Publication:

Relaparotomy in obstetrics and gynecological surgeries: a retrospective study in a tertiary care hospital

Background Relaparotomy is biggest dilemma to the surgeon as well as to the patient to undergo second surgery in a short span of time. It may be required due to post-operative complications as lifesaving procedure. Objectives of this study are to determine the risk factors, indications, management and outcome in obstetric and gynecological surgeries in a tertiary care hospital attached to Mysore Medical College and Research Institute (MMCRI), Mysore.

Methods It is a retrospective observational study for the duration of 5 years from January 2016 to December 2020 in Cheluvamba Hospital attached to MMCRI, Mysore.

Results Incidence of relaparotomy was 0.11%; 0.1% for obstetric indication and 0.06% for gynecological procedure most common indication for relaparotomy was atonic postpartum hemorrhage (PPH) (35%) followed by burst abdomen (26%), uterine scar dehiscence 13%. Time interval between primary and secondary surgery is <24 hours in 57% of cases mainly due to obstetric hemorrhage. About 74% of patients post relaparotomy were stable and 26% patients needed intensive care unit (ICU) admission. Out of 23 relaparotomy cases 4 patients died with mortality rate of 17% (all relaparotomies were related to obstetric causes) with zero mortality rate for relaparotomies done for gynecological case. The major cause of death was found to be multiorgan dysfunction syndrome (MODS).

Conclusions Relaparotomy is lifesaving procedure; early recognition of complications, good primary surgery, good surgical techniques, meticulous hemostasis and strict asepsis can prevent relaparotomy.