Short term outcomes and associated factors For Relaparotomies At Muhimbili National Hospital

Abstract

ABSTRACT Background:Relaparotomies contin¬ue to be a challenge since they carry a high morbidity and mortality despite developments in general surgery services. Globally, an incidence of 0.6-24% of relaparotomy rates with its indication and adverse effects have been reported in various studies. At MNH, it has been observed that a significant proportion of abdominal surgery cases due to intestinal obstruction and peritonitis have high likelihood of subsequent relaparotomy. This study will determinethecharacteristics, magnitude and outcome of relaparotomies among patients attending MNH. Methods: A cross sectional, hospital-based study was carried out for a period of 12 months involving 101 patients who underwent relaparotomy within a period of 60 days of the index laparotomy in the department of surgery at MNH. Indications, findings at surgery, surgery done and short-term outcomes were recorded in a data collection tool and analyzed. Results: There were 101 relaparotomiesdone at MNH withrepeat laparotomy rate of 7.6%. Patient’s mean age was 37±19.7 (0.024 – 86) years. Residents and registrars performed majority of emergency surgery, 68.4%. Bowel repair or anastomosis was the leading procedure done (47.5%).The common indications for relaparotomy included anastomotic leak (37.6%), abdominal abscess/collection (29.7%), bowel fistula (19.8%) and wound dehiscence (18.8%). Short term outcomes for relaparotomy included electrolyte imbalance (22.9%), anemia (21.5%), wound infection (18.9%), prolonged hospital stay and death (40%). Septicemia (80%) was the main cause of post-operative deaths. Conclusion:Repeat laparotomy at MNH was low compared to other studies but its accompanying mortality rate and complications were both highat 40 %. Bowel leak following emergency bowel surgeries is the most frequent cause for relaparotomies and subsequent fatalities. These surgeries are done at night by junior surgeons, residents and registrars. Key words: Relaparotomy, morbidity, mortality