Damage control surgery for abdominal trauma.

OBJECTIVE

To review the physiology, indications, technical aspects, morbidity, and mortality of damage control surgery.

DESIGN

Retrospective study of published papers.

SETTING

Teaching hospital, United Arab Emirates.

INTERVENTIONS

A MEDLINE search on damage control surgery for the years 1981-2001. Further articles were retrieved from the references of the original articles.

RESULTS

The indications for damage control surgery are: the need to terminate a laparotomy rapidly in an exsanguinating, hypothermic patient who had developed a coagulopathy and who is about to die on the operating table; inability to control bleeding by direct haemostasis; and inability to close the abdomen without tension because of massive visceral oedema and a tense abdominal wall. The principles of damage control surgery are: Phase I: laparotomy to control haemorrhage by packing; shunting, or balloon tamponade, or both; control of intestinal spillage by resection or ligation of damaged bowel, or both. Phase II: physiological resuscitation to correct hypothermia, metabolic acidosis, and coagulopathy. Phase III: planned reoperation for definitive repair. Damage control surgery is appropriate in a small number of critically ill patients who are likely to require substantial hospital resources; it has a high mortality (mean 45%, range (10%-69%).

CONCLUSION

Damage control surgery offers a simple effective alternative to the traditional surgical management of complex or multiple injuries in critically injured patients. Phases I and II can be done at a rural hospital before transfer to a major trauma centre for definitive repair.