Causes and Outcome of Relaparotomies for Warfare Penetrating Abdominal Injuries

Abstract

Background: Worldwide the incidence of penetrating abdominal injuries, including warfare injuries, is increasing and in most cases exploratory laparotomy is warranted. A single laparotomy may not be sufficient and a relaparotomy sometimes may be needed to deal with these patients.
Aim  of  the  study:  This  study  was  done  to  evaluate  the  causes  of relaparotomy  following  warfare  penetrating  abdominal  injuries  and  to determine the relationship between the cause of the relaparotomy and the outcome. 
Patients and methods: A retrospective study conducted on 252 patients undergoing  laparotomy  for  penetrating  abdominal  injuries  at  Baghdad teaching hospital or was admitted to the hospital for continued care, in the period from August 2014 to August 2015. Out of these 252, relaparotomy was needed in 42 patients within 60 days of the primary surgery.
Results: Among 252 patients, in whom emergency exploratory laparotomy for   warfare   penetrating   trauma   were   done,   42   patients   required relaparotomy (16.17%), 40 patients (95.23%) were military male and 2 patients (4.77%) were civilians as one male and one female. The causes for a second laparotomy found to be broadly divided into three main groups: A – Completion of damage control surgery (DCS) in 19 / 42 patients (45.24%) 
B – Missed injuries in 8 / 42 patients (19.05%) 
C – Postoperative complications in 15 / 42patients (35.71%) 
The mortality rate was 4.36% after the first laparotomy and 21.42% after the second laparotomy. 
Conclusions:   Completion of damage control surgery and dealing with postoperative complications are the most common causes of relaparotomy.  Relaparotomy is associated with a higher mortality rate, particularly among those with a leak from anastomosis or missed bowel injuries.