AbstractThe literature on reinterventional abdominal surgery is confusing. The incidence and mortality rates are greatly affected by the type of surgery reported. There is also a difference between recent and older studies with regard to definitions and indications for relaparotomy, rendering comparison of these studies rather useless.Reinterventional laparotomy is reported to occur in 0.5–15% of all laparotomies. The highest incidence is seen in gastrointestinal surgery and the lowest in vascular surgery. The indications are infection and disruption of anastomoses, wound dehiscence, hemorrhage, obstruction, ischemia and necrosis, multiple system failure, and miscellaneous indications. The overall mortality rate after reinterventional laparotomy is over 40%, ranging from 24 to 71%. Factors that appear to correlate with mortality are age over 50, peritonitis at initial procedure, and multiple system failure. Criteria leading to relaparotomy are usually clinical (tenderness, fever, and absence of bowel sounds) and, to a minor extent, depend on radiological procedures of which computed tomographic scanning has the highest accuracy (97%).Multiple system failure carries the highest mortality rate (80% if treated, 100% if untreated) and presents the greatest number of negative laparotomies. Arguments for accepting this criterion are discussed. Mortality rates apparently will not be lowered limiting technical failures. A better yield could be gained by improving perioperative management and inducing a shift toward second‐look or elective procedures within a fully developed protocol.