Relaparotomy
The relaparotomy in the parlance of surgery is the renewed operative opening of the abdominal cavity after a recently performed laparotomy .
indication
Often, a relaparotomy must be performed to treat an unexpected complication of surgery. The most common reasons are rebleeding and anastomotic leakage . Depending on the previous operation and the current indication, the relaparotomy may be necessary to correct a minor problem or to control a life-threatening situation.
Smaller problems are here e.g. B. a bile fistula after a complicated operation on the liver , gall bladder or biliary tract , a bruise that does not appear to be resorbed in a reasonable time or a large accumulation of unspecific tissue fluid ( seroma ).
Postoperative mass bleeding, anastomotic leakage with subsequent generalized peritonitis or complete postoperative bowel obstruction are more likely to be directly life-threatening complications that require relaparotomy as an emergency intervention.
The so-called programmed relaparotomy must be distinguished from these emergency indications: Here, the need for a new laparotomy was already determined during the first operation, because serious inflammatory changes, e.g. B. in the case of perforated appendicitis in the sense of generalized peritonitis due to the present findings no possibility of healing without further intervention.
execution
As a rule, the already existing, not yet healed surgical wound is reopened. Depending on the reason for the relaparotomy, bleeding is stopped, leaks in the gastrointestinal area are closed, bruises are flushed and removed, or only inflammatory changes are cleaned, flushed and drained. If it is clear from the outset that a single relaparotomy is not sufficient (this is most often the case with generalized, purulent peritonitis ), a so-called programmed stage lavage is applied.
