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"Second-look" laparotomy: warranted, or contributor to excessive open abdomens?
Natasha Hansraj1, Amelia M Pasley2, Jason D Pasley2
1Division of Acute Care Surgery, Department of Surgery, University of Maryland School of Medicine, 22 South Greene Street S10B00, Baltimore, MD, 21201, USA. natashahansraj@gmail.com.
Summary
Second look laparotomy is a reasonable strategy for select emergency general surgery patients with open abdomens requiring bowel resection. Some patients needed reoperation even with initially normal-appearing bowel, indicating careful patient selection is crucial.
Area of Science:
- General Surgery
- Surgical Outcomes
- Abdominal Surgery
Background:
- The utility of temporary abdominal closure and second look laparotomy in emergency general surgery is debated.
- Overuse may lead to increased open abdomen patients.
Purpose of the Study:
- To evaluate the necessity and outcomes of second look laparotomy in open abdomen patients.
- To determine if single-stage operative therapy could reduce open abdomen cases.
Main Methods:
- Retrospective review of prospectively collected data (June 2013-June 2014).
- Inclusion criteria: Emergency general surgery patients with open abdomens requiring bowel resection.
- Data collected: Demographics, clinical variables, complications, mortality. Statistical analysis using Fisher's exact t test.
Main Results:
- 96 patients managed with open abdomen; 59 required bowel resection.
- 18 (30%) patients required bowel resection at second look laparotomy.
- Of those resected at second look, 39% had normal-appearing bowel at the initial operation. Preoperative shock predicted need for further resection.
Conclusions:
- Second look laparotomy is a reasonable strategy in select emergency general surgery patients with open abdomens.
- Almost one-fifth of patients undergoing second look laparotomy required bowel resection.
- 6.8% of resections at second look were on initially normal-appearing bowel.