Early relaparoscopy for management of suspected postoperative complications.

BACKGROUND: Diagnosis of complications after laparoscopic surgery is difficult and sometimes late.

METHODS: We compared the outcome of patients who had early (<48 h) relaparoscopy for suspected postoperative complication to those where relaparoscopy was delayed (>48 h).

RESULTS: During the study period, 7726 patients underwent laparoscopic surgery on our service. Of these, 57 (0.7%) patients had relaparoscopy for suspected complication. The primary operations were elective in 48 patients and emergent in nine. Thirty-seven patients had early, 20 had delayed, secondary operations. The most common indication in the early group was excessive pain (46%) followed by peritoneal signs in 35%. In the delayed group, the most common indication was signs of systemic inflammatory response syndrome in 30% and peritoneal signs in 25%. Relaparoscopy was negative in 16 (28%) patients with no difference between groups. The identified complication was treated laparoscopically in 37(65%) patients, and the rest were converted. The patients in the delayed group had a significantly longer hospital stay (p < 0.003) and had a higher rate of complications (p < 0.05). They also had a higher mortality rate (10% vs. 2.7%), but the difference was not statistically significant.

CONCLUSIONS: A policy of early relaparoscopy in patients with suspected complications enables timely management of identified complications with expedient resolution.