Indications and Outcome of Patients who had Re-Laparotomy: Two Years' Experience from a Teaching Hospital in a Developing Nation.

backgroundComplications from abdominal surgery may necessitate a second or more surgeries, re-laparotomy. It is associated with significant morbidity and mortality. Data on relaparotomy from the developing nations is limited. This study aims to assess the indications and outcome of patients who had relaparotomy.

methodsA retrospective review of medical records of all patients who underwent Re-laparotomy at St. Paul's Hospital Millennium Medical College from January 2016 to December 2017 was done.

resultOf 2146 laparotomies, 6.9% (149) needed re-laparotomy and 129 patients were analyzed. Most (123,95.3%) had on-demand re-laparotomy. Patients operated on emergency made 70.5% (91) of the cases making the ratio of emergency to elective surgery 2.4:1. The three most common surgeries that needed re-laparotomy were, Perforated appendicitis (35,27.1%), bowel obstructions (28,21.7%) , and trauma (20,13.4%). The most common indications for relaparotomy were intra-abdominal abscess (57,44.23%), wound dehiscence (17,13.2%) and anastomotic leak (15 ,11.6%). Surgical site infection (128,100%) and malnutrition (58,45%) were the leading complications. The overall mortality rate was 12.8 % (19). There was no statically significant difference in mortality rate between on-demand and planned re-laparotomy (P=0.388), urgency of the primary surgery (P=0.891) and the number of relaparotomy (p=0.629). Re-laparotomy for anastomotic leak (p=0.001) and patients above fifty years of age (P=0.015) had significant associations with mortality.

conclusionIntra-abdominal abscess collection, wound dehiscence and anastomotic leak were the most common indications of re-laparotomies. Age above fifty years and anastomotic leaks were significantly associated with mortality.