POSTOPERATIVE COMPLICATIONS IN EMERGENCY VERSUS ELECTIVE LAPAROTOMIES AT A PERIPHERAL HOSPITAL
AbstractBackground: Laparotomy is a commonly performed procedure in any surgical unit. Postoperativecomplications directly affect the outcome of the disease. The aim of the study was to evaluate andcompare the postoperative complications in emergency versus elective laparotomies at aperipheral hospital. Methods: This comparative cross-sectional study was carried out at theDepartment of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment fromFeb 2006 to May 2009. One hundred and four consecutive patients undergoing laparotomy wereincluded. They were divided into two groups: emergency laparotomies (Group-A) and electivelaparotomies (Group-B). They were followed up meticulously and the postoperativecomplications/sequel were recorded. Results: In Group-A there were 83 patients while in GroupB only 21 patients were recorded. A total of 73 postoperative complications were seen in 28patients (33.7%) in Group-A, while 5 complications were seen in 3 patients (14.2%) in Group-B.The Group-A showed 21.6% postoperative fever and wound infection, postoperative nausea andvomiting was 13.2%, wound dehiscence 4.8%, incisional hernia 3.6%, pneumonia/anastomoticdisruption 2.4% and duodenal fistula/peristomal excoriation/adhesive intestinal obstruction 1.2%.The septicaemia was seen in 6.0% and mortality in 8.4%. Group B showed 14.2% postoperativefever and 4.7% postoperative nausea and vomiting/wound infection. No case of septicaemia ormortality was seen. Conclusion: The postoperative complications are more common inemergency laparotomies as compared to the elective ones. Postoperative fever, wound infection,nausea and vomiting are the mostly encountered complications.Keywords: Laparotomy, emergency, elective, postoperative, complications
Natalie L, Semchyshyn N. Dermatological surgical
complications. [Online] updated May 29, 2009 [cited 2009
May 29] Available from: http://www.emedicine.com/derm/
Jawaid M, Masood Z, Iqbal SA. Post-operative complications
in a general surgical ward of a teaching hospital. Pak J Med
Ayanian JZ, Weissman JS. Teaching hospitals and quality of
care: a review of the literature. Milbank Q 2002;80:569–93.
Khan S, Khan IU, Aslam S, Haque A. Retrospective analysis
of abdominal surgeries at Nepalgunj Medical College
(NGMC), Nepalgunj, Nepal: 2 years experience. Khatmandu
Uni Med J 2004;2:336–43.
J Ayub Med Coll Abbottabad 2010;22(3)
Toledo-Pereyra LH. William Stewart Halstead (1852–1922).
In: Toledo-Pereyra LH. Vignettes on Surgery, History and
Humanities. 1st ed. Georgetown Texas: Landes Bioscience;
Driscoll P, Farmery AD, Bulstrode CJK. Post-operative care.
In: Russel RCG, Williams NS, Bulstrode CJK. Bailey &
Love’s Short Practice of Surgery. 24th edn. New York:
Oxford University Press;2004.p.1436–49.
Al-Hashemy AM, Seleem MI, Khan ZA, Nowry SM. Postoperative wound infection in surgical procedures. Saudi Med
Waqar SH, Malik ZI, Razzaq A, Abdullah MT, Shaima A,
Zahid MA. Frequency and risk factors for wound dehiscence/
burst abdomen in midline laparotomies. J Ayub Med Coll
Buhler L, Mentha G, Borst F, Roche B, Morel P, Rohner A.
Safety of cholecystectomy by laparotomy in elective situation
and in emergency. J Chir (Paris) 1992;129:466–70.
Shukla HS, Kumar S, Misra MC, Naithani YP. Burst
abdomen and suture material: a comparison of abdominal
wound closure with monofilament nylon and chromic catgut.
Indian J Surg 1981;43:487–91.
Singh A, Singh S, Dhaliwal US, Singh S. Technique of
abdominal wall closure; a comparative study. Indian J Surg
Choudhary SK, Choudhary SD. Mass closure versus layer
closure of abdominal wound: a prospective clinical study. J
Indian Med Assoc 1994;92:229–32.
Heller L, Levin S, Butler C. Management of abdominal
wound dehiscence using vacuum assisted closure in patients
with compromised healing. Am J Surg 2006;191:165–72.
Col C, Soran A, Col M. Can postoperative abdominal wound
dehiscence be predicted? Tokai J Exp Clin Me. 1998;23:123–7.
Graham DJ, Stevenson JT, McHenry CR. The association of
intra-abdominal infection and abdominal wound dehiscence.
Am Surg 1998;64:660–5.
Niggebrugge AH, Hansen BE, Trimbos JB, van de Velde CJ,
Zwaveling A. Mechanical factors influencing the incidence
of burst abdomen. Eur J Surg 1995;161:655–61.
Moosa AR, Lavelle-Jone M, Scott M. Surgical
complications. In: Sabiston DC. Textbook of Surgery: the
biological basis of modern surgical practice. 13th ed.
Philadelphia: WB Saunders; 1986:331–45.
Adrian S, Peter L. Wound dehiscence, incisional hernia and
parastomal hernia. In: Moris PJ, Williams W: Oxford
Textbook of Surgery. 22nd ed. UK: Oxford University Press;
Glona JL, Benedick PJ, Link WJ. The use of thermal knives
in surgery: electro surgery, laser, plasma scalpel. Curr Prob
Efron G. Abdominal wound disruption. Lancet 1965;1:1287–90.
Hanif N, Ijaz A, Niazi UF, Akhtar I, Zaidi AA, Khan MM.
Acute wound failure in emergency and elective laparotomies.
J Coll Physicians Surg Pak 2000;11:23–6.
Gerald ML. Ventral hernia repair by the laparoscopic
approach. Surg Clin North Am 2000;80:1329–39.
Mudge M, Hughes LE. Incisional hernia: A 10 year
prospective study of incidnec and attitude. Br J Surg
Anthony T, Bergen PC, Kim LT. Factors affecting recurrence
following incisional herniorrhaphy. World J Surg
Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional
hernia: A prospective study of 1129 major laparotomies.
Israelsson LA, Jonsson T. Incisional hernia after midline
laparotomy: a prospective study. Eur J Surg 1996;162:125–9.
Hoer J, Lawong G, Klinge U, Schumpelick V. Factors
influencing the development of incisional hernia. A
retrospective study of 2983 laparotomy patients over a period
of 10 years. Chirurg 2002;73:474–80.
Seffah JD, Adanu RMK. Sonographic findings in women
with complications after hysterectomy. Int J Gynecol Obstet
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.