Urgent and emergent re-laparotomy in trauma. A preventable cause of increased mortality?

In a 2-year period, 96 patients required laparotomy for trauma at the University of Kansas Medical Center. Fifteen patients required a total of 25 emergent and urgent reexplorations. Six patients required reoperation for bleeding, eight for intra-abdominal sepsis, and 3 for inadequate initial operation or missed injury. Forty per cent of patients undergoing multiple laparotomies died, versus 16 per cent for single operations. Factors predisposing to complications requiring re-laparotomy include multi-system trauma, blunt abdominal injury, and inadequate or delayed initial resuscitation and operation. Recognition of these factors and resuscitation and operation by personnel experienced in trauma care should lead to lower reoperation rates, and decreased morbidity and mortality when reoperation is necessary.