Relaparotomies after ruptured abdominal aortic aneurysm repair.
The outcome of ruptured abdominal aortic aneurysm repair was reviewed in 83 consecutive patients with special emphasis on the influence of subsequent laparotomy. The overall 30-day mortality was 47%. Causes of death were exsanguination in six, cardiac failure in 15, uncontrolled hypotension in six, multiple organ failure (MOF) in nine, adult respiratory distress syndrome in one and sepsis in two patients. Thirty-three relaparotomies were performed in 21 patients after a mean interval of 10 days. Suspected intraabdominal haemorrhage was the indication in 15 and sepsis in 18 cases. The preoperative diagnosis proved to be correct in 12/15 (80%) and 11/18 (61%) instances, respectively. Negative explorations were mainly performed in patients with an established MOF syndrome. Relaparotomies were associated with a significantly (p < 0.05) increased mortality of 76%. The complications that give rise to the need for surgical reintervention are usually accompanied by a clinical deterioration of the patient and inevitably reduce the chances of survival. However, until a reliable predictor of mortality is developed, treatment should not be denied in individual cases.