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April 1984

Early Urgent Relaparotomy

Author Affiliations

From the Surgical Service, Veterans Administration Medical Center, Louisville, and the Department of Surgery, University of Louisville School of Medicine. Dr Fry is now with Western Reserve University and the VA Medical Center, Cleveland.

Arch Surg. 1984;119(4):369-374. doi:10.1001/archsurg.1984.01390160005001

• We analyzed the indications for and implications of reoperation in 113 patients who required early urgent relaparotomy. Infection with intact organs was the most common indication, causing the most diagnostic difficulties, and presenting the most varied findings. Suture-line leaks and dehiscence were next in frequency. Bleeding caused the earliest relaparotomies and obstruction, the latest. In seven patients a technical error at the primary laparotomy was identified, and in 56 patients an error of some sort was presumed. High-mortality categories were identified, including the elderly, who were particularly susceptible if bleeding or after an emergency primary laparotomy. An aggressive policy of reoperation resulted in 59 survivors and seems to be the only practical approach in the treatment of these usually desperately ill patients.

(Arch Surg 1984;119:369-374)