["Damage control surgery" concept in gastrointestinal surgery]

In recent years, damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. The "damage control" concept also has been shown to increase overall survival and is likely to modify the management of critically ill patients suffering from gastrointestinal disease. In these patients the "lethal triad" of hypothermia, acidosis, and coagulopathy acts as a vicious cycle that often can not be interrupted and marks the limit of the patient's ability to cope with the physiological consequences of traditional and extensive surgical procedures. The principles of damage control are to control bleeding, obstruction, and/or infection until the physiologic derangement has been restored and the patient could undergo a prolonged operation for definitive repair. This approach is unfolded in three phases. During the initial operation, the surgeon carries out only the absolute minimum necessary to improve patient's condition and to control bleeding, obstruction, and/or infection. The second phase consists of secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, correction of coagulopathy, rewarming, and complete ventilatory support. During the third phase, definitive operation is performed.