Patterns of Primary Surgical Indications in Laparotomy Cases Following LUCS and TAH

Author(s): Dr.nur -un-naher nazme, Dr. Mst. Shorifa Rani, Dr. Tasnim Mahmud

Background:

Emergency laparotomy is a major surgical procedure performed to address life-threatening intra-abdominal complications such as haemorrhage, sepsis, or organ injury. When required as a re-exploration following obstetric or gynaecological surgery, it represents a serious event associated with increased morbidity and mortality. The growing frequency of caesarean sections and hysterectomies worldwide has contributed to a corresponding rise in postoperative complications that may necessitate relaparotomy.

Objective:

To determine the distribution of indications for primary Lower Uterine Segment Caesarean Section (LUCS) and Total Abdominal Hysterectomy (TAH) among patients who subsequently underwent laparotomy.

Methods:

This retrospective cross-sectional study was conducted from November 2011 to April 2012 in the Department of Obstetrics and Gynaecology at Rajshahi Medical College Hospital, Bangladesh. Hospital records of 41 patients who underwent laparotomy following primary obstetric or gynaecological surgery were reviewed. Data regarding surgical indication, timing of relaparotomy, hospital stay, and patient outcomes were analyzed using descriptive statistics, and results were expressed as frequencies and percentages.

Results:

Among the 41 relaparotomy cases, 34 (82.93%) followed LUCS and 7 (17.07%) followed TAH. The most common indications for primary LUCS were term pregnancy with previous caesarean section (17.07%) and oligohydramnios (14.64%), while fibroid uterus (42.85%) and bulky uterus (42.85%) were the predominant indications among TAH cases. Most relaparotomies (39.02%) occurred within 15–42 days of the initial surgery. The survival rate was 82.93%, and mortality was recorded in 17.07% of cases.

Conclusion:

Previous caesarean delivery and benign uterine disorders were the leading indications for primary surgeries among patients requiring relaparotomy. Early identification of high-risk patients, meticulous intraoperative technique, and vigilant postoperative monitoring are essential to prevent avoidable re-explorations and improve patient outcomes.