J Korean Surg Soc.
1998 Jun;54(Suppl):958-965.
A Clinical Review of Reoperation after Intraabdominal Operation
- Affiliations
-
- 1Department of Surgery, College of Medicine, Chung-Ang University.
Abstract
- The need for a relaparotomy shortly after an initial abdominal operation indicates a serious complication
and may frequently constitute a surgical failure. Many of the postoperative symptoms that might
indicate the onset of complications may be masked by the usual postoperative course. Reported findings
vary widely. Thus there is no clear picture for a surgeon to use as a guide. In an attempt to obtain
more definite guidelines regarding the indications for and the timing of reintervention a retrospective study
based on a 7-year survey was undertaken to assess the problem of reoperation after abdominal
surgery. This study consisted of a retrospective clinical analysis made an 95 patients who required reoperation
due to postoperative complications and planned stage operations during 7 years from January
1990 to December 1996. The number of reoperations was 95 cases (24%) among 3932 patients who
had undergone abdominal operations at our department. The sex distribution for the reoperations was
58 males and 37 cases in females. The peak age incidence was the 6th decade in 25 cases(26.3%). The
most common physical findings of the patient who required reoperations were abdominal pain and
tenderness (56.8%). The main cause necessitating reoperation was intestinal obstruction (25.3%). The
most common types of reoperations were common bile duct exploration with T-tube insertion(24.2%).
The time interval between initial operation and reoperation was within 10 days in 10 cases (10.5%) and
25 months grouped in separate admission in 36 cases (37.9%). The most frequent complication was
wound infection(15.8%) and the mortality rate was 4 cases (4.2%). Conservative treatment cannot be
recommended for severe complications, such as postoperative bleeding or peritonitis, due to free
anastomotic leakage. However, in doubtful cases, when there is mild peritonitis of an undetermined
origin, ileus, well-controlled billiary or duodenal leaks, and the like, the high mortality associated with
reintervention should be borne in mind. In these cases, conservative treatment with close supervision
of the patient may prove the most prudent course.