Relaparotomy in the treatment of postoperative complications in abdominal surgery

Objective. To analyze the results of relaparotomy for the treatment of complications after surgery for various abdominal pathologies and to identify risk factors for mortality after this intervention. Materials and methods. We analyzed the treatment outcomes of 72 patients who underwent surgery at the Clinic of Surgery, Plastic Surgery, and Endoscopy of the Faculty of Postgraduate Education of Danylo Halytsky Lviv National Medical University (base – Department No. 2 of the Center for Surgery and Oncology of the Municipal Non­Profit Enterprise "1st Territorial Medical Association of Lviv") for the period from January 2021 to December 2024. Repeat interventions were performed mainly in patients who were treated for acute adhesive intestinal obstruction and colorectal cancer with its complications – 11 (15.3%) patients each. The vast majority of the complications studied (44.4%) required repeat surgery under general anesthesia (according to the Clavien–Dindo classification) and were accompanied by the onset of multiple organ dysfunction (45.8%). Results. In cases of peritonitis or intestinal obstruction, intra­abdominal bleeding, emergency relaparotomy was performed in 64 (88.9%) patients. In the remaining 8 (11.1%) patients, programmed reintervention was performed due to an unpredictable course of the pathology with its expected progression (acute mesenteric blood flow disorder) or for step­by­step sanitation of purulent­destructive foci (acute destructive pancreatitis with purulent­septic complications). Complications in the early period after relaparotomy occurred in most patients – 40 (55.5%), and in 16 (40%) of them, repeated interventions had to be performed to eliminate them, in particular, in 9 (22.5%) – once, in the remaining 7 (17.5%) – from 2 to 4 times. Thirty­nine patients died, and the postoperative mortality rate was 54.2%. Using multivariate analysis (Mann–Whitney U test), 4 predictors of mortality after relaparotomy were identified. Conclusions. Complications after surgical treatment of colorectal cancer and acute adhesive intestinal obstruction require relaparotomy. Multiple organ failure and sepsis are the most common complications after relaparotomy. Mortality after relaparotomy remains high. Complications of class IVa and above according to the Clavien–Dindo classification are the most significant predictor of mortality after relaparotomy.