Koirala Rabin, Mehta Naimish, Varma Vibha, Kapoor Sorabh, Kumaran Vinay, Nundy Samiran
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India 110060C.
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India 110060C ; R. No. 2222, Liver Transplant Unit, Sir Ganga Ram Hospital, 2nd Floor, SSRB, New Delhi, India 110060.
Indian J Surg. 2015 Jun;77(3):195-9. doi: 10.1007/s12262-012-0760-9. Epub 2012 Sep 27.
A proportion of the operations performed in a surgical gastroenterology department are unplanned repeat laparotomies for complications of the original procedure. We examined why, in our department, these 'redo' laparotomies were performed and what was their outcome. We retrospectively analyzed 6530 patients operated between September 1996 - December 2010, of these 257 redo laparotomies were performed in 193(2.5 %) patients. There were 138 males and 55 females who had a mean age of 42 years (range 7-68 years). Eighty one (42 %) of the index surgeries were elective and 112 (58 %) performed in the emergency situation. Pancreas was the commonest organ for the index operation {50 (25.9 %)}, followed by the colon and rectum {45 (23.3 %)} and the small bowel {36 (18.7 %)}. Postoperative bleeding was the most common cause for re-exploration 66 (34.2 %) followed by an abscess or fluid collection that required surgical drainage 57 (29.6 %). The mortality rate after redo laparotomies was 33.2 % with sepsis and multi-organ failure being the commonest cause of death. Urgent redo-laparotomies that are performed following complicated abdominal operations have a high mortality rate. Postoperative bleeding, intrabdominal abscess and peritonitis are the commonest cause for redo-laparotomy. Multiple redolaparotomies and associated co-morbid conditions are significant predictors of mortality.
外科胃肠病学科室所进行的一部分手术是针对原手术并发症的非计划性再次剖腹手术。我们研究了在我们科室进行这些“再次”剖腹手术的原因及其结果。我们回顾性分析了1996年9月至2010年12月期间接受手术的6530例患者，其中193例（2.5%）患者进行了257次再次剖腹手术。有138名男性和55名女性，平均年龄为42岁（范围7 - 68岁）。初次手术中有81例（42%）为择期手术，112例（58%）在急诊情况下进行。胰腺是初次手术最常见的器官{50例（25.9%）}，其次是结肠和直肠{45例（23.3%）}以及小肠{36例（18.7%）}。术后出血是再次探查最常见的原因，有66例（34.2%），其次是需要手术引流的脓肿或积液，有57例（29.6%）。再次剖腹手术后的死亡率为33.2%，脓毒症和多器官功能衰竭是最常见的死亡原因。复杂腹部手术后进行的紧急再次剖腹手术死亡率很高。术后出血、腹腔内脓肿和腹膜炎是再次剖腹手术最常见的原因。多次再次剖腹手术及相关的合并症是死亡率的重要预测因素。
