Analysis of early relaparotomy after lower gastrointestinal system surgery.

PURPOSE: To evaluate the complications after lower gastrointestinal system (GIS) operations, and to investigate the reasons for and outcomes of relaparotomy (RL), and the factors influencing its mortality rate.

METHODS

The subjects of this retrospective study were 38 patients who underwent early RL for complications of lower GIS surgery. We analyzed the demographic features and initial diagnoses of the patients, the reasons for their initial surgery and their postoperative complications, and the number, duration, and outcome of early RLs.

RESULTS

The average patient age was 54.8 +/- 16.2 years and the male:female ratio was 30:8. Early RL was performed for the following complications: leakage of an intestinal repair or anastomosis (n = 17, 44.7%); intraabdominal infection or abscess (n = 8, 21%); stomal complications (n = 5, 13.2%); necrosis caused by mesenteric arterial thrombosis (n = 4, 10.5%); hemorrhage (n = 2, 5.3%); and intestinal rupture (n = 2, 5.3%). A mortality rate of 36.8% (n = 14) was attributed mainly to infections (n = 27, 71.4%). The average interval between the first laparotomy and RL was 5.5 +/- 3.5 days, and the average hospital stay was 27.1 +/- 19.4 days.

CONCLUSIONS

Relaparotomy performed soon after major lower GIS surgery is associated with a high mortality rate. Thus, to decrease both the RL and mortality rates, complicated surgery should ideally be performed by experienced surgeons in fully equipped facilities.