Damage Control in Abdominal Surgery

Damage Control Surgery (DCS) is established as a life-saving procedure in severely injured patients. In addition to the trauma, hemorrhage and tissue hypoperfusion, a secondary systemic injury, by inflammatory mediator release, contributes to acidosis, coagulopathy, and hypothermia and leads to multi system organ failure. It is necessary to identify patients unable to tolerate a traditional approach due to the present or impending state of shock. Use of an abbreviated laparotomy is focused only on control of bleeding and contamination to limit surgical insult and allow for aggressive resuscitation in an Intensive Care Unit (ICU) to regain physiological reserves. Only after correction of acidosis, hypothermia and shock are definitive repairs attempted. Closure of the abdominal wound has developed thanks to a better understanding of the importance of Intraabdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS). A good knowledge of DCS has led to a significant increase in survival of severely injured patients. The authors provide an overview of the DCS approach, as well as the indications for DCS and DCS sequence, followed by a discussion of DCS-associated complications.