Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma

Weale, Ross; Kong, Victor; Blodgett, Joanna M.; Buitendag, J J P; Ras, A; Laing, G L; Bruce, J L; Bekker, W; Manchev, V; Clarke, Damian

doi:10.1136/jramc-2018-000950

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…Preoperative severe acidosis, the intraoperative need for a massive transfusion in the first 24 hours and median PATI score of 47 were independent predictors for increased mortality and similarly compares with both international and local experience. [21][22][23]…”

Section: Discussionmentioning

confidence: 99%

Damage control laparotomy outcomes in a major urban trauma centre

Kruger¹,

McPherson²,

Nicol³

et al. 2022

S. Afr. j. surg.

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BACKGROUND: Damage control laparotomy (DCL) is associated with high mortality. The purpose of this study was to review the outcomes of DCL. METHODS: All patients undergoing DCL for penetrating trauma from May 2015 to July 2017 were reviewed. Data retrieved were demographics, mechanism of injury, vitals, and biochemical parameters. Injury severity was described by the revised trauma score (RTS), penetrating abdominal trauma index (PATI), injury severity score (ISS) and trauma and injury severity score (TRISS). Indications for DCL, length of ICU stay, number of procedures and primary abdominal closure rates, complications and mortality were recorded. RESULTS: Fifty-one patients underwent DCL and 47 patients sustained gunshot injuries. Indications for laparotomy were haemodynamic instability (n = 27) and peritonism in stable patients (n = 22). The medians for the different severity scores were RTS 7.36, ISS 20, and PATI 30. The organs most commonly injured, in decreasing frequency, were small bowel (33), large bowel (25), abdominal vasculature (22), liver (18), stomach (14), kidney (10), diaphragm (10), spleen (9) and pancreas (8). DCL procedures performed were abdominal packing (36), temporary bowel ligation (30), vascular (5) and ureteric (1) shunting. The median number of laparotomies performed per patient was three, with a primary fascial closure rate of 69%. The mortality rate was 29%. CONCLUSION: DCL in our centre is associated with a 29% mortality rate. Severe acidosis, massive blood transfusion in first 24 hours and median PATI score more than 47 are independent risk factors associated with increased mortality.

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Section: Discussionmentioning

confidence: 99%