Relaparotomy in Children in a Developing Country: A 10-Year Review
Abstract
Background: Complications arising from abdominal surgeries may necessitate a relaparotomy. The purpose of this study was to evaluate the indications, outcome and factors affecting mortality following pediatric relaparotomy in Enugu, Nigeria.
Methods: This was a retrospective study of children that had relaparotomy at the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. The parameters assessed included patients’ demographics and other factors that may affect mortality following relaparotomy using a multivariate analysis.
Results: A total of 683 laparotomies were performed during the study period, out of which 31(4.5%) patients had relaparotomy. The ages of the patients ranged from 2 weeks to 15 years, with a median of 10 years. Typhoid intestinal perforation was the most common initial pathology that necessitated the initial laparotomy and right hemicolectomy with ileotransverse anastomosis was the most common initial procedure performed. Anastomotic leak (61.3%) was the most common indication for relaparotomy and surgical site infection (29%) was the most common complication following relaparotomy. Mortality rate was 19.4% and statistical analysis (multivariate analysis) showed post-operative complication as the only factor that affected mortality (p value = 0.04).
Conclusion: Relaparotomy is inevitable in many unsuccessful primary laparotomies. The mortality rate in developing country like Nigeria is high and efforts should be made towards improving outcome.
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Introduction
Abdominal surgeries may be associated with myriad of complications that necessitates reoperation. Simply put relaparotomy means a repeat abdominal operation after the initial operation. Most researchers define relaparotomy as abdominal surgeries performed within 60 days after the initial surgery [1,2]. There is no consensus on the classification of relaparotomy. Early or late, emergency or elective, planned or unplanned are some of the proposed classifications [3]. Survival and recovery following relaparotomy have been used by some clinicians as an indicator of the quality of surgical care [4]. Most common indications for relaparotomy include intra-abdominal fluid collection, anastomotic leak, bleeding, wound dehiscence, bowel necrosis, bowel obstruction [5,6]. Before a decision for a relaparotomy is taken, an important question has to be answered: Will reoperation make the patient’s clinical condition better or worse [7]. Improvements in imaging investigations have greatly assisted surgeons in taking informed decisions [7]. It must be remembered that relaparotomy is froth with lots of morbidity and mortality because the patient is at higher risk of wound complications and fascial dehiscence [7].
Conclusion
Relaparotomy in a developing country like Nigeria is relatively common and the attendant mortality of 19.4% is high. Complication following relaparotomy was the only factor found to affect mortality in the present study. Early detection of complications, improved training of surgeons and provision of facility will improve outcome of laparotomy in children in developing countries.