Evaluation of factors that affecting mortality in urgent redo-laparotomies

Yıl 2017, Cilt: 4 Sayı: 5, 35 - 43, 31.05.2017

Erdal Uysal , Kadir Turel Efe Sezgin

https://doi.org/10.17546/msd.315378

Öz

Objective: The aim of this study was to investigate the factors that affect mortality in patients undergoing Urgent abdominal redo-laparatomies (UARLs) and to analyze the common indications and operative,demograhic and clinical characteristics in UARLs.

Material and Methods: Our study was designed as a retrospective, observational and multi-centric study. A total of 155 patients from two separate clinics undergoing urgent, unplanned redo-laparatomy were included in the study. The data obtained from all clinics were collected and and the relations of the demographic, clinical and operational factors with the mortalities of primary surgery and multiple UARLs were analyzed.

Results: Mortality was observed in 42 (27%) patients. The most frequent causes of mortality were sepsis and multi-system organ failure in 23 (53.4%) patients. The relationships between the number of redo-laparotomy presence of blood transfusion,  older age,classification of surgery  and mortality were significant (p<0.05).

Conclusion: Sepsis and multi-organ failure were the most frequent cause of mortality in our study as well, with a rate of 53.4 %. No significant relationship was observed between mortality and initial surgery under emergency conditions and presence of comorbidity.  Redolaparatomies inevitable in some clinical situations. Since multiple redolaparatomies are associated with mortality , it is necessary to avoid complications during initial surgery to reduce UARLs. Major surgery operation UARLs in elderly people should be avoided. Finally, the surgeon should also make the UARLs decision at the right time.

Anahtar Kelimeler

Urgent, redo-laparatomy, mortality

Kaynakça

• 1. Koirala R, Mehta N, Varma V, Kapoor S, Kumaran V, Nundy S. Urgent Redo-Laparotomies: Patterns and Outcome-A Single Centre Experience. Indian J Surg. 2015;77:195-9.
• 2. Haluk RU, Erdinc K, Haldun K, Ahmet B, Mustafa P, Mehmet AO. Urgent abdominal re-explorations. World J Emerg Surg. 2006;1:10.
• 3. Pusajó JF, Bumaschny E, Doglio GR, Cherjovsky MR, Lipinszki AI, Hernández MS, et al. Postoperative intra-abdominal sepsis requiring reoperation. Value of a predictive index. Arch Surg. 1993;128:218-22.
• 4. Fry DE, Garrison RN, Neitsch RC, Calhoun K, Polk HC. Determinants of death in patients with intra-abdominal abscess. Surgery1980; 88:517-523.
• 5. Christou NV, Barie PS, Dellinger EP, Waymack JP, Harlan H. Surgical Infection Society Intra-abdominal Infection Study. Arch Surg. 1993;128:193-199.
• 6. Butler JA, Huang J, Wilson SE. Repeated laparotomy for postoperative intra-abdominal sepsis. An analysis of outcome predictors. Arch Surg. 1987;122:702-6.
• 7. Ching SS, Muralikrishnan VP, Whiteley GS. Relaparotomy: a fiveyear review of indications and outcome. Int J Clin Pract. 2003; 57:333-337.
• 8. Hinsdale JG, Jaffe BM. Re-operation for intra-abdominal sepsis. Indications and results in modern critical care setting. Ann Surg. 1984;199:31-6.
• 9. Nakayama Y, Konishi M, Gotohda N, Kato Y, Aizawa H, Kudo M, et al. Comparison of postoperative early and late complications between pancreas-sparing duodenectomy and pancreatoduodenectomy. Surg Today. 2016; doi: 10.1007/s00595-016-1418-1.
• 10. Loveček M, Skalický P, Köcher M, Černá M, Prášil V, Holusková I, et al. Postpancreatectomy haemorrhage (PPH), prevalence, diagnosis and management. Rozhl Chir. 2016;95:350-357.
• 11. Teichmann W, Wittmann DH, Andreone PA. Scheduled reoperations (etappenlavage) for diffuse peritonitis. Arch Surg. 1986;121:147-52.
• 12. Sautner T, Gotzinger P, Redl-Wenzel EM, Dittrich K, Felfernig M, Sporn P, et al. Does reoperation for abdominal sepsis enhance the inflammatory host response? Arch Surg. 1997;132:250-5.
• 13. Wittmann DH, Aprahamian C, Bergstein JM. Planned relaparotomy: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg. 1990;14:218-26.
• 14. Billing A, Frohlich D, Mialkowskyi O, Stokstad P, Schildberg FW. Treatment of peritonitis with staged lavage: prognostic criteria and course of treatment. Langenbecks Arch Chir. 1992;377:305-13.
• 15. Nathens AB, Rotstein OD, Marshall JC. Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg. 1998;22:158-63.
• 16. Marshall JC, Christou NV, Horn R, Meakins JL. The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg. 1988;123:309-15
• 17. Mulier S, Penninckx F, Verwaest C, Filez L, Aerts R, Fieuws S, et al. Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg. 2003;27:379-384.
• 18. Mulari K, Leppaniemi A. Severe secondary peritonitis following gastrointestinal tract perforation. Scand J Surg. 2004;93:204–208
• 19. Zavernyi LG, Poida AI, Melik VM, Bondarenko ND, Tarasov AA, Nadeev SS, et al. Prognosis in the outcome of relaparotomy. Klin Khir. 1992;8:12-16.
• 20. Oddeke VR, Cecilia WM, Kimberly RB. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 2007;298:865–872.
• 21. Holzheimer RG, Gathof B. Re-operation for complicated secondary peritonitis – how to identify patients at risk for persistent sepsis. Eur J Med Res. 2003;8:125–134.
• 22. Hutchins RR, Gunning MP, Lucas DN, Allen-Mersh TG, Soni NC: Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery. World J Surg. 2004, 28:137-141.
• 23. Rygachev GP, Nekhaev AN, Kerez PI, Kremen VE. Relaparotomy in the treatment of generalized postoperative Peritonitis. Khirurgiia 1997;1:45–48.
• 24. Harbrecht PJ, Garrison RN, Fry DE. Early urgent relaparotomy. Arch Surg. 1984; 119:369-374.
• 25. Tasu JP, Vesselle G, Herpe G, Ferrie JC, Chan P, Boucebci S, et al. Postoperative abdominal bleeding. Diagn Interv Imaging. 2015;96:823-31.
• 26. Tera H, Aberg C: Relaparotomy. A ten-year series. Acta Chir Scand. 1975;141:637-644.
• 27. Krivitskii D, Shuliarenko VA, Babin IA. Indications for relaparotomy. Klin Khir. 1990; 1:18-21.
• 28. Kononov AG, Sotnicenko BA, Makarov VI. Relaparotomy for intra-abdominal hemorrhage. Acta Chir Iugosl. 1990;37:65-73.
• 29. Mamchich VI, Shaprinskii VA, Palienko PK. Intraabdominal hemorrhage after surgery on the abdominal organs requiring relaparotomy. Klin Khir. 1992;8:31-34.
• 30. Leshchenko IG, Panov FI: Relaparotomy for postoperative mechanical intestinal obstruction in abdominal injuries. Vestn Khir Im I I Grek. 1991;146:88-91.
• 31. Wain MO, Sykes PA. Emergency abdominal re-exploration in a district general hospital. Ann R Coll Surg Engl. 1987;69:169-74.
• 32. Zavernyi LG, Poida AI, Tarasov AA, Mel'nik VM, Nadeev SS. Indications for relaparotomy in acute postoperative intestinal obstruction. Klin Khir. 1992; 4:4-7.
• 33. Ellozy SH, Harris MT, Bauer JJ, Gorfine SR, Kreel I. Early postoperative small-bowel obstruction: a prospective evaluation in 242 consecutive abdominal operations. Dis Colon Rectum. 2002;45:1214-1217.
• 34. QuatromoniJC, RosofiL, HallsJ, Yellin AE. Early postoperative small bowel obstruction. Ann Surg. 1980; 191:72-4.
• 35. Pusajó JF, Bumaschny E, Doglio GR, Cherjovsky MR, Lipinszki AI, Hernández MS, et al. Postoperative intra-abdominal sepsis requiring reoperation. Value of a predictive index. Arch Surg. 1993;128:218-22.