The 1-2-3 approach to abdominal packing.
Carlos Ordoñez1, Luis Pino, Marisol Badiel
1Departamento de Cirugía, Fundación Valle del Lili, Avenida Simón Bolivar, Carrera 98 Número 18-49, Cali, Colombia. ordonezcarlosa@gmail.com
World Journal of Surgery
|September 8, 2012
Summary
Abdominal packing (AP) in damage-control laparotomy (DCL) should not be removed before postoperative day one due to re-bleeding risks. Optimal AP duration is 2-3 days, as longer periods increase infectious complications in trauma patients.
Area of Science:
- Trauma Surgery
- Surgical Critical Care
- Hemorrhage Control
Background:
- Damage-control laparotomy (DCL) utilizes abdominal packing (AP) to manage coagulopathic hemorrhage in severe trauma.
- The optimal duration of AP and its impact on re-bleeding and intra-abdominal infections remain unclear.
Purpose of the Study:
- To evaluate complications associated with AP duration in penetrating abdominal trauma.
- To determine the ideal timing for AP removal after DCL.
Main Methods:
- Retrospective analysis of prospectively collected data from an urban level I trauma center (2003-2010).
- Inclusion criteria: adult patients with penetrating abdominal trauma surviving initial DCL and re-laparotomy, with AP for hemorrhage control.
- Patients were grouped by AP duration: <1, 1-2, 2-3, and >3 days. Outcome measures included re-bleeding, intra-abdominal infection, and 30-day mortality.
Main Results:
- Re-bleeding rates were lower (14.3%) in patients with AP for 1-2 days compared to <1 day (38.5%).
- Intra-abdominal infection rates increased significantly with AP duration, tripling from 16.7% (1-2 days) to 44.4% (>3 days).
- Mortality attributable to re-bleeding decreased with longer AP, while infection-related deaths increased (p=0.04 for trend).
Conclusions:
- AP in DCL for coagulopathic hemorrhage should be retained for at least the first postoperative day to mitigate re-bleeding risk.
- An AP duration of 2-3 days appears optimal, balancing hemorrhage control with infectious complication risks.
- AP exceeding 3 days is associated with a significantly higher incidence of infectious complications.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
01:25Assessment of the Abdomen I: Inspection and Auscultation
Introduction
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection.
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection.
01:23Assessment of the Abdomen III: Palpation
Palpation is a crucial tactile examination method for assessing abdominal organs and detecting conditions like tenderness, distention, masses, or fluid. It involves both light and deep palpation techniques, each serving specific diagnostic purposes. Light palpation helps identify tenderness and other surface-level indicators, while deep palpation locates and assess abdominal masses and organ boundaries. A skilled professional can gather valuable insights through palpation, including evaluating...
01:19Abdominal Regions and Quadrants
To promote clear communication, for instance, about the location of a patient's abdominal pain or a suspicious mass, anatomists and clinicians typically use imaginary lines to categorize the abdominopelvic cavity into either four quadrants or nine regions to identify organs in the cavity.
The simpler quadrants approach, which is more commonly used in medicine, subdivides the cavity with one horizontal and one vertical line that intersects at the patient's umbilicus (navel). The four quadrants...
The simpler quadrants approach, which is more commonly used in medicine, subdivides the cavity with one horizontal and one vertical line that intersects at the patient's umbilicus (navel). The four quadrants...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...