Damage control surgery (DCS) is a technique of surgery used to care for critically ill patients.While typically trauma surgeons are heavily involved in treating such patients, the concept has evolved to other sub-specialty services. This approach is successful when there are a limited number of injuries, the patient is not physiologically impaired, and if there are adequate resources. as endoscopic retrograde cholangiogram, percutaneous drainage, and angiography) [28]. devices have been developed to enhance vascular closure without need for prolonged compression. Initially, the DCS has been described in severe liver trauma associated with coagulopathy. © 2008-2021 ResearchGate GmbH. Methods In a retrospective analysis of 144 patients with severe (AAST grade III–V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Of 398 patients with liver trauma, 64 (16%) were found to have high-grade liver injuries. perfusion due to bleeding in particular plays a role in its formation [11]. PDF; Surgical “damage control” techniques developed at US urban trauma centres to keep victims of multiple gunshot wounds alive are now being used to save the lives of soldiers injured in Iraq and Afghanistan. To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser. Tissue hypoperfusion due to serious bleeding occurs and deteri‐. whom temporary abdominal closure techniques are applied [15] (. Rapid closures, moderately rapid. Elle peut même précipiter une issue fatale. Over time, Due to the observed advantages, the DSC approach has become standard practice for abdominal trauma with the extent to … J Trauma. Conclusion: Damage control surgery and damage control management of the patient are important for improved survival rates and success of treatment before the lethal triad occurs deeply. Damage control surgery techniques have evolved within the continuum of military and civilian trauma care since the Napoleonic Wars. Damage control surgery in the era of damage control resuscitation C. M. Lamb, P. MacGoey, A. P. Navarro and A. J. Brooks* EastMidlands Major Trauma Centre, Queen’sMedical Centre Campus, Nottingham University Hospitals, DerbyRoad, Nottingham NG5 2UH, UK * Corresponding author. DCR involves haemostatic resuscitation, permissive hypotension (where appropriate) and damage control surgery Rapid abdominal decompression is applied in the treatment [18]. Collected data included the number and types of liver-related complications. Surgical treatment was found to be associated with higher complication rate. Keywords: Damage control resuscitation, Acute traumatic coagulopathy, Massive transfusion protocol, Damage control surgery, Balanced resuscitation Background Massive bleeding following injury remains the main cause of death in trauma patients. Damage Control Surgery Variable Odds Ratio (95% CI) p Value INR >1.2 10.64 (1.32 - 83.33) 0.026 Base Deficit >3 mmol/L 4.85 (1.10 - 23.81) 0.040 AIS Head 3 4.27 (1.55 - 11.76) 0.005 Body Temperature <35°C 3.68 (1.15 - 11.76) 0.029 Lactate >6 mmol/L 2.96 (1.00 - 9.09) 0.050 Hemoglobin <7 g/dL 2.76 (1.02 - 7.46) 0.045 Frischknecht et al. ERCP failed in one case. A total of 67 patients were enrolled and the device was utilized in 63 patients. Conclusions: There were 24 deaths (37%), the majority from uncontrolled haemorrhage (18 patients). 2001; 136: 676–681. Forty patients (62%) required operative treatment. The diagnosis of bile leaks was suspected with abdominal CT scan, which revealed intraabdominal collections (n = 6), and ascites (n = 2). atic İnjuries. syndrome in damage-control laparotomy after trauma. 2010 (submitted) > DC procedures in 319 pat. With the purpose of controlling bleeding and hemostasis, packing, clamping, ligation, and shunting procedures are applied to the four quadrants or a balloon catheterization is done. Both univariate and multivariate analyses were performed to identify patient and management factors associated with improved survival. Femoral artery puncture closure was performed immediately after completion of the procedure. This research was scheduled as a retrospec- tive study. Sajs. In 29 of 33 cases, mechanism of injury was blunt trauma and all were FAST positive during primary survey. ominous predictor of survival. With the start of the process, Rotondo, afterwards, their complementary surgeries and abdominal closing procedures are, Actual Problems of Emergency Abdominal Surgery. *Address all correspondence to: burhankanat@hotmail.com, 1 Training and Research Hospital, General Surgery Department, Elazığ, Turkey, 3 Iskenderun State Hospital, General Surgery Department, Hatay, Turkey. If hypothermia persists, it leads to cardiac, systemic vascular resistance, and a leftward shift in the oxygen dissociation, term. Then, abdominal closure (temporary abdominal closures; TAC) is done with the Baker. This review summarizes the main perioperative complications of colorectal surgery and influencable and non-influencable risk factors which are important to the general surgeon and the relevant specialist as well. interventions can be options for treatment of complications. AE at admission was associated with a significantly higher rate of biliary complications. Definitive hepatic repair was performed in 62(51.2 %) patient. The principles of trauma surgery have evolved during the past 20 years; from initial aggressive, definitive management of all surgical injuries in the traumatised patient to an abbreviated laparotomy, secondary correction of abnormal physiological parameters and then planned definitive re-exploration; the damage control sequence. After all injuries are detected and any hemorrhages are stopped, complementary gastrointestinal repair (such as resections and anastomoses) is done and if it is not necessary, then ostomy and the opening of enteric feeding tubes are avoided. Stage III (definitive/complementary surgery), Following 24–48 h of resuscitation after primary surgery in intensive care, planned definitive, done [7]. years. Pleural lavage can be applied to patients whose body temperature does, the methods applied. Attention is directed at using all available techniques for controlling bleeding, including packing. 2010; 38: during laparotomy. Although there are many underlying factors, massive transfusion and hypothermia are. With the shift toward nonoperative management, most hepatic injuries are managed nonoperatively. Time to hemostasis (TTH), time to ambulation (TTA) and data regarding short-term and 30-day clinical follow-up were recorded. Academia.edu no longer supports Internet Explorer. Rev Col Bras Cir. Academia.edu uses cookies to personalize content, tailor ads and improve the user experience. In the rapid/primary surgery stage, the purpose is controlling bleeding and contamination. Complications such as fistula, pseudocyst, and abscess can be. As a result, the triad of hypothermia, acidosis, and coagulopathy, along with the frequent complication of abdominal compartment syndrome, are critical factors that require correction in the intensive care unit. Training of the surgeon, hospital volume and learning curves are becoming increasingly more important to maximize patient safety, surgeon expertise and cost effectiveness. The aim of the current study was to define hepatic related morbidity in patients sustaining high-grade hepatic injuries that could be safely managed non-operatively. A combination of acidosis, hypothermia, and co… Join ResearchGate to find the people and research you need to help your work. The period of stay in the intensive care unit, duration of re-operation and number of re-operations were also recorded. Tertiary referral/level I trauma center. Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathie and hypothermia. Balk, Emerg Surg. Indications for patient selection for damage control surgery [7]. tography (ERCP) provides accurate anatomical delineation of the duct injury [29]. No major adverse events were identified during hospitalization or at the 30 day follow-up. success of treatment before the lethal triad occurs deeply. Sorry, preview is currently unavailable. Development of abdominal compartment syndrome, prophylactic use of an open abdomen to prevent development of intra-abdominal hypertension/abdominal compartment syndrome, and use of a multi-modality surgical/medical management algorithm were identified as independent predictors of survival. The purpose of … Results: Damage control surgery facilitates a strategy for life-saving intervention for critically ill patients by abbreviated laparotomy with subsequent reoperation for delayed definitive repair after physiological resuscitation. In patients with clinical evidence of biliary complications, CT scan is a useful diagnostic and therapeutic tool. 2005; 43(3): 92–102. 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