RECONSTRUCTIVE ABDOMINAL OPERATIONS AFTER LAPAROSTOMY AND MULTIPLE REPEAT LAPAROTOMIES FOR SEVERE INTRAABDOMINAL INFECTION

Between 1980 and 1993, 18 patients underwent formal laparotomy after l aparostomy and healing of the peritoneal cavity by granulation. The ma jority (12 patients) were men and the median age was 47 (range 22-67) years. Intraabdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1 -18) months after laparostomy. The indication for surgery was for clos ure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a seco nd laparotomy: two for elective restoration of bowel continuity, two f or recurrent fistula and one for an acute abdomen. After reconstructiv e surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short bowel syn drome. In contrast, the two oldest patients in the series died from mu ltiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evide nce of further intra-abdominal infection after reconstruction.