Reoperative abdominal surgery.

Certain complications that arise after initial abdominal operation require abdominal reoperation. As the casualty progresses rearward along the medical evacuation chain, medical personnel must be ever vigilant in the early recognition of these complications. The U.S. Air Force, with its aeromedical evacuation responsibility, has a special interest and great experience in the recognition and treatment of these complications. During the Vietnam conflict, one of every six casualties with abdominal wounds removed from the air evacuation system at Clark Air Force Base required reoperation. Because of the severity of their abdominal wounds and the high frequency of associated injuries, these patients frequently present confusing findings The indications for reoperation are often not well defined. To make matters even more difficult, these complica tions may not develop until the postoperative patient arrives at a higher echelon hospital and comes under the care of surgeons who were not involved in the primary operation. On occasion, the medical records accompanying these patients may lack sufficient detail regarding the injury and the details of the first operative procedure to be helpful in subsequent evaluation. Given these circumstances, the surgeon must rely heavily on past experience for guidelines in reoperation of abdominal war wounds. The inherent problems of making a preoperative diagnosis in the most difficult group of patients should not deter an aggressive approach. This philosophy will prove much more rewarding than procrastination. Practical points gained from such experience follow.