Damage control surgery in emergency general surgery: What you need to know

Abstract

Damage control surgery (DCS) is a strategy adopted to limit initial operative interventions in the unstable surgical patient, delaying definitive repairs and abdominal wall closure until physiologic parameters have improved. Although this concept of "physiology over anatomy" was initially described in the management of severely injured trauma patients, the approaches of DCS have become common in the management of non-traumatic intra-abdominal emergencies. While the utilization of damage control methods in emergency general surgery (EGS) is controversial, numerous studies have demonstrated improved outcomes, making DCS an essential technique for all acute care surgeons. Following a brief history of DCS and its indications in the EGS patient, the phases of DCS will be discussed including an in-depth review of preoperative resuscitation, techniques for intra-abdominal source control, temporary abdominal closure, ICU management of the open abdomen, and strategies to improve abdominal wall closure.

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

“…Life-threatening hemorrhage is a major preventable cause of early death after trauma [ 13 ]. Bleeding control with circulating blood volume restoration is a priority in polytrauma care and the main goal of damage control strategies [ 14 , 15 ]. Arterial hypotension and hypoxia are frequently observed after isolated tSCI, especially when the injury occurs at high spinal cord levels [ 1 ].…”

Author Reply: “What do we mean by source control and what are we trying to accomplish with an open abdomen in severe complicated intra-abdominal sepsis?”

“…W e sincerely appreciate the commentary generated by Coccolini and colleagues regarding source control and the true intention of an open abdomen approach in the management of severe intra-abdominal sepsis described in our recent review. 1,2 The concept of source control is indeed nebulous, and the lack of a discrete definition complicates both clinical management and research endeavors. Currently, the only way to truly know if source control has been obtained is, in hindsight, patients who progress expectantly after surgical intervention, resuscitation, and antibiotic management are assumed to have had "adequate or complete" source control.…”