 29 days to 18 years, who underwent abdominal surgery, had serum albumin levels measured at pre-operative and within 48 hours post-operatively, and hospitalized in Paediatric Intensive Care Unit of Dr. Cipto Mangunkusumo Hospital, Indonesia. The primary outcomes were post-operative complications (sepsis, surgical site infection, shock), length of stay in PICU, dehiscence, relaparotomy, and postoperative mortality.
 Results This study recruited a total of 201 children. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were found in 15.4% and 51.2%, respectively. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were associated with higher risk of post-operative sepsis (RR 3.4; 95%CI 1.54 to 7.51) and relaparotomy (RR 3.84; 95%CI 1.28 to 1.49). The median of length of PICU stay was 4 days longer in children with pre-operative serum albumin levels ≤ 3.00 g/dL (P<0.001).
 Conclusions Hypoalbuminemia condition in children undergo abdominal surgery is associated with increased risk of post-operative sepsis, longer length of stay in PICU, and risk of relaparotomy.

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

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.

Re-laparotomy after cesarean section: risk, indications and management options.

ABSTRACTAim:To identify risks, indications and outcomes for relaparotomy after cesarean delivery.Methods:A prospective case-controlled study conducted at Mansoura University Hospital, Egypt from 2009 to 2012. Each case was matched randomly to 2 cases that had delivered by cesarean section during the same period and did not undergo repeated surgical intervention. Information's on indications were obtained to gather information's on risks factors.Results:relaparotomy complicated 1.04 %(n= 26) of the total number of the cesarean section (CS) (n=2500). The principal indications for relaparotomy were internal bleeding (Intra-abdominal bleeding in 41.7% (n=10); rectus sheath hematoma in 29.2% (n=7) and uncontrolled postpartum hemorrhage (PPH) in 29.2 %(n=7) of cases, followed by infections in 7.7% (n=2) of cases. Resulting in 11.5 %(n=3) maternal death. Predictors for relaparotomy after cesarean delivery from univariate logistic model, placenta previa (OR=6.898, 95% CI=1.867- 25.4, P=.004), fetal weight greater than 4 kg (OR=6.409, 95% CI=1.444-28.44,. 015). Previous cesarean section and parity were not a risk for re-laparotomy.Conclusion:In this study, the incidence of relaparotomy after cesarean delivery was very high (1.04%). Associated with high maternal mortality (11.5%). The main predictors were placenta previa and fetal macrosomia.

Predictors of relaparotomy after nontrauma emergency general surgery with initial fascial closure

Background Relaparotomy after emergency surgery for nontrauma intraabdominal catastrophes (NTIAC) is morbid. Our objective was to identify patients who likely will need on-demand relaparotomy after surgery for NTIAC. Methods A retrospective chart review of patients from 1998 to 2008 identified cases of NTIAC surgery with fascial closure. Demographics, comorbidities, intraoperative findings, morbidity, and mortality were analyzed. Relaparotomy was defined as any return to the operating room with surgical re-entry of the abdominal cavity. Results A total of 129 patients underwent NTIAC surgery with fascial closure. Twenty-nine patients (22%) required relaparotomy and 100 patients (78%) did not. Multivariate analysis identified the following predictors of relaparotomy: peripheral vascular disease ( P = .04), alcohol abuse ( P = .02), body mass index of 29 kg/m 2 or greater ( P = .04), the finding of any ischemic bowel ( P = .02), and operating room latency of 60 hours or longer ( P = .01). Patients with 2 or more of these predictors had a 55% risk of relaparotomy whereas patients with fewer than 2 of these predictors had a 9% risk ( P < .001). Conclusions Patients whose fascia is closed during NTIAC surgery do worse when they require relaparotomy. We have identified preoperative and intraoperative predictors that may help identify patients at high risk of on-demand relaparotomy.

Re-laparotomy After Cesarean Section

Because little is known about repeat laparotomy in the early postoperative period following cesarean section-one of the least frequent short-term complications-the investigators reviewed 3380 women having cesarean deliveries in the years 1996 to 2006. They represented 18% of all parturients seen during this period. Eighteen women, 0.53% of those having cesarean section, underwent re-laparotomy during the same hospitalization. The indication for re-operation was hemorrhage in 12 instances, eventration (protrusion of intestines through the abdominal wound) in 3, and formation of an intra-abdominal abscess in 3 others. There were no maternal deaths. All women re-operated on for bleeding underwent drainage, hemostasis, and either re-suturing or scar repair. None of these women had arterial ligation, and the uterus was spared in all cases. Eventration was treated effectively by debridement and secondary re-suturing. All 3 women with abscesses initially failed to respond to treatment for endometritis or to conservative management once the diagnosis was made by CT scanning. One of these women required hysterectomy because of extensive myometrial infection and necrosis. The risk of re-laparotomy in the postoperative period following cesarean section can be minimized by recognizing high-risk patients, utilizing meticulous surgical technique, optimizing hemostasis, properly closing the abdominal wound, and ensuring close postoperative follow-up.