Clinical Outcome of Re-laparotomy

Background: Re-laparotomy (RL) is a rare occurrence to treat complication after surgery associated with significant morbidity and mortality. Inappropriate selection of patients for re-laparotomy, those who will not clearly get benefit from surgery can be detrimental. Objective: To observe the post-operative outcomes in terms of post-operative mortality and morbidity following re-laparotomy. Methods: This prospective observational study was conducted in the Department of Surgery, Dhaka Medical College Hospital over a period of 6 months. A total of 41 patients undergone re-laparotomy were selected for the study sample. Data were collected in a pre-designed data collection sheet including particulars of the patients, detailed history, pre- and per-operative findings; surgical procedures and postoperative complications were investigated. Chi-square test was used to analyze categorical variables. Results: Forty-one patients (mean age 37.9 ± 15.2 years; 63.4% male) underwent re-laparotomy; 28.6% required multiple re-laparotomies. Initial index surgeries comprised bowel resection (34.2%) and perforation repair (24.4%). Indications included new or recurrent perforation (36.6%) and anastomotic leakage (22.0%). Overall mortality was 46.3%, with survival at 53.7%; mortality increased to 100% in patients aged > 64 years (p=0.04). Postoperative ICU admission occurred in 17.1% with mean ICU stay of 5.0 ± 3.0 days. Mean hospital stay was 22.5 ± 18.5 days. Complications included wound infection (26.8%), sepsis (17.1%), burst abdomen (12.2%), pulmonary complication (14.6%), acute kidney injury (4.9%), and DIC (4.9%). Chi-square analysis identified age > 44 (χ²=8.62, p=0.01) and multiple re-laparotomies (χ²=2.45, p=0.12) as predictors. RL incidence: 5.0%. Conclusions:  Re-laparotomy is a life-saving procedure, but it has a high mortality rate particularly with increasing age. Re-laparotomy prolongs post-operative hospital stay creating financial burden to patients. Although timely re-laparotomy can save the life, the main focus should be on lowering re-laparotomy rates. The first laparotomy should be done with extreme care.