Damage Control Laparotomy Beneficial in Trauma Patients

Despite often leading to complications and readmissions, the overall benefit of performing damage control laparotomy (DCL) for trauma patients is indisputable, according to a new study.

Researchers at the University of Maryland (Baltimore, USA) conducted a prospective study of 88 patients who were admitted to a level-1 trauma center between January 1, 2000, and December 31, 2003; the patients underwent DCL and they were subsequently followed up through December 31, 2008. The main outcome measures were major and long-term complications, lengths of stay, mortality, readmissions, subsequent surgical procedures, activities of daily living, and return to work.

The results showed that 42 of the patients had penetrating trauma; the others had blunt trauma injuries. Liver injuries were most common, followed by injuries to the bowel, spleen, major vessels and pancreas; 25 patients (28%) died during the initial hospitalization; of the 63 patients who survived, 58 underwent intra-abdominal closure with polyglactin mesh. All 63 survivors were readmitted at least once over an average follow-up of 4.3 years. The primary reason for hospital readmission was for ventral hernia repair, with infection the second most common reason; 51 patients required a second readmission, and 29 required a third. In all, they had 186 readmissions and 92 surgical procedures during the follow-up period, but all survived the rest of the study. The study was published early online on December 20, 2010, in Archives of Surgery.

"Despite the high rate of open abdomens after DCL, patients fared well with staged closures and had a very acceptable rate of recurrent hernia. Although all patients required readmission and reoperation, 0% mortality leaves no room for improvement,” concluded lead author Megan Brenner, MD, and colleagues. "The long-term survival and functional outcomes after DCL truly justify its high utilization of resources.”

DCL is the first of three phases of care for severely injured patients, with the aim of stopping the bleeding from the abdominal organs, not to repair the injuries. The second phase is expeditious surgical control of hemorrhage with temporary abdominal closure, and rewarming and resuscitation of the patient in an intensive care unit (ICU); the third phase, usually performed 24-72 hours after trauma, is definitive surgical repair.

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