Retrospective Study on Relaparotomy Cases in the Department of Obstetrics and Gynaecology at a Tertiary Care Hospital in South India

Abstract

Objectives: Aim of the study was to determine incidence of relaparotomy and its indications, management, and outcome in the department of Obstetrics and Gynaecology, Karnataka Institute of Medical Sciences, Hubli.
Materials and Methods: It is a retrospective observational study performed for a duration of 2 years between August 2020 and July 2022. Data was obtained from the records maintained in the department of Obstetrics and Gynaecology, Karnataka Institute of Medical Sciences, Hubli. The data was analysed with respect to clinical presentation, pre-operative investigations, indication, procedure undertaken, intra-operative and post-operative complications and outcome. Total number of surgeries -10,520. Total number of relaparotomy- 28 which included referral cases.
Results: Incidence of relaparotomy was 0.26%. Indications of relaparotomy included internal haemorrhage in 11 cases (39.2%), postpartum hemorrhage (PPH) in 10 cases (35.7%), pyoperitoneum in 5 cases, bowel perforation in 1 case (3.5%) and burst abdomen in 1 case (3.5%). Average ICU stay was found to be 8 days. Most common procedure performed was subtotal abdominal hysterectomy -13 cases (46.4%). Various complications were observed such as requirement of mechanical ventilation, sepsis, DIC, peripartum cardiomyopathy, pneumonia, AKI, MODS. Mortality occurred in 9 patients (32.1%)
Conclusion: Emergency relaparotomy is a life-saving procedure. It is a very difficult decision requiring good clinical judgment and is critical for the patient to undergo second surgery within short span of time. 19 out of 28 patients who underwent relaparotomy were discharged home successfully. Timely diagnosis and intervention with relaparotomy in the indicated cases is the need of the hour.