Letter to the Editor: Standard of Care and Outcomes of Primary Laparotomy Versus Laparotomy in Patients with Prior Open Abdominal Surgery (ReLap Study; DRKS00013001)

Abstract

Dear Editor, Wewould like to congratulate the authors for an exemplary article on re-laparotomy and discussing the difference in outcomes of patients undergoing re-laparotomy as compared to primary laparotomy. We read this article with great interest and a few important observations came up, which could be beneficial to the readers. 1. This controlled clinical trial was performed to evaluate the standard of care and risk of intraoperative and postoperative complications of re-laparotomy compared to primary laparotomy. However, the control group or the primary laparotomy group patients did not resemble the re-laparotomy group regarding the type of surgery performed, which has a major bearing on the size of incision, operative duration, and intraand postoperative complications. For instance, in a systematic review assessing the risk of adhesive small bowel obstruction (SBO) post-laparotomy, risk of SBO was highly influenced by type of procedure, from as high as 19.3% after ileal pouch-anal anastomosis, 11.1% after gynecological procedures, 9.5% after open colectomy, and 7.1% in open cholecystectomy to 1.3% in open appendectomy. The heterogeneity of the sample should have been addressed; otherwise, this article does not add much to the existing literature. 2. The protocol is very flexible, with most decision-making points in control of the surgeon. For instance, the indication for mesh placement has not been specified. The technique of abdominal wall closure is not uniform. European Hernia society guidelines recommend the small bites technique with suture to wound length (SL/WL) ratio at least 4/1 with a slowly absorbable monofilament suture . This was largely based on two randomized controlled trials. 5