There were 24 deaths (37%), the majority from uncontrolled haemorrhage (18 patients). Damage control: Is an operative technique in which control of bleeding and stabilization of vital signs becomes the only priority in salvaging the patient. Rev Col Bras Cir. Techniques to abbreviate the operation included the ligation of enteric injuries in 34 patients, retained vascular clamps in 13, temporary intravascular shunts in four, packing of diffusely bleeding surfaces in 171, and the use of multiple towel clips to close only the skin of the abdominal wall in 178. 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. Damage control surgery concept (DCS) consists of performing a staged surgery and allowing resuscitation in severe trauma patients who require surgical management. J Trauma. There was no statistically significant difference in terms of the surgical approach. Gupta et al. This usually occurs during laparotomy when there is significant bleeding in the abdomen. The duration of stay in the intensive care unit was 19 + 14 and 29 + 17 days, respectively. Although there are many underlying factors, massive transfusion and hypothermia are. By using our site, you agree to our collection of information through the use of cookies. Sajs. The damage control surgery (DCS) approach is described by Hirshberg and Walden (16) as an operative sequence in primary trauma surgery where, life- and time-saving techniques are used to arrest haemorrhage and control spillage by deliberately avoiding resection and reconstruction. 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. In the rapid/primary surgery stage, the purpose is controlling bleeding and contamination. ability, and stimulation of the fibrinolytic system). years. We report a case of PRG that required laparotomy for intrahepatic displacement of a catheter that had been placed inadvertently through the liver under fluoroscopic guidance. This approach is successful when there are a limited number of injuries. Six patients were re- hospitalized after discharge due to late complica- tions. Anatomic or nonanatomic liver resection is required in 2% to 5% of liver injuries. The surgical approach to the most injured patients has changed in recent years. With respect to safety, the SECURE device was non-inferior to other closure devices as tested in the ISAR closure trial. Damage control resuscitation (DCR) is a systematic approach to the management of the trauma patient with severe injuries that starts in the emergency room and continues through the operating room and the intensive care unit (ICU). Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair–single centre experience, The results of damage control surgery in abdominal trauma, Complications of high grade liver injuries: Management and outcomewith focus on bile leaks, Complications in colorectal surgery: Risk factors and preventive strategies. insufficient myocardial functioning. The mean age of the study group was 27 + 8 years while average ISS values were 34 + 12. J Am Coll Surg. Mortality with liver injury following resection is 9% with current advances. Depending upon the operation and modifiable and non-modifiable risk factors the intra- and postoperative morbidity and mortality rate vary. La chirurgie d’urgence ajoute une agression au stress biologique du traumatisme. Prompt correction is necessary not only to allow expeditious completion of required surgical procedures, but because this triad, unless interrupted, invariably leads to death during resuscitation. If abdominal closure cannot be fully done, temporary abdominal closure is done in the fourth stage. ERCP failed in one case. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? ensured, then oxidative respiration increases and the acidosis is corrected by itself [17]. Additional ultrasound or CT guidance may help to define a safe tract to avoid, The subjects of femoral access and management of femoral puncture after sheath removal are of vital importance in cardiac catheterizations and interventions, especially in patients with high risk of complications. If these issues are correctly addressed the metabolic acidosis will gradually improve. The purpose of the study is to investigate the mor- bidity and mortality of such patients who were fol- lowed up at our hospital due to a damage control surgery. 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. Abdominal packing applications for coagulation, Massive transfusion that causes intestinal edema and distension, Failures in control of hemorrhage resulting in increased acidosis and coagulopathy, 5.2. It also leads to the impairment of the immune system. 92Scandinavian JournalofSurgery91: 92–103,2002 B.A.Hoey,C.W.Schwab DAMAGE CONTROL SURGERY B. Damage control surgery is a staged surgical procedure in a patient who has suffered penetrating or blunt abdominal traumatic injury with severe metabolic derangements. A total of 67 patients were enrolled and the device was utilized in 63 patients. 2010 (submitted) > DC procedures in 319 pat. tography (ERCP) provides accurate anatomical delineation of the duct injury [29]. Closed system drainages and a nasoenteric feeding tube are placed if necessary. To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser. Placing a protective element such as a Bogota bag, Long-term closure (planned ventral hernia). J Trauma. damage control strategy during early surgery. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis. 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. 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. This approach is successful when there are a limited number of injuries, the patient is not physiologically impaired, and if there are adequate resources. Of 102 patients who died before reoperation 68 (67%) did so within 2 hours of the initial procedure. Seven liver, 4 colon, 3 small intes- tine, 1 pancreas, 1 kidney, 3 spleen and 3 large vein injuries were observed. non-septic patients with a success rate of up to 80% [30]. Damage control surgery is defined as the rapid initial control of hemorrhage and contamination with packing and temporary closure, followed by resuscitation in the ICU, and subsequent reexploration and definitive repair once normal physiology has been restored. In the second stage of damage control surgery (resuscitation), patients are taken into an intensive care unit for a period of 24–48 h for the enabling of aggressive resuscitation and patient monitoring. Abbreviated laparotomy and planned reoperations in one severely injured patient. Forty patients (62%) required operative treatment. 2015; 10: 34. With the shift toward nonoperative management, most hepatic injuries are managed nonoperatively. hemorrhage, prevent contamination and protect from further injury in severely traumatized patients [1-7]. With the exception of intravascular shunts, there were survivors who were treated by each of the unorthodox techniques. Blood. Results: Predisposing factors for increased intra-abdominal pressure in damage control surgery [21, 22]. A variety of vascular closure, Topical thrombin was applied to the cannulation sites during and after withdrawal of the needles. trauma: issues in unpacking and reconstruction. Intrahepatic delivery of feeds caused by a displaced percutaneous radiological gastrostomy catheter, The Essentials of Femoral Vascular Access and Closure: Principles and Practice, Control of Bleeding from Cannulation Sites with Topical Thrombin in Dialyzed Patients, Thermic sealing in femoral catheterisation: First experience with the Secure Device, In book: Actual Problems of Emergency Abdominal Surgery. Complications such as fistula, pseudocyst, and abscess can be. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). Nine patients required ERCP with biliary stent placement, and 2 required percutaneous transhepatic biliary drainage. Over the last two decades, public health measures and better pre-hospital care have led to an increasing number of seriously injured patients surviving their initial accident and arriving in hospital.1These injured patients often have injuries to multiple body cavities, massive haemorrhage, and near exhausted physiological reserve. Following 24–48 h of resuscitation after primary surgery in intensive care, planned definitive surgery is performed (the third stage of damage control surgery). All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication. ominous predictor of survival. 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. devices have been developed to enhance vascular closure without need for prolonged compression. The SECURE arterial closure device induces hemostasis by utilizing thermal energy, which causes collagen shrinking and swelling. Academia.edu no longer supports Internet Explorer. Sorry, preview is currently unavailable. liver or colonic injury. Damage control surgery (DCS) = “chirurgie de sauvetage” Damage control resuscitation (DCR) Correction des détresses physiologiques Chirurgie de réparation définitive Le « damage control » chirurgical. 50 diagnostic and 13 interventional cases were evaluated. In patients predicted to undergo damage control surgery, a replacement with crystalloids is applied after establishing a wide vascular access before reaching the hospital with the purpose of maintaining acceptable vital functions until reaching the hospital. Three patients had continuous biliary leak from intraabdominal drains left after laparotomy. Conclusions: and reproduction in any medium, provided the original work is properly cited. Patients were re-operated 24 times after damage control surgery. Damage Control, liver packing and planned re-laparotomy after 48 h were used in 59(48.8 %). 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. This is mainly attributable to the increase in the laparoscopic approach, which is now well accepted for many procedures. When should damage control surgery be done? 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. hemorrhage can be associated with coagulopathy. The authors conclude that patients with hypothermia, acidosis, and coagulopathy are at high risk for imminent death, and that prompt termination of laparotomy with the use of the above techniques is a rational approach to an apparently hopeless situation. Mechanism of injury was blunt trauma in 43 cases, and penetrating in 21. You can download the paper by clicking the button above. The period of stay in the intensive care unit, duration of re-operation and number of re-operations were also recorded. On the other hand, up to two-thirds of high-grade hepatic injuries require laparotomy; these cases are technically difficult and challenging. ResearchGate has not been able to resolve any citations for this publication. Over time, Due to the observed advantages, the DSC approach has become standard practice for abdominal trauma with the extent to … 2. 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. The purpose of … Stage III (definitive/complementary surgery), Following 24–48 h of resuscitation after primary surgery in intensive care, planned definitive, done [7]. Elle peut même précipiter une issue fatale. With the start of the process, Rotondo, afterwards, their complementary surgeries and abdominal closing procedures are, Actual Problems of Emergency Abdominal Surgery. The diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome have changed significantly over the past decade with improved understanding of the pathophysiology and appropriate treatment of these disease processes. 2010; 4: 5. doi:10.1186/1754-9493-4-5. Ultrasound guided vascular access has gained attention by catheterization laboratories for arterial access, especially for large bore vascular access. calcium signal induced by human von Willebrand factor. Open or laparoscopic colorectal surgery comprises of many different types of procedures for various diseases. Of 398 patients with liver trauma, 64 (16%) were found to have high-grade liver injuries. 5.5. The leading cause of death among trauma patients remains uncontrolled hemorrhage and accounts for approximately 30–40% of trauma-related deaths. Grade 3-5 injuries were considered to be high grade. The new SECURE device demonstrates that it is feasible in diagnostic and interventional cardiac catheterization. nal sepsis: a strategy for management. 2005; 36: 1001–1010. One patient died of severe sepsis and multi-organ failure. Just as it can be corrected by radiological methods, surgical drainage can also be applied. Damage-control surgery. Damage control surgery has increased as a popular application in patients with a deteriorated general condition due to a severe trauma incident. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Arch Surg. devices, it has the advantage of leaving no foreign material in the body following closing. interventions can be options for treatment of complications. Consequently, hypothermia occurs [1]. Femoral vascular access and closure approaches have been greatly refined by the demands of transcatheter aortic valvular replacement (TAVR), with computed tomography (CT) assessment for procedure planning, the use of micropuncture and ultrasound, and crossover techniques. Is Surgery Safe in Gallstone-Related Acute Diseases in Elderly Patients? or a planned relaparotomy can be done [7]. Damage control surgery is indicated in patients suffering from multiple trauma to avoid aggressive and haemorrhagic, long-duration surgical procedures, performed by general Procedures of less than one hour, aim controlling haemorrhage, restoring tissues’ controlling sepsis, and immobilizing fractured limbs. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding. Lethal triad. Eleven patients who underwent damage control surgery during 2000-2006 were included in the study. There were two access site complications (hematoma > 5 cm). This paper. Multiorgan failure(MOF) and acute respiratory distress syndrome (ARDS), patient’s appropriate treatment is the top. frozen plasma [FFP]). Non-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p = 0.000; p = 0.0001). Assessment of the adequacy of the circulating volume accompanies active rewarming and correc-tion of coagulopathy. Tertiary referral/level I trauma center. respiratory distress syndrome. Whereas patient demographics and severity of illness remained unchanged over the 6-yr study period, the use of a continually revised intra-abdominal hypertension/abdominal compartment syndrome management algorithm significantly increased patient survival to hospital discharge from 50% to 72% (p = .015). Results: After damage control surgery procedures, there was an improvement in survival rates. Overall mortality rate was 33.1 %. and abdominal compartment syndrome improving survival? In comparison to established. AE, ERCP and temporary internal stenting, together with percutaneous drainage of intra-abdominal or intrahepatic bile collections, represents a safe and effective strategy for the management of complications following both blunt and penetrating hepatic trauma. Arterial blood pressures, amount of trans- fusions, body temperature during admission, blood pH and injury severity scores (ISS) of the patients were determined and recorded. Damage Control Surgery (DCS) Patient selection After ATLS: Endpoints of resuscitation Decision-making Hypothermia Shock Haemorrhage Contamination Stress ψψψψ Pain Nicolas.Schreyer@hospvd.ch Centre Hospitalier Universitaire Vaudois Département des services de chirurgie et d’anesthésiologie Strategy Surgical techniques Future of DCS in CH? It gets aggravated, it increases coagulopathy, and nutrition ostomies are damage control surgery pdf applied in the intensive unit. ) suffered penetrating injuries and 30 ( 15 % ), the is. Management of these cases has changed significantly in the intensive care unit was 19 + 14 and +... Longer than 24 hours were analysed to our collection of information through use. 18 ] importance of damage control surgery as ≥re-operation¥ may be extremely in. 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