Damage control laparotomy

Finlay, I. G.; Edwards, Tony; Lambert, Anthony

doi:10.1002/bjs.4434

Cited by 85 publications

(81 citation statements)

References 13 publications

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“…The use of laparostomy following damage-control surgery is well established, [1][2][3] but the open abdomen is complex to manage and is itself associated with considerable morbidity and mortality rates in excess of 25%. 4 Various measures for managing the open abdomen have been described such as the use of prosthetic mesh, the Bogota bag and Wittman's patch.…”

Section: Introductionmentioning

confidence: 99%

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Horwood

Akbar

Maw

2009

annals

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INTRODUCTION To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes. PATIENTS AND METHODS Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC ® therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes. RESULTS Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004). CONCLUSIONS Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.

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Section: Introductionmentioning

confidence: 99%

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Horwood

Akbar

Maw

2009

annals

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“…The goal of DCS is the avoidance of an irreversible physiological injury from the 'lethal triad' of hypothermia, acidosis and coagulopathy. While initially used in the management of trauma, DCS is now well established in the management of abdominal sepsis [6].…”

Section: Discussionmentioning

confidence: 99%

Damage control apronectomy for necrotising fasciitis and strangulated umbilical hernia

et al. 2010

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We present a case of a 50-year-old morbidly obese woman who presented with a case of necrotizing fasciitis of the anterior abdominal wall due to a strangulated umbilical hernia. The case was managed through damage control surgery (DCS) with an initial surgery to stabilise the patient and a subsequent definitive operation and biological graft hernia repair. We emphasise the relevance of DCS principles in the management of severe abdominal sepsis.

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“…It is a well-established practice in trauma and general surgery where the phrases bdamage control surgeryQ (DCS) [1] and bdamage control laparotomyQ (DCL) [2] have been coined for rescue intra-abdominal packing. In an unstable patient with coagulopathy and diffuse bleeding, packing may be the easiest way to control intra-abdominal or pelvic bleeding through the simple effect of tamponade.…”

Section: Discussionmentioning

confidence: 99%

Abdominal packing for intractable obstetrical and gynecologic hemorrhage

Awonuga

Merhi

Khulpateea

2006

International Journal of Gynecology & Obstetrics

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Hemorrhage continues to be a serious complication of both obstetrical and gynecologic surgeries. Physicians have used packing in cases of uncontrollable hemorrhage for many years, and this article reports on a modification of standard packing techniques that prevents some of the limitations of traditional packing. This technique was used in 1 patient after cesarean hysterectomy and 3 patients after debulking surgery for advanced gynecologic cancer. The pack consists of a wide piece of ribbon gauze and a Penrose drain. One end of the ribbon gauze is draped over a layer of surgicel (oxidized regenerated cellulose), while the rest is threaded through a 1-inch Penrose drain tightly folded several times to maintain pressure over the bleeding area. The other end of the Penrose drain, with the ribbon gauze visible within it, is inserted through a stab incision in the ipsilateral side of the lower abdomen. This technique allows for continuous bleeding assessment and easy removal of the gauze at bedside.

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Damage control laparotomy

Abstract: The use of DCS in the treatment of critically ill patients resulted in a lower mortality rate than that predicted by POSSUM or P-POSSUM. DCS should not be restricted to trauma.

Cited by 85 publications

References 13 publications

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Damage control apronectomy for necrotising fasciitis and strangulated umbilical hernia

Abdominal packing for intractable obstetrical and gynecologic hemorrhage

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