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“Relaparoscopic” management of surgical complications: The experience of an Emergency Center

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Abstract

Background/aim

Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications.

Materials and methods

We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated.

Results

Sixty-six patients (88 %) were managed with laparoscopic approach without conversion; of these, sixty-three patients (84 %) had no more or further complications and were discharged from hospital between 4 ± 3 days after “second-look” surgery; three patients (4 %) developed postoperative complications requiring a third surgery. Nine cases (12 %) underwent conversion in open surgery after laparoscopic approach. Two elderly patients (2.7 %) died in intensive care unit, because of multi-organ failure syndrome. Median time elapsed between an intervention and another was about 2.5 ± 9.5 days. Mean operative time was 90 ± 150 min. Postoperative hospital stay was between 4.5 and 18 days.

Discussion and conclusion

Laparoscopy has begun to be the preferred method to manage postoperative problems, but only few reports are available actually. Our experience in “relaparoscopic” management of surgical complications seems to suggest that laparoscopy “second look” is an effective tool after open or laparoscopic surgery for the management of postoperative complications and it may avoid diagnostic delay and further laparotomy and related problems.

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Authors and Affiliations

  1. Dipartimento di Chirurgia Generale e d’Urgenza, Policlinico Universitario “Paolo Giaccone”, Palermo, 90121, Sicily, Italy

    Antonino Agrusa, Daniela Chianetta, Leonardo Gulotta, Giuseppe Di Buno, Vincenzo Sorce, Giorgio Romano & Gaspare Gulotta

  2. Ospedale “Umberto I°”, U.O. Medicina e Chirurgia d’Accettazione e d’Urgenza, ASP n°4, Contrada Ferrante, Enna, 94100, Sicily, Italy

    Silvia Di Giovanni

  3. Ospedale “Michele Chiello”, Unità Operativa Complessa di Chirurgia Generale e d’Urgenza, ASP n° 4 Contrada Bellia, 94015, Piazza Armerina, Sicily, Italy

    Giuseppe Frazzetta

  4. Ospedale “Umberto I°”, Unità Operativa Complessa di Chirurgia Generale e d’Urgenza, ASP n°4, Contrada Ferrante, 94100, Enna, Sicily, Italy

    Giuseppe Frazzetta

Authors
  1. Antonino Agrusa
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  2. Giuseppe Frazzetta
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  3. Daniela Chianetta
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  4. Silvia Di Giovanni
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  5. Leonardo Gulotta
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  6. Giuseppe Di Buno
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  7. Vincenzo Sorce
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  8. Giorgio Romano
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  9. Gaspare Gulotta
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Corresponding author

Correspondence to Giuseppe Frazzetta.

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Disclosures

Antonino Agrusa, Giuseppe Frazzetta, Daniela Chianetta, Silvia Di Giovanni, Vincenzo Sorce, Di Buono Giuseppe, Leonardo Gulotta, Giorgio Romano and Gaspare Gulotta have no conflict of interest or financial ties to disclose.

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Agrusa, A., Frazzetta, G., Chianetta, D. et al. “Relaparoscopic” management of surgical complications: The experience of an Emergency Center. Surg Endosc 30, 2804–2810 (2016). https://doi.org/10.1007/s00464-015-4558-2

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  • DOI: https://doi.org/10.1007/s00464-015-4558-2

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