REPEATED OPERATIONS IN ABDOMINAL SURGERY

Abstract

The aim of the work: to study the reasons, indications and results of performing relaparotomy after surgical operations on the organs of the abdominal cavity, depending on the nosology and the nature of the first surgical intervention.

Material and Methods. In the course of the study, 38 cards of inpatients who were treated in the clinic of surgery, plastic surgery and endoscopy of the FPDO of Danylo Halytskyi Lviv National Medical University were analyzed (base – Department No. 2 of the Surgery and Oncology Center of the First Lviv Medical Union) for the period from January 2021 to December 2023. The majority were women (21 patients – 55.3 %) aged from 24 to 85 years (average age – 61.8 ± 16.32 years). The main pathology that required relaparotomy in the postoperative period was colorectal cancer (8 patients – 21.1 %). The severity of the patient's preoperative condition according to ASA was grades I and II (12 patients each – 31.6 %), grade III – 10 (26.3 %) and grade IV – 4 (10.5 %). The degree of severity of complications according to Clavien-Dindo classification was mostly IIIb – 17 patients (44.7 %) and IVb – 18 (47.4 %).

Results and Discussion. All relaparotomy surgeries were performed under endotracheal anesthesia. The vast majority of patients (36 – 94.7 %) underwent forced repeated interventions, and the time of their implementation was mostly more than 10 days after the primary surgical intervention. Among repeated abdominal interventions, from the simplest operations (drainage of the abdominal cavity) to those of a certain technical complexity (right-sided hemicolectomy) were used. Complications in the early postoperative period after relaparotomy occurred in 16 (42.1 %) patients, and in 11 (28.9 %) it was necessary to perform repeated interventions to eliminate them, in particular, in 7 (18.4 %) – once and repeatedly – in the rest. The most common complications were the progression of sepsis. 21 patients died; postoperative mortality was 55.3 %. The main cause of death was multiple organ failure (18 patients).