Analysis Of54Cases Of Reoperation For Postoperative Intra-abdominal Hemorrhage

Objective:To investigate etiology and the effectiveness of reoperation of postoperative intra-abdominal hemorrhage(PAH) after abdominal procedures. And sum up the experiences on management of postoperative intra-abdominal hemorrhage.Methods:The clinical records of patients confirmed by reoperations due to postoperative abdominal cavity hemorrhage in the General Surgery Department of Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital between January,2009and December,2011were analysed retrospectively.The early postoperative intra-abdominal hemorrhage (EPAH) refered to hemorrhage taking place within3days after the procedure and delayed postoperative intra-abdominal hemorrhage (DPAH) refered to hemorrhage occurring more than3days after the surgery. There were37cases in EAPH group and17cases in DAPH group. Clinical datas were compared between EAPH group and DAPH group.Results:54cases were confirmed by reoperations due to postoperative abdominal cavity hemorrhage.33cases were male with an average age of59.5±13.5years.21cases were female with an average age of51.8±14.8years. The laparoscopic approaches were conducted in13cases of postoperative intra-abdominal hemorrhage after laporascopic procedures without change to laparotomy.The rest41cases were rendered to laparotomy via prior incisions. There were no significant differences in sex, age, pre-surgery comorbidities, abdominal surgical history, emergency setting, systole blood pressure, prothrombin time and heart rates between EAPH group(n=37) and DAPH(n=17) group. In the primary prodedure, there were no significant differences in operation time, blood loss, blood transfution volume, urinary output, combined-organ surgery and laparoscopic surgery between the two groups. There were significant differences in reoperative time, peritoneal accumulated blood volume, complications and average hospital stay after reoperation.The reoperative time were70(20～200)min and120(40～200)min in EPAH group and DPAH group respectively (p=0.012).The peritoneal accumulated blood volume in reoperation were300(100～5000) ml and1000(100～3000)ml respectively(p=0.018).2cases in EPAH group and4cases in DPAH group developed complications after reoperation, including incisional infection, inflammatory intestinal obstruction and pulmonary infection. The average hospital stay after reoperation were6.6±3.2days and8.6±3.4days respectively(p=0.040).Re-hemorrhage occurred in1cases in EPAH group and DPAH group respectively (p=0.227).6patients were dead eventually.The death rate was11.1%.3cases died from pulmonary infections. Disseminated intravascular coagulation resulted in2deceased cases.Hemorrhagic shock during reoperation claimed1patient’s life. The rest patients had a sound recovery without re-hemorrhage and intra-abdominal infections. There were3deaths in EPAH group and DPAH group respectively(p=0.300).Conclusion:Compared with EPAH, Patients in DPAH group are with more blood loss,longer reoperative time,increased complications and longer average hospital stay after reoperation. Reoperation and hemostais should be encouraged in treatment for postoperative intra-abdominal hemorrhage. Laparoscopic approach is practicable in laparoscopic postoperative intraabdominal hemorrhage.