Volume : 3, Issue : 5, MAY 2017

ESTABLISHING A CLINICAL AND THERAPEUTIC MODEL TO PREDICT SUCCESSFUL EARLY RE-INTERVENTION IN SEVERELY COMPLICATED LAPAROTOMY AT THE LUBUMBASHI UNIVERSITY HOSPITALS, IN THE DEMOCRATIC REPUBLIC OF CONGO.

C. Saleh, W. Arung, W. Waratch, F. Tshilombo, H. Tamubango Kitoko, Sodi Musanka, BFK Odimba

Abstract

Introduction A major abdominal surgery is mainly the surgical operation during which the cavity of the abdomen is opened and is designed as “coeliotomy” and most frequently “laparotomy”. Despite the occurrence of non invasive investigations and the introduction of laparoscopic surgery, in many Third Word countries, laparotomy still occupies an important place in the management of surgical patients as diagnostic or treatment tool. In the same manner, post laparotomy complications, despite careful planning and safe surgical technique remain common and have high outcomes risk even at the most skilled and experienced hands in our environment. However it has been shown that early recognition of a postoperative complication that need relaparotomy and a perfect performance of this second laparotomy guarantee the best prognosis. This study was aiming to develop an accurate and affordable clinic-therapeutic model that allows an early the decision-making process and to propose a related cost effective relaparotomy technique in the similar conditions of medical practice

Methods This was a prospective analytic cohort study of surgical patients undergoing relaparotomy at the tertiary Hospitals of Lubumbashi: the University clinics of Lubumbashi and the Jackson Sendwe hospital of reference of Lubumbashi (DRC) between 1st January 2012 and 31st December 2015 All patients who had laparotomy during the same the concerned hospitals and in the referring were studied, a total of 304 patients in two groups (with or without relaparotomy). Social demographic factors, data relating to the initial laparotomy, the outcomes after the initial laparotomy, the surgical teams’ impact were recorded until patient’s discharge (or death). The use of univariate and multivariate analysis with logistic regression of dependent and independent variables has allow to build up a clinic-therapeutic model to predict the need for relaparotomy and the way to perform an effective re laparotomy

Results In this prospective study, the total amount of patients operated by laparotomy was 304 whose 204 discharged in due time (81,58%, : Group N), and 56 had a re laparotomy (18,42% : Group P). The hospital relaparotomy incidence was 22, 37%. Ages distribution ran from seven months to 83 years in group P with mean age at 34,6 ± 19 years and from 5 years to 68 years. in group N with mean age at 25 ± 14 years. BY combining analysis of parameters of the two groups, more than 8 variables revealed statistically significant to predict a re-laparotomy after logistic regression were conducted by two separate team: 5 dependent variables as post laparotomy manifestations ( sensation from the patient of not feeling well, increasing abdomen perimeter of more than 1cm every 12 hours, high heart beat despite fluid or blood replacement, pour urine out put and permanent dirty surgical site or drainage orifice) and 3 prelaparotomy parameters or independent factors (extreme age: below five or beyond 60 years; referral from outside Lubumbashi city; poor condition at the initial laparotomy due to financial difficulties to fulfill operation fee, patient’s co-morbidity ap an ASA grade>I, an emergency laparotomy, or non qualified principal operator) The logistic regression model was statistically significant, χ2 (6) = 259.2, p < 0.0001. The model explained 96.1% (Nagelkerke R2) of the variance in re-laparotomy and correctly classified 98.7.0% of cases. Sensitivity was 96.2%, specificity was 99.2%, positive predictive value was 96.2% and negative predictive value was 99.2%. Of the six predictor variables only four were statistically significant: Ad>2/d, Finance, Co-morbid condition and GenFeel (as shown in the below). ADgt2d had 976077 times higher odds to undergo re-laparotomy than non-ADgt2d individuals. Increasing the financial capacity and co morbidity was associated with a reduction in likelihood of re-laparotomy but increase in GenFeel and Referrals was associated with a increase in the likelihood of re laparotomy All re-laparotomies (100%) were done on demand and were not planned from the initial laparotomy. The proposed relaparotomy procedure infers from comparison between uncomplicated and complicated original laparotomies and the observation suggesting that after the first relaparotomy any further relaparotomy should be avoided being not cost-effective..

Conclusion We have established a clinical and therapeutic model using only locally and affordable diagnostic tools to predict the need for relaparotomy in patients with complicated post major abdominal surgery. An inferred relaparotomy is also presented. It is the hope that both the model and the relaparomy technique will be adopted and get validated by surgical teams working in the similar conditions of service. More research works are still requested in the similar aeas to increase the statistical data

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Research Paper E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 5 | MAY 2017
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