title: Relaparotomy after initial surgery in obstetric and gynecologic operations: analysis of 113 cases.
abstract: CONCLUSIONS
  Even though relaparotomy is unavoidable in some cases, several measures such as careful surgical technique, meticulous hemostasis and aseptic conditions must be undertaken to prevent unnecessary interventions in obstetrics and gynecology
  
  
  OBJECTIVE
  To assess the indications, procedures, risk factors and outcome for relaparotomy after obstetric and gynecological operations.
  
  
  METHODS
  A retrospective observational study during a four-year period in a tertiary care center was performed. Demographics such as age, parity and indications for relaparotomy as well as outcome measures in terms of complications and mortality rates were assessed in 113 patients who had undergone a relaparotomy after the initial obstetric or gynecological surgery
  
  
  RESULTS
  The overall incidence of mortality after relaparotomy was 3.5%. Leading indications for the initial operation included placental abruption in 10 cases (8.8%), followed by the HELLP syndrome and previous cesarean section both in 5 cases (4.4%), and postpartum atonia in 4 (3.5%). The most common operations performed initially were cesarean section in 78 cases (69.0%) and 31 hysterectomies (27.5%). Principal indications for relaparotomy were bleeding and hematoma in 80 cases (70.8%) and abscess in 10 cases (8.8%). The most frequently performed procedures at relaparotomy were drainage and resuturing of hematomas (n = 42, 37.1%), hypogastric artery ligation (n = 32, 28.3%), hysterectomy (n = 31, 27.5%), and drainage of abscess (n = 7, 6.2%). A second relaparotomy was performed in 4 cases (3.5%). Complications were encountered in 4 patients and 4 cases ended up with mortality
  
  
  CONCLUSIONS
  Hemorrhagic and infectious complications were the main indications for relaparotomy after obstetric and gynecologic surgeries. Cases with a history of placental abruption, HELLP Syndrome and previous cesarean section were under risk for relaparotomy. Despite favourable outcome, preventive measures such as careful surgical technique, meticulous hemostasis and aseptic conditions should be undertaken.
authors.affiliation: Dicle University, School of Medicine, Department of Obstetrics and Gynecology, Diyarbakir, Turkey. drmesak@yahoo.com
authors.forename: Muhammet Erdal
authors.initials: ME
authors.lastname: Sak
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Turgut
authors.forename: Mehmet Siddik
authors.initials: MS
authors.lastname: Evsen
authors.forename: Hatice Ender
authors.initials: HE
authors.lastname: Soydinc
authors.forename: Ali
authors.initials: A
authors.lastname: Ozler
authors.forename: Sibel
authors.initials: S
authors.lastname: Sak
authors.forename: Talip
authors.initials: T
authors.lastname: Gul
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D016387:Women's Health; D055815:Young Adult