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The Relaparotomy in the Delayed (2–3 Week) Postoperative Period

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Complications in Acute Care Surgery

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Abstract

The main questions when approaching a patient who potentially requires a relaparotomy in the delayed postoperative period can be split into the following categories: preoperative decision-making, intra-operative management, and postoperative challenges. The most important question to answer preoperatively is whether this patient indeed requires another laparotomy or will the cure, operative, or non-operative be worse than the situation at hand. Advances in imaging techniques, particularly computed tomography, not only have greatly enhanced our ability to make more educated decisions regarding the need for reoperation but have also greatly assisted our ability to preoperatively plan. Reentry into the abdomen can be difficult. An extension of the existing open incision or even an alternate incision may be helpful in gaining entry into the peritoneal cavity. Limiting the re-exploration to the minimum that is needed to address the issues at hand without causing further harm is essential. Utilizing native tissue for closure is the most desired option if at all possible. If the fascia will not close without tension, a fascial release with or without buttressing with an underlay of vicryl mesh or a biologic can be used. Postoperatively, the re-operative patient is at a much higher risk for wound complications and fascial dehiscence than after the primary operation. The surgical site should be carefully inspected for any signs and symptoms of infection and/or dehiscence. In conclusion, relaparotomy in the delayed postoperative period can be accomplished safely. Taking a stepwise approach to the patient is essential as there are potential pitfalls at every step.

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Authors and Affiliations

  1. Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box Surg, Rochester, NY, 14642, USA

    Nicole Stassen & Michael Rotondo

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  1. Nicole Stassen
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  2. Michael Rotondo
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Correspondence to Nicole Stassen .

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Editors and Affiliations

  1. R Adams Cowley Shock Trauma Center Acute Care Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Jose J. Diaz

  2. Acute Care Surgery, John Hopkins Hospital Acute Care Surgery, Baltimore, Maryland, USA

    David T. Efron

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Stassen, N., Rotondo, M. (2017). The Relaparotomy in the Delayed (2–3 Week) Postoperative Period. In: Diaz, J., Efron, D. (eds) Complications in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42376-0_24

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  • DOI: https://doi.org/10.1007/978-3-319-42376-0_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42374-6

  • Online ISBN: 978-3-319-42376-0

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