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Reinterventions after damage control surgery.

David Mejia1,2, Salin Pereira Warr3, Carlos Andrés Delgado-López2

  • 1Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.

Colombia Medica (Cali, Colombia)
|December 15, 2021
PubMed
Summary

This study outlines recommendations for re-interventions after damage control surgery. Key strategies include packing for bleeding control, deferred anastomosis for intestinal injuries, and timely re-intervention for vascular shunts to reduce complications.

Keywords:
Laparotomyabdominal wallanastomosis surgicalcardiac surgical procedurescolostomyintensive care unitsintra-abdominal hypertensionostomypostoperative periodreoperationsurgical wound infectionthoracic cavity

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Area of Science:

  • Trauma Surgery
  • Surgical Critical Care

Background:

  • Damage control surgery involves established procedures but lacks consensus on re-intervention timing and methods.
  • Controversies persist regarding patient selection, scheduling, and techniques for second interventions in damage control surgery.

Purpose of the Study:

  • To provide recommendations from the Trauma and Emergency Surgery Group (CTE) Cali-Colombia for second interventions in patients undergoing damage control surgery.
  • To standardize the approach to re-interventions, aiming to improve outcomes in trauma patients.

Main Methods:

  • The recommendations are based on the collective experience and consensus of the CTE Cali-Colombia.
  • This summary outlines specific strategies for bleeding control, intestinal repair, vascular shunt management, and abdominal/thoracic wall closure.

Main Results:

  • Packing is recommended as the primary method for bleeding control, with re-exploration (unpacking) advised within 48-72 hours.
  • Deferred anastomosis is suggested for managing intestinal lesions, and definitive management for vascular shunts should occur within 24 hours.
  • Attempted closure of the abdominal or thoracic wall should be performed within eight days post-initial surgery.

Conclusions:

  • Implementing these standardized strategies for re-interventions can significantly decrease postoperative complications, morbidity, and mortality in patients undergoing damage control surgery.
  • These guidelines offer a structured approach to complex surgical management, improving patient outcomes in critical care settings.