[Serial repeated laparatomy in severe trauma]

Multivisceral trauma and exanguinating hemorrhage lead to hypothermia, coagulopathy and acidosis. Formal resections and reconstructions in these unstable patient is often result in irreversible physiologic insult. For the patients with life-threatening injuries the staged control and repair of injuries may be a saving surgical strategy. The initial phase of "damage control" involves an abbreviated laparotomy, which entails temporary hemorrhage control, perfusion of vital organs and avoidance of enteric or urinary spillage. The surgical procedure is rapidly terminated, with emphasis on a temporary physiologic equilibrium rather than anatomic integrity. That is, the damage control surgery represents an extension of resuscitation phase of trauma in the operating room. The second therapeutic phase involves standard resuscitation and control of hypothermia, coagulopathy and acidosis, combined with surveillance and management of the abdominal compartment syndrome. The last phase involves the definitive repair of all temporized injuries, homeostasis, vascular reconstruction and abdominal wall repair.