Clinical Outcome of Emergency Laparotomy: Our Experience at tertiary care centre (A case series)
DOI:
https://doi.org/10.7439/ijbar.v6i10.2578Abstract
Introduction: Laparotomy is broadly used for any surgery requiring opening of abdominal wall and exploration of the underlying structures. Elective laparotomy indirectly implies that there is ample time for preoperative assessment and preparation of the patient. On the other hand, an emergency laparotomy is a lifesaving procedure, undertaken mostly in acute cases, without much preparation of the patient. Materials and methods: This retrospective study included cases that underwent laparotomy for acute abdominal conditions between Jan 2013 to Jan 2014.We also studied the morbidity associated with each case and compared the results. Results: Morbidity and mortality after emergency laparotomy is high. This incidence increases in cases with associated co morbidities like COPD, asthma, diabetes mellitus, hypertension, pneumonia, renal failure. Out of 100 cases of emergency exploratory laparotomy performed 56 cases were due to hollow viscus perforation in which duodenal perforation was most common accounting for 28 cases. However, the maximum mortality rate was seen with gastric (26%) followed by ileal (10.5%), duodenal (10.5%), and jejunal and colonic perforations (5.25%). Conclusion: Most common condition for which emergency laparotomy was done was perforated peptic ulcer. The mortality and morbidity after emergency laparotomy is closely related to presence or absence of diabetes mellitus, hypertension, chronic renal impairment, cardiovascular disease (angina), asthma, liver disease, chronic obstructive pulmonary disease and metastatic disease and morbidity and mortality of patients who underwent emergency laparotomy is high when associated with these conditions.Downloads
References
Zimmerman JE; Wagner DP; Draper EA; Wright L; Alzola C; Knaus WA. Evaluation of Acute Physiology and Chronic Health Evaluation III predictions of hospital mortality in an independent database. Critical Care Medicine 1998; 26: 1317-1326.
Tekkis PP, Kocher HM, Bentley AJE, Cullen PT, South LM, Trotte GA, Ellul JPM. Operative mortality rates among surgeons. Comparison of POSSUM and p-POSSUM scoring systems in gastrointestinal surgery. Dis Col Rectum 2000; 43: 1528-1532.
Cook TM, Day CJ. Hospital mortality after urgent and emergency laparotomy in patients aged 65 yrs and over. Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth 1998; 80: 776-81.
Linn BS, Linn MW, Wallen N. Evaluation of results of surgical procedures in the elderly. Ann Surg 1982; 195: 90-6.
Arenal JJ; Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 2003; 46: 11-116.
Waldron RP, Donovan IA, Drumm J, Mottram SN, Tedman S. Emergency presentation and mortality from colorectal cancer in the elderly. Br J Surg 1986; 73: 214-6.
Kettunen J, Paajanen H, Kostiainen S. Emergency abdominal surgery in the elderly. Hepatogastroenterology 1995; 42: 106-8.
Copland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78: 356-360.
Knaus WA, Zimmerman JE, Wagner DP et al. APACHE - acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981; 9: 591-597.
Mohil RS, Bhatnagar D, Bahadur L, Rajneesh, Dev DK, Magan M. POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. Br J Surg 2004; 91:500-3.
Jones HJS, de Cossart L. Risk scoring in surgical patients. Br J Surg 1998; 86: 149-157.
Fazio VW, Tekkis PP, Remzi F, Lavery IC. Assessment of operative risk in colorectal cancer surgery: the Cleveland Clinic Foundation colorectal cancer model. Dis Colon Rectum 2004; 47: 2015-24.
Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth.1996; 77: 217-22.
Tiret L, Hatton F. Prediction of outcome of anaesthesia in patients over 40 years: a multifactorial risk index. Statistics in Medicine 1988; 41: 83-90.
Owens WB, Felts JA, Sitznagel EL. ASA physical status classification: A study of consistency of ratings. Anaesthesiology 1978; 49: 239-243.
Beal AL and Cerra FB. Multiple organ failure syndromes in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA 1994; 271: 226-233.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, for the Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New Eng J Med 2001; 345: 1368-1377.
Awad SS. State-of-the-art therapy for severe sepsis and multisystem organ dysfunction. The American Journal of Surgery 2003; 186/5A: 23S
Barlow AP, Zarifa Z, Shillito RG, Crumplin MKH, Edwards E, McCarthy JM: Surgery in a geriatric population. Ann R Coll Surg Engl 1989; 71: 110-4.
Makela JT, Kiviniemi H, Laitinen S: Prognostic factors of perforated sigmoid diverticulitis in the elderly. Dig Surg 2005; 22: 100-106.
Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ.POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enumeration of Mortality and morbidity. Br J Surg 1998; 85: 1217-20.
Knaus WA, Draper EA, Wagner DP. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-829.
Reiss R, Deutsch A, Nudelman I. Surgical problems in octogenarians: epidemiological analysis of 1083 consecutive admissions. World J Surg 1992; 16: 1017-21.
Playforth MJ, Smith GMR, Evans M, Pollock AV. Pre-operative assessment of fitness score. Br J Surg 1987; 74: 890-2.
Kennedy RH, al-Mufti RA, Brewster SF, Sherry EN, Magee TR, Irvin TT. The acute surgical admission: is mortality predictable in the elderly. Ann R Coll Surg Engl 1994; 76: 342-5.
Wacha H, Linder MM, Feldman U, Wesch G, Gundlach E, Steifensand RA. Mannheim Peritonitis Index
Goris RJA, teBoekhorst TPA, Nuytinck JKS, Gimbrere JSF. Multi-organ failure. Generalized autodestructive inflammation? Arch Surg 1985; 120: 1109-15.
LeGall J, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D. A simplified acute physiology scores for ICU patients. Crit Care Med 1984; 12: 975-977.
Elebute EA, Stoner HB. The grading of sepsis. Br J Surg 1983; 70: 29-31.
Yoshiko K, Masayuki N, Akihiko W, Hirofumi I, Teruyuki S, Takatsugu Y, et al. Study of Mannheim Peritonitis Index to Predict Outcome of Patients with Peritonitis. Japanese J Gastroentero Surg 2004; 37:7-13.
Singh R, Kumar N, Bhattacharya A, Vajifdar H. Preoperative predictors of mortalityin adult patients with perforation peritonitis. IIJCCM 2011; 15:157-163.
Wacha H, Linder MM, Feldmann U, Wesch G, Gundlach E, Steifensand RA. Mannheim peritonitis index - prediction of risk of death from peritonitis; Construction of a statistic and validation of an empirically based index. Theoretical Surgery 1987; 1:169-177
Rajesh V, Chandra SS, Smile SR. Risk factors predicting operative mortality in perforated peptic ulcer disease. Trop Gastroenterol 2003 Jul-Sep; 24(3): 148-150.
Ozalp N, Zulfikaroglu B, Bilgic I, Koc M. Evaluation of risk factors for mortality in perforated peptic ulcer in Ankara Numune Teaching Hospital, Ankara, Turkey. East African Medical Journal 2004; 8: 634-637.
Chandrashekar N et al., Prabhakar GN, Gurukiran CS, Shivakumarappa GM, Naveen H M.
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
How to Cite
