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.     

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%).     

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.     

The problem of relaparotomy in emergency surgery

For the recent 15 years the authors have made 6220 operations on organs of the abdominal cavity, among them there were 111 relaparotomies in 96 patients (1.78%). An atypical course of the postoperative period was an early symptom of unfavorable state of the stomach. Thirty patients died (31.25%). The authors consider that a delayed first operation in urgent surgery is one of the main causes resulting in relaparotomy and appeal to properly perform the sanitary-instructive work, dispensary observation and planned sanitation of surgical patients.     

Diagnostic errors and inadequate therapeutic tactics in tumors of the large intestines

The authors observed 21 patients after previous non-radical treatment in other medical institutions. The age of the patients was from 38 to 80. Radical operations were performed on all the patients during relaparotomies. The authors make a conclusion that choice of a rational surgical and curative tactics in colonic tumors was determined individually with special reference to the general state of the patient, careful assessment of the degree of local spread of the tumor. A dogmatic approach is thought to be inadmissible.     

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.     

Early reoperations after resection of stomach in gastroduodenal ulcers]

The material is based on the 20 years' experience in urgent surgical treatment of 2146 patients with gastroduodenal ulcers (GDU). 120 patients of them underwent relaparotomy. The main reasons for the repeated operations were insufficiency of the sutures of the duodenal stump, peritonitis, bleeding, abscesses of the abdominal cavity. Owing to new tactics of surgical treatment for GDU the authors managed to reduce the number of relaparotomies from 9.3 to 3.7% and total mortality rate from 5 to 0.7%.     

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%.     

Planned relaparotomies in the surgical treatment of severe generalized peritonitis from intestinal origin

The evolution of the septic state and the mortality rate are analyzed in a group of 42 selected patients presenting with severe peritonitis from small or large intestinal origin. All patients presented in a septic state with signs of generalized peritonitis for at least 24 hours. Planned relaparotomies are preferable to the conventional surgical approach of peritoneal lavage which frequently must be followed by demand relaparotomies in patients with recurring peritonitis. The mortality rate in the planned relaparotomy group (29%) was significantly lower than in the conventional treatment group (73%). The poor prognosis of persistent or recurrent multisystem failure complicating septic shock is confirmed. The planned relaparotomy tactic should be considered a valuable alternative approach to the treatment of severe forms of peritonitis.     

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%.     

"Routine" versus "on demand" ultrasonography in the surgical intensive care patient. A prospective randomized study

Between May 1988 und March 1989 all patients who underwent elective or emergency surgery followed by intensive care were randomly assigned to group A (n = 149): routine sonography at the postoperative day 1, 3, 7 and 9, group B (n = 151): sonography on demand. In these two groups, the following parameters were compared: number of relaparotomies, lethality of relaparotomies, total lethality, moment of relaparotomy, period of hospitalisation, time spent with sonography. In the analyzed parameters, our examination showed no difference between the two groups. For this we state that the routine sonographical control of the surgical patient with intensive care being opposed to the sonography on demand shows no significant advantage. The demand for a routine sonography as a postoperative control can not be generally supported.     

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.     

"Second-look" operations in patients with colorectal tumour

The diagnostic problems of metastases and recurrences in colorectal tumour patients are reviewed. The question and indications of relaparotomies are discussed in detail. The results of relaparotomies made for tumorous and nontumorous indications at the Department of Surgery of the National Cancer Institute are reported.     

Urgent Abdominal Re-Explorations

Background  

Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality.     

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.     

Abdominal zippers for temporary abdominal closure in planned relaparotomies for peripancreatic sepsis: experience in a developing country

Background: Planned relaparotomies have generated renewed interest because of the high mortality rates associated with conventional management techniques in severe intraabdominal sepsis. The use of abdominal zippers for temporary abdominal closure was devised to facilitate repeated explorations, allowing daily cleansing of the peritoneal cavity and the detection and management of septic complications. Methods: In our institution, eight patients were managed in a 4-year period, using abdominal zippers for peripancreatic sepsis. Results: In all eight patients, subsequent laparotomies allowed the detection of progressive necrosis. Repeated explorations successfully controlled the sepsis in five patients. In three patients, the condition deteriorated, and they died of multiple organ failure. Conclusions: The technique warrants further prospective controlled trials in the local setting to ascertain its role in the management of severe intraabdominal sepsis, and in other patients who may require "second-look" operations. Received: May 11, 2001 / Accepted: August 1, 2001     

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.     

Early surgical complications of corrective operations in congenital hydronephrosis in children

The analysis of immediate results of 271 correcting operations for congenital hydronephrosis in children has shown that the operations may be followed by such complications at the early postoperative period as aggravation of pyelonephritis (10 patients), urinal fistulas (8 patients), urinary leakage (4 patients), paraureteral abscesses (3 cases) as well as postoperative bleedings (5 cases) and suppuration of the operative wound (4 cases). The exact performance of plastic operations according to the elaborated method, strict observation of indications and contraindications, complex therapy in the postoperative period were found to reduce the amount of complications.     

Laparoscopic "second-look" in the management of mesenteric ischemia

Mesenteric ischemia is a major cause of mortality in surgery. Despite the advances in medicine, considerable number of patients undergoes reoperations for a better assessment of intestinal viability. Although great majority of these second-look operations are "negative explorations," progressive nature of this devastating disease pushes surgeons to re-explore the abdomen. This study compares open and laparoscopic "second-look" procedures in patients with mesenteric ischemia. In the first group (n = 41), abdomen was closed and second-look laparotomy was performed to 23 patients. In the second group (n = 36), a 10-mm trocar was inserted before closing the abdomen and second-look intervention was performed by a telescope to 23 patients. Sixteen of relaparotomies in the first group (70%) revealed nothing and were unnecessary. Two patients (8%) in the laparoscopy group needed re-resection while 20 patients (87%) were rescued from unnecessary laparotomies. Conclusively, patients with mesenteric ischemia are "ill enough" to deserve the "minimal invasion" spirit of laparoscopic surgery.