DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20221943
Published: 2022-07-27

Relaparotomy in obstetrics and gynecological surgeries: a retrospective study in a tertiary care hospital

Sunanda N., Talath Aisha

Abstract


Background: Relaparotomy is biggest dilemma to the surgeon as well as to the patient to undergo second surgery in a short span of time. It may be required due to post-operative complications as lifesaving procedure. Objectives of this study are to determine the risk factors, indications, management and outcome in obstetric and gynecological surgeries in a tertiary care hospital attached to Mysore Medical College and Research Institute (MMCRI), Mysore.

Methods: It is a retrospective observational study for the duration of 5 years from January 2016 to December 2020 in Cheluvamba Hospital attached to MMCRI, Mysore.

Results: Incidence of relaparotomy was 0.11%; 0.1% for obstetric indication and 0.06% for gynecological procedure most common indication for relaparotomy was atonic postpartum hemorrhage (PPH) (35%) followed by burst abdomen (26%), uterine scar dehiscence 13%. Time interval between primary and secondary surgery is <24 hours in 57% of cases mainly due to obstetric hemorrhage. About 74% of patients post relaparotomy were stable and 26% patients needed intensive care unit (ICU) admission. Out of 23 relaparotomy cases 4 patients died with mortality rate of 17% (all relaparotomies were related to obstetric causes) with zero mortality rate for relaparotomies done for gynecological case. The major cause of death was found to be multiorgan dysfunction syndrome (MODS).

Conclusions: Relaparotomy is lifesaving procedure; early recognition of complications, good primary surgery, good surgical techniques, meticulous hemostasis and strict asepsis can prevent relaparotomy.


Keywords


Relaparotomy, Obstetric and gynecological surgeries, Peripartum hysterectomy, Caesarean section, Burst abdomen

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References


Unalp HR, Kamer E, Kar H, Bal A, Peskersoy M, Ali Onal M. Urgent abdominal re-explorations. World J Emerg Surg. 2006;1(1):1-6.

Levin I, Rapaport AS, Satzer L, Maslovitz S, Lessing JB, Almog B. Risk factors for relaparotomy after cesarean delivery. Int J Gynecol Obstet. 2012;119(2):163-5.

Seal SL, Kamilya G, Bhattacharyya SK, Mukherji J, Bhattacharyya AR. Relaparotomy after cesarean delivery: experience from an Indian teaching hospital. J Obstet Gynaecol Res. 2007;33(6):804-9.

Ahmed M, Pandya ST, Supraneni T. Return to the operation theatre: an analysis of repeat surgeries in operative obstetrics. J Obstet Gynaecol India. 2016;66(1):117-21.

Seffah JD. Re-laparotomy after Cesarean section. Int J Gynecol Obstet. 2005;88(3):253-7.

Gedikbasi A, Akyol A, Asar E, Bingol B, Uncu R, Sargin A, Ceylan Y. Re-laparotomy after cesarean section: operative complications in surgical delivery. Arch Gynaecol Obstet. 2008;278(5):419-25.

Thombarapu U, Veeravalli S, Koneru GR, Kodey PD. Relaparatomies after obstetric surgeries at a tertiary care hospital, NRI General Hospital, Chinnakakani, Guntur. Indian J Obstet Gynaecol Res. 2019;6(4):448-51.

Bijjaragi B, Amulya MN. Re-laparotomy in OBG: a clinical study. Int J Reprod Contracept Obstet Gynaecol. 2018;7(4):1367-72.

Khan NB, Kolasseri SS. Relaparotomy after caesarean section: an analysis of the risk factors, indications and outcome. Int J Reprod Contracept Obstet Gynaecol. 2015;4(3):575-81.