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Burden of Emergency Exploratory Laparotomies: Sleepless Nights in Operation Rooms

Background: Recently the burden of emergency exploratory laparotomies has increased very rapidly. Both traumatic and non-traumatic abdominal emergencies are dealt with in surgical emergency departments which not only increase financial burden to health care setup but also a physical and psychological burden to healthcare providers. The purpose of this study was to share the burden and spectrum of these laparotomies in the emergency surgical department of a tertiary care hospital in a third world country. 
Materials and Methods: A retrospective observational study conducted at Surgical Unit-I, Holy Family Hospital, Rawalpindi, Pakistan from June 2014 to December 2016. All patients above 12 years presenting to our emergency department directly or referred from any other facility who underwent midline exploratory laparotomy in our hospital were included in our study. 
Results: A total of 433 patients were included in our study. Out of which, 254 (58.66%) were males and 179 (41.33%) were females and male to female ratio was 1.41:1.342 (78.9%) patients presented with non-traumatic cause whereas 91 (21%) patients have the history of abdominal trauma. Peritonitis (57.6%) followed by intestinal obstruction (28.65%) were the two most common indications of laparotomy in non-trauma patients whereas road traffic accidents and falls (65%) were the most common cause of laparotomy in trauma patients. Intraoperative findings and operative management was compared between trauma and non-trauma patients. 
Conclusion: In resource-limited countries, they are posing a great burden to emergency departments of tertiary care hospitals. More specialized trauma centers should be established to cope with this burden.