Relaparotomy after appendectomy]

A result of 70 relaparotomies performed after the operative intervention for acute appendicitis has been analysed. The causes and indications for reoperation, an outcome, nature of complications which required performance of relaparotomy have been considered. A classification of relaparotomies depending on time of their performance is suggested.     

Surgical treatment of complications after operations on the biliary tract

Causes of relaparotomies after operations for cholelithiasis are analyzed. The frequency of relaparotomies after cholecystectomies was 2.1%. Technical defects in performing operations were the cause of postoperative complications in 52.4% of the cases. Of 63 patients subjected to relaparotomy 23 patients died (36.5%). Prophylactics of complications after operations on bile ducts should be directed first of all to careful observation of the cholecystectomy technique.     

Possibility of predicting and preventing postoperative complications leading to relaparotomy

The occurrence of relaparotomies is known to be 1,2% of operations on the abdomen organs. Pyo-inflammatory complications are responsible for more than half cases resulting in relaparotomies. Relaparotomies are divided into emergent and urgent, radical and palliative. A system for prognosis of complications and differential diagnosis of postoperative paresis of the gastro-intestinal tract and postoperative peritonitis is presented. Prophylactics of postoperative complications reduced lethality after relaparotomies from 79% to 56%.     

Indications for relaparotomy and its results

For the recent six years 6855 operations on abdominal organs have been performed which were followed by relaparotomies in 104 patients (1.5%). The authors show that the greatest amount of relaparotomies followed operations for ulcer disease, tumors and cholecystitis. The main causes of relaparotomies were peritonitis, intestinal obstructions and bleedings. The group of greater risk consisted of men aged 50-60. The amount of relaparotomies can be reduced due to unification of medical tactics, strict observation of the operation technique and responsible management of the patients in the postoperative period.     

Early relaparotomy

An analysis of 14565 operations on organs of the abdominal cavity has shown that main causes of early relaparotomies were peritonites (47,4%), intestinal obstruction (33,3%), eventration of the abdominal organs (16,0%) and hemoperitoneum (3,3%). The highest lethality was after postoperative peritonitis (54,1%). For the recent 10 years the total lethality has become 31,6% lower due to better diagnosis and early relaparotomies.     

Diagnosis and treatment of postoperative intraabdominal complications

Postoperative complications after 8168 reoperations were seen in 143 (1.8%) patients. Clinical symptoms, laboratory tests, results of x-ray and ultrasound examinations were taken into account in diagnosis of the complications. Differential diagnosis of postoperative peritonitis, stable paralytic intestinal obstruction, early adhesive obstruction and intraabdominal bleeding based only on clinical data is difficult in many cases. Ultrasonic examination and laparoscopy permitted to reduce number of unjustified relaparotomies. In the majority of cases relaparotomy was considered as a method of choice in treatment of these complications. Mini-invasive surgeries may be performed only in mild complications. Lethality in the treatment of postoperative complications after relaparotomy was 39.4%, after laparoscopic surgeries--8.8%, after US-assisted drainage--0. General lethality was 29.4%.     

Relaparotomies following the creation of intestinal anastomoses in newborn infants]

An analysis of the immediate postoperative period in 295 newborns after putting intestinal anastomoses was made. Postoperative surgical complications were found in 38 children who required 47 relaparotomies. Surgical tactics was determined for the complications of the postoperative period as well as the indications for relaparotomy.     

Programmed relaparotomy in generalized purulent peritonitis

Efficacy of programmed relaparotomy in combined treatment of 51 patients with generalized peritonitis is analyzed. Based on evaluation of surgical data, basic clinical and laboratory markers of endotoxicosis algorithm of programmed relaparotomy has been developed. Comparative analysis of the results of treatment of 36 patients after 1-2 programmed relaparotomies (1.6+/-0.5 surgeries) and 15 patients after repeated relaparotomies (3.4+/-0.3 surgeries) demonstrated that these methods were more effective before development of significant polyorganic disturbances. Nine (17.6%) patients died.     

Early post‐liver transplant surgical morbidity in HIV‐infected recipients: risk factor for overall survival? A nationwide retrospective study

The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV‐infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause‐specific early relaparotomies were noted when compared with a non‐HIV control group, matched for MELD, recipient age, HCV‐RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux‐en‐Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux‐en‐Y choledochojejunostomy are associated with increased risk of early relaparotomy.     

Elective relaparotomy as a method of treatment and prevention of complications of diffuse suppurative peritonitis

The results of treatment of 41 patient with diffuse purulent peritonitis, who underwent 2 and more relaparotomies are analysed. It has been proved that performance of the elective relaparotomy for preventing the development of intraabdominal complications of peritonitis were superior to the existing methods of treatment. It permitted to reduce lethality in diffuse purulent peritonitis 3.6-fold.     

Surveillance and rescue of pancreas grafts

BACKGROUND: Technical failure rates are higher for pancreas allografts (PA) compared with other solid organs. Posttransplant surveillance and prompt availability of rescue teams with multidisciplinary expertise both contribute to improve this result. We herein report a single institution's experience with posttransplant surveillance and rescue of PA. METHODS: A retrospective survey was performed of a consecutive series of 177 whole organ pancreas transplants in 173 patients. Antithrombotic prophylaxis was used in all recipients and tailored on anticipated individual risk of thrombosis. During the first posttransplant week, all PA were monitored with daily Doppler ultrasonography. Surgical complications were defined as all adverse events requiring relaparotomy during the initial hospital stay or the first 3 posttransplant months. RESULTS: A total of 26 relaparotomies were performed in 25 patients (14.7%). One recipient needed two relaparotomies (0.6%). Graft rescue was attempted in patients without permanent parenchymal damage at repeat surgery and in 12 recipients diagnosed with nonocclusive vascular thrombosis. Overall 25 grafts (96.3%) were rescued and one was lost. One-year recipient and graft survivals in patients with versus without complications potentially leading to allograft loss were 92.6% and 63.0% versus 94.4% and 94.3%, respectively. Excluding complications for which graft rescue was not possible, 1-year graft survival rate increased to 78.7%. CONCLUSIONS: Close posttransplant surveillance can allow rescue of a relevant proportion of PA developing nonocclusive venous thrombosis or other surgical complications. Further improvement awaits better understanding of biological reasons for posttransplant complications jeopardizing PA survival and the development of more effective preventive measures.     

An analysis of the reasons for relaparotomy in the surgical clinic]

The results of surgical treatment of 4,078 patients who underwent operation in 1985-1989 were studied. Due to the occurrence of complications in the early postoperative period, 182 relaparotomies were carried out in 164 patients. The main indications for relaparotomies were advanced underlying disease, surgical errors (tactical, technical), changes of the patients' immune status. Early diagnosis, timely operation with the use of technically correct manipulations, and the application of a full complex of intensive therapy measures in the postoperative period are important in the prevention of complications.     

Relaparotomies: Why is Mortality Higher?

Background:   

Relaparotomy is sometimes required for complications that develop after abdominal surgery, but it is associated with high mortality. We aimed to investigate the independent risk factors related to mortality in patients that undergo relaparotomies.     

Surgical complications after liver transplantation

AIM: The number of liver transplantations in Italy has steadily increased over the last 10 years as a result of the use of donors aged more than 60 years. The use of organs with a reduced functional reserve has been compensated for by improvements in immunosuppressive therapy, surgical techniques and the management of postoperative complications. This article describes the incidence and treatment of the main surgical complications after liver transplantation. METHODS: Between January 1996 and June 2003, 398 patients received 430 transplants at our Centre. Thirty-seven early relaparotomies were performed (8.6%), including 12 retransplantation (2.8%). The 1-, 3- and 5-year actuarial survival of the patients was 79.8%, 72.2% and 67.5%, and that of the grafts was 75.9%, 68% and 63.4%. Perioperative mortality was 10.5% (with no intraoperative deaths). RESULTS: The overall incidence of biliary complications was 31.6%, 9.1% of which were due to the removal of the Kehr tube. There were 42 (9.8%) anastomotic stenoses, 5 (1.2%) extra-anastomotic stenoses, 1 (0.2%) anastomotic leak, 5 (1.2%) extra-anastomotic leaks, and 19 (4.4%) ischemic-type biliary lesions. The overall incidence of vascular complications was 6.9%: 7 (1.6%) cases of hepatic artery thrombosis, 17 (4.0%) arterial stenoses, 1 (0.2%) arterial pseudoaneurysm, 4 (0.9%) cases of portal thromboses and 1 (0.2%) case of caval laminar thrombosis. Eight patients (1.9%) developed massive and persistent post-transplant ascites and/or hydrothorax. CONCLUSION: The use of donors aged more than 60 years makes it possible to maintain high standards of patient and graft survival that is not only due to the optimisation of immunosuppressive protocols, but also to improvements in surgical techniques, intensive care and the management of surgical complications.     

Relaparotomy in children

124 relaparotomies were performed in 70 children (1,9% of all the patients who had been operated on organs of the abdominal cavity). Eventrations made their appearance mainly in children of the first year of life, operated upon for malformations and having severe background diseases. The transrectal incision was found to have no advantages over the median incision in relation to the appearance of eventrations. Lethality after relaparotomied was 36,6%.     

Relaparotomy in abdominal injuries in children]

An analysis of 18 relaparotomies in 12 children with injuries of the abdominal organs is presented. Inadequate measures against paresis immediately after laparotomy are felt to be the main cause of reoperations for an adhesive-dynamic form of the obstruction. While accomplishing relaparotomy, it is recommended not to resort to reconstructive operative procedures in cases where a palliative operation promptly liquidating complications would suffice.     

Emergency relaparotomy in children

Early relaparotomies following operations on organs of the abdominal cavity were shown by the authors to be necessary in 1,3% of the patients operated on due to developing intraperitoneal complications. The main causes of repeated operations were: intestinal obstruction, diffuse peritonitis, intestinal eventration, limited purulent processes in the abdominal cavity and intraperitoneal bleedings. Postoperative lethality proved to be high (23,5%).     

Combined treatment of acute diffuse peritonitis]

Results of treatment in 199 patients were analysed. The patients were divided into 3 groups. In group 1 (80 patients) acute diffuse peritonitis was treated with conventional methods, in group 2 (62 patients) conventional treatment was supplemented by exchange plasmapheresis, in group 3 (57 patients) conventional treatment was used together with extracorporeal detoxication and elective relaparotomies. Plasmapheresis and elective relaparotomies resulted in increase of effectiveness of the treatment in acute diffuse peritonitis. The intervals between the elective relaparotomies and sessions of plasmapheresis depended on the stage and the course of peritonitis. Lethality rate in conventional method of treatment for acute diffuse peritonitis made up 39%, in plasmapheresis 29%, and in combined treatment--24.5%.     

The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis

Background Secondary peritonitis causes considerable mortality and morbidity. New strategies have been introduced like relaparotomy and temporary abdominal closure in the management of such persistent intra-abdominal infections. Materials and methods Rats were divided into five groups each having ten animals. After induction of peritonitis, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques. After performing two relaparotomies during a 48-h period, all fascias closed primarily and incisional tensile strengths, hydroxyproline contents, and adhesions were measured on the following seventh day. Results The median values of tensile strength and hydroxyproline concentrations were lowest in skin-only closure rats. Intraperitoneal adhesion scores were highest in Bogota bag closure group. Conclusion Primary, Bogota bag, and polyprolene mesh closures seem to be safe in terms of early fascial wound healing. Although it is easy to perform, skin-only closure technique has deleterious effects on fascial wound healing probably due to fascial retraction. Interestingly, Bogota bag has caused increased intraperitoneal adhesion formation.