• Chad G Ball and David V Feliciano.
• University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada. Electronic address: Ball.chad@gmail.com.
• J. Am. Coll. Surg. 2020 Nov 1; 231 (5): e1e6e1-e6.

BackgroundReoperative abdominal surgery is one of the most challenging endeavors that general surgeons face. The aim of this narrative review is to offer a detailed and nuanced discussion of preoperative patient and surgeon preparation and intraoperative surgical technique.Study DesignThe topics discussed in this review are based on both the current literature and the experiences of the authors with complex reoperations in general, trauma, acute care, and hepatopancreatobiliary surgery.ResultsTen essential steps for reoperative abdominal surgery include the following: 1. Review all previous operative notes and discharge summaries; 2. Review all prior outside and current in-house imaging; 3. Assess the patient's overall health status, reverse nutritional deficits, and explain risks of reoperation to the patient and family; 4. Refer the patient to a plastic surgeon when future skin coverage of a prosthesis in the abdominal wall may be needed; 5. Do a bowel preparation preoperatively; 6. Use selected Enhanced Recovery After Surgery protocols; 7. Operative technique matters; 8. Restoring gastrointestinal continuity simultaneously with abdominal wall reconstruction is not recommended; 9. Technical tips for complex reoperations; and 10. Plan well for the day of the operation.ConclusionsSuccessful reoperative abdominal surgery in the most complex patients after previous trauma or acute care laparotomies demands adequate preoperative patient preparation, a clear-cut plan for operation, superb intraoperative technique, and solid decision-making; ie an unwavering commitment to making the patient whole again.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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