[Relaparotomy, retrospective analysis and intensive care aspects]

A high mortality rate of the patients in the Surgical University Clinic Mainz in 2441 laparotomies from 1977 to 1979 with 92 relaparotomies in 66 patients (40% proving fatal) could be associated with the following factors: female sex, old age in males, malignant disease, esp. carcinoma of pancreas, colon and rectum, upper gastrointestinal bleeding, presence of concomitant affections, esp. three or more and particularly angiocardiopathy, liver diseases and after radiotherapy, long lasting primary operation, several operations in short intervals (about a week). Astonishingly we found a lower rate of mortality in cases of: Primary laparotomy in an emergency situation, postoperative complications within the first two days or after several weeks, multiple relaparotomies within intervals of at least two weeks. In cases of several severe postoperative complications, esp. renal insufficiency with dependence on dialysis and simultaneous respiratory insufficiency with dependence on artificial respiration a relaparotomy is indicated, if the intra-abdominal complication can be cured. In these cases the intensive care cannot cure the patient's conditions, but mechanical respiration and dialysis improve it. The existence of lethal trias of renal and respiratory insufficiency with a surely unremovable surgical problem forbids a relaparotomy.