Damage Control Procedures Provide Life-Saving Benefit in Abdominal Emergencies

Surgical Rounds®, December 2013,

Patients who have experienced hemorrhage and sepsis seem to gain the most benefit from damage control procedures if the surgeon uses careful patient selection.

Damage control surgery is often used after patients experience traumatic injury. In the operative suite, well-defined damage control principles can reduce mortality in non-trauma abdominal emergencies, as well.

As damage control surgery is widely accepted by emergency surgeons as a life-saving strategy for critically ill patients who have abdominal complications, researchers from the Department of Traumatology at John Hunter Hospital and the University of Newcastle in Australia presented a literature review of data from the 10 years leading up to August 2013 in order to describe current knowledge about damage control surgery for abdominal emergencies.

Damage control starts with abbreviated laparotomy, which controls blood loss and contamination in the abdomen. Eventually, surgeons can perform subsequent reoperation for delayed definitive repair after physiological resuscitation.

Even though minimal evidence validates the benefit of damage control surgery in general surgical abdominal emergencies, the authors proposed that roughly 3% of patients who have shock from uncontrolled hemorrhage or sepsis could benefit, and they described a 6-phase strategy that can be used in severely injured patients.

Analyzing the results of 16 studies — the majority of which were retrospective case series — the researchers found patients who have experienced hemorrhage and sepsis seem to gain the most benefit if the surgeon uses careful patient selection.

Though damage control procedures can save lives, they expose patients to the risks of multiple surgeries, open abdomen management, and prolonged intensive care stay if they are inadequately performed. Trigger points to consider in damage control surgery for non-traumatic abdominal emergencies might include hypothermia, metabolic acidosis, or coagulopathy; however, they are not supported by controlled clinical trials.

Damage control surgery is employed in a wide range of abdominal emergencies. It appears to be a life-saving tool when patients are physiologically disturbed. Further research on the topic should help surgeons identify patients at greatest need for damage control.