Reasons for relaparotomies following operations on the biliary tract in nontumorous lesions

According to the authors' data the incidence of relaparotomies after 1500 operations for non-tumor diseases of bile ducts was 2.5%. Causes of relaparotomies at early and late terms of the postoperative period were different. The dependence of results of the treatment on the amount of relaparotomies and the presence of such complications as jaundice, cholangitis and pancreatitis has been established. In such complications and increased amount of relaparotomies lethality was considerably higher. General lethality after relaparotomies was 49%. Complex of prophylactic and curative measures of the complications resulting in relaparotomies has been developed.     

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.     

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 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.     

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%.     

Indications for relaparotomy

From 1980 to 1987, 10,446 patients were operated on. In 152 patients, the necessity of a repeated operative intervention arose. In 106 patients the emergency, in 42--delayed, and in 4--elective relaparotomies were performed. There were the following indications for relaparotomy: diffuse and circumscribed peritonitis (78 patients), ileus (46), eventration (11), hemorrhage (12), others (5). Diagnosis of postoperative complications requiring relaparotomy is difficult. The postoperative lethality was 26%.     

Peritoneal sorption and lymphotropic therapy of postoperative diffuse purulent peritonitis

New method for treatment of postoperative diffuse purulent peritonitis is proposed and used in 30 patients. It is based on combined application of sanation relaparotomies, peritoneosorption by the sorbent SUMS-1 with metronidazole, adsorbed on it, and lymphotropic antibacterial therapy. The treatment resulted in quicker restoration of clinical and laboratory values, reduced in frequency of pyoinflammatory complications and decreased lethality rate to 20% in comparison with conventional treatment.     

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.     

Intraabdominal hemorrhage after surgery on the abdominal organs requiring relaparotomy]

The results of 76 relaparotomies performed for intraabdominal postoperative hemorrhage after emergency and elective operation on the abdominal organs are presented. The clinical features, diagnosis of profuse and capillary postoperative hemorrhage, causes and indications for relaparotomy performance are considered. Lethality in intraabdominal postoperative hemorrhage was 18.4%.     

Proteins of blood plasma in patients with pancreonecrosis

Dynamics of effective and general concentration of albumins and middle-size molecules in blood plasma of patients with severe pancreonecrosis is described. Significant differences of these data in operated and non-operated patients are revealed. A negative correlation between severity of pancreatic necrosis and concentrations of albumins, and a direct correlation between necrotic lesion and concentration of middle-size molecules in blood plasma were demonstrated. The above parameters are important for assessment of treatment efficacy, prognosis of postoperative complications and determination of indications to sanated relaparotomies in patients with pancreonecrosis.     

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.     

Relaparotomy in children]

Specific features of the course of complicated and noncomplicated postoperative period were studied in 21,294 children. Data of 682 relaparotomies were analyzed. The definition of the term "relaparotomy" and classification of relaparotomies are given.     

Principles of determination of surgical policy in general peritonitis

Based on clinical examination and analysis of treatment results of 575 patients with general peritonitis, the most informative factors were determined which predict lethal outcome, progression of peritonitis and help choose the most effective surgical policy. It is demonstrated that conventional treatment is preferable in the interval of perioperative score of APACHE II from 0 to 10, and programmed sanation relaparotomies -- from 11 to 15. Data about efficacy of total intestinal decompression and peritoneal-enteral lavage, and also methods of mathematical prediction of postoperative complications and outcomes are presented. Prognostic value of individual symptoms, different degree of organs dysfunction and SIRS criteria in early postoperative period were determined.     

Strategy of the surgical treatment of postoperative complications in patients with obstructive ileus of the colon of tumorous etiology]

Under analysis were postoperative intraperitoneal complications and results of relaparotomies in 33 patients (13 women and 20 men) aged from 33 to 76 years with obturative ileus caused by stenosing cancer of different portions of the colon. High frequency of peritonitis in the general picture of postoperative complications was due to incompetent sutures of the colonic anastomoses applied during emergency and urgent operations in patients with sub- and decompensated forms of intestinal obstruction. The best variant of completion of radical operations in emergency surgery in this category of patients is the formation of a single- or double-trunk colostomy without a primary reestablishment of the continuity of the intestinal tube especially when stenosing cancer is localized in the left part of the colon.     

Postoperative ileus--early, late or no surgery at all?

One third of all relaparotomies are due to early postoperative bowel obstructions. Operations on the small bowel and colon are predominant among the primary procedures. The main causes of obstructions are adhesions. The symptoms of intestinal obstruction in the early postoperative period can be masked by a prolonged postoperative ileus. Reoperation of bowel obstruction is easier and safer in the first ten postoperative days compared to delayed reintervention after unsuccessful conservative treatment. When obstruction occurs after the first postoperative week, an initial conservative therapy for 7 to 10 days can be successful in over 50%.     

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.     

Criteria of early diagnosis of postoperative peritonitis in abdominal injuries]

The article deals with 221 relaparotomies in abdominal injuries. It was undertaken for postoperative peritonitis in 136 (61.5%) patients. It was established that signs of intoxication are the early diagnostic criteria of peritonitis which determine the indications for laparotomy in injuries to the abdomen. Signs of peritoneal irritation are less informative. The diagnosis of postoperative peritonitis can be made sufficiently objectively on the grounds of a diagnostic index suggested by the authors.     

Surgical treatment of appendicular peritonitis in children

The article is based on the results of 10-year use of the method of aspiration drainage of the abdominal cavity in the treatment of 980 children with purulent peritonitis of appendicular origin. The authors used only a polymer tube to drain the cavity of the true pelvis and in principle did not resort to intraoperative irrigation of the abdominal cavity, postoperative lavage, and intraperitoneal injection of antibiotics. Postoperative complications were recognized in the early stages of development and were treated by nonoperative methods on the main. The number of relaparotomies was 0.83% of the total number of operations for appendectomy. The described method meets the principles of pediatric surgery most fully, is more sparing than the other methods, and the authors recommend it for wide introduction into practice.     

Postoperative peritonitis

About 50% of relaparotomies in the early postoperative period are caused by peritonitis, the lethality ranges from 32 to 88% (average 56%). The most frequent reasons for the development of peritonitis following abdominal surgery are presented as well as the possible way to early diagnosis of this complication. In view of the poor prognosis an aggressive proceeding in therapy is necessary: referring to the results published since Starlinger (1954) the importance of an early decision for relaparotomy in order to raise the survival rate is pointed out.