Lessons learned from a decade of re-exploratory laparotomies in obstetrics and gynecology at a tertiary care hospital in Mumbai, India, 2014-2024

Background
Re-exploratory laparotomy in obstetrics and gynecology is a serious and challenging surgical event associated with significant morbidity and mortality. Understanding its incidence, indications, and outcomes is crucial for improving patient care and surgical safety. This study presents a comprehensive analysis of re-exploratory laparotomies over a 10-year period in a major tertiary care center.

Methods
A retrospective cohort study was conducted on all patients who underwent re-exploratory laparotomy following obstetric or gynecological surgery between 2014 and 2024. Data on patient demographics, primary surgery, indications for re-exploration, time to re-intervention, procedures performed, and postoperative outcomes were collected and analyzed. Statistical analysis was performed using descriptive statistics, chi-square tests, and t-tests to identify significant associations.

Results
A total of 117 cases of re-exploratory laparotomy were identified. The mean age of patients was 31.8 ± 7.0 years. The most common primary surgeries were Cesarean Sect. (46.2%) and total abdominal hysterectomy (23.1%). The leading indications for re-exploration were postpartum hemorrhage (26.5%), muscle hematoma (20.5%), and burst abdomen (17.1%). The mean time to re-exploration was 4.7 ± 2.7 days. The overall mortality rate was 8.5%, and the postoperative complication rate was 46.2%. No significant association was found between the level of emergency and patient outcome (p = 0.637).

Conclusion
Re-exploratory laparotomy remains a critical event in obstetric and gynecological practice, with hemorrhage and postoperative wound complications being the primary drivers. This study highlights the need for meticulous surgical technique, early recognition of complications, and prompt intervention to improve patient outcomes. Further research is needed to identify high-risk patient groups and optimize management strategies.