Damage Control Laparotomy in Abdominal Emergencies: A Clinical Prospective Study
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- Category: Vol. 84, June 2016
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Damage Control Laparotomy in Abdominal Emergencies: A Clinical Prospective Study, YEHIA G. ABOSAYED
Abstract
Design: This study was designed to evaluate the imple-mentation of the concept of Damage Control Laparotomy (DCL) in critical ill patients with surgical abdominal emer-gencies.
Background: The lethal triad of hypothermia, acidosis, and coagulopathy has been the nemesis of trauma surgeons for decades. Many advances in the field of trauma have evolved around prevention and treatment of this clinical scenario. One useful technique is Damage Control Laparotomy (DCL). The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. We reviewed our experience, at Shebin El-Kom Teaching Hospital, in application of this concept for cases of surgical abdominal emergencies.
Methods: This study was conducted in Department of General Surgery in Shebin El-Kom Teaching Hospital from August 2013 to July 2015. All patients admitted to the hospital with acute surgical abdominal emergencies and fulfilled the created inclusion criteria were the candidates of this study. All patients will pass through the three phases of DCL. The patients records were reviewed to determine type of surgical emergency, indications of DCL, type of Temporary Abdominal Closure (TAC), resuscitative measures, time and methods of delayed closure, complications of DCL and mortality.
Results: Thirty five patients that fulfilled the inclusion criteria underwent DCL in the 2-year period. The median age was 46 (22:74) years. There were 21 males and 14 females. The most common primary indications for DCL were major trauma (13 patients), peritonitis (10 patients), obstruction (5 patients) and bowel ischemia (5 patients) and ACS in (2 patients). Most of patients had an American Society of An-esthesiologists (ASA) score of 3 or 4. Temporary abdominal closure for all patients was done by using Bogota bag. Overall, 23 patients (65.7%) underwent closure of the fascia within 7 days, 6 patients (17.1%) were closed after more than 7 days and 3 patients (8.6%) could not undergo primary closure.
Overall complications were reported in 11 patients (31.4). Sepsis was documented in 5 patients (14.3%), intra-abdominal collections together with intra-abdominal hypertension in 4 patients (11.4%) and pulmonary embolism in 2 cases. Overall mortality was recorded in 6 patients (17.1 %) without significant difference regarding time of final abdominal closure.
Recommendation: Damage control surgery can be applied in a wide range of abdominal emergencies and it is increasingly recognized as life-saving tactic in emergency surgery per-formed on physiologically deranged patients.