"Relaparoscopic" management of surgical complications: The experience of an Emergency Center.
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.



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.



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.



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.
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Antonino
A
Agrusa
Ospedale "Michele Chiello", Unità Operativa Complessa di Chirurgia Generale e d'Urgenza, ASP n° 4 Contrada Bellia, 94015, Piazza Armerina, Sicily, Italy. giuseppe.frazzetta@libero.it.|Ospedale "Umberto I°", Unità Operativa Complessa di Chirurgia Generale e d'Urgenza, ASP n°4, Contrada Ferrante, 94100, Enna, Sicily, Italy. giuseppe.frazzetta@libero.it.
Giuseppe
G
Frazzetta
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Daniela
D
Chianetta
Ospedale "Umberto I°", U.O. Medicina e Chirurgia d'Accettazione e d'Urgenza, ASP n°4, Contrada Ferrante, Enna, 94100, Sicily, Italy.
Silvia
S
Di Giovanni
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Leonardo
L
Gulotta
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Giuseppe
G
Di Buno
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Vincenzo
V
Sorce
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Giorgio
G
Romano
Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy.
Gaspare
G
Gulotta
D018784:Abdominal Abscess / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D002763:Cholecystectomy; D015331:Cohort Studies; D061887:Conversion to Open Surgery; D057210:Delayed Diagnosis; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D061646:Operative Time; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D024162:Second-Look Surgery; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
Relaproscopy; Surgical complications; “Redo” surgery; “Second-look” surgery