Planned Re-Laparotomy in a Non-Trauma Setting: A Single Center Experience

Area of Science:

• Surgical pathology
• Emergency medicine
• Abdominal surgery

Background:

• Damage control laparotomy (DCL) is standard for trauma patients.
• DCL principles are increasingly applied to non-trauma surgical conditions.
• Planned re-laparotomy (PRL) is a strategy used in these non-trauma cases.

Purpose of the Study:

• To assess the experience with planned re-laparotomy (PRL) in non-trauma patients.
• To compare outcomes of PRL in non-trauma abdominal pathology with existing literature.
• To identify factors influencing mortality in non-trauma PRL.

Main Methods:

• Retrospective review of 181 patients undergoing PRL for non-trauma abdominal pathology over 6 years.
• Data collected included demographics, vital signs, lab tests, surgical indications, and outcomes.
• Analysis focused on indications, risk factors, and mortality rates.

Main Results:

• The most common indications for PRL were primary abdominal sepsis (50), postoperative sepsis (49), mesenteric events (32), and intestinal obstruction (28).
• Overall mortality rate was high at 48.6%.
• Factors associated with increased mortality included advanced age, hypotension, hypothermia, metabolic acidosis, and renal failure. Primary anastomosis (46.7%) had lower mortality (33.3%) than postponed anastomosis (55.4%).

Conclusions:

• Planned re-laparotomy (PRL) in non-trauma abdominal emergencies is associated with significant mortality.
• Consideration of primary intestinal anastomosis during PRL may improve outcomes.
• Further research into optimizing PRL strategies for non-trauma conditions is warranted.