Saudi Surgical Journal

ORIGINAL ARTICLE
Year
: 2014  |  Volume : 2  |  Issue : 3  |  Page : 75--79

Damage control surgery/laparostomy in nontrauma emergency abdominal surgery: A new concept of care


Asri Che Jusoh, Ong Yanzie 
 Department of General Surgical, Kuala Krai District Hospital, Kuala Krai, Kelantan, Malaysia

Correspondence Address:
Asri Che Jusoh
Department of General Surgery, Kuala Krai Hospital, 18000 Kuala Krai, Kelantan
Malaysia

Introduction: The established success of damage control surgery (DCS) in trauma of torso motivates surgeon to apply similar concept in managing complicated intra-abdominal sepsis. The main objective of this study is to audit our new practice of such in nontrauma emergency abdominal surgery. Materials and Methods: We retrospectively reviewed all emergency abdominal surgeries (nontrauma) done from February 2013 to February 2014. All patients who had damage control procedures done for complicated intra-abdominal sepsis were analyzed. Results: A total of 60 patients were operated within that period. Six patients (10%) had undergone DCS with or without laparostomy. All were male with mean age of 48.5-year-old (26-61-years-old). Most were in ASA 3 (83%, 5 patients) with only one in ASA 4. Primary indications were ischemic bowel with mesenteric vein thrombosis (3 patients, 50%), abdominal compartment syndrome (ACS), bleeding post near total splenectomy for splenic abscess and gangrenous proctitis with purulent peritonitis. Nearly, all patients (5 patients, 83.3%) were severely acidotic with pH <7.2 intra-operatively, which triggered the DCS. Nevertheless, only 3 patients (50%) benefited from laparostomy and all of them achieved complete fascial closure within 2.6 days (mean). Their mean total Intensive Care Unit (ICU) stay was 15 days (9-32 days). Overall predicted mean Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity mortality rate was 51%. However, the observed (actual) mortality rate was only 33% (2 patients). Conclusion: The result of the practice of DCS in the septic abdomen is very encouraging. It appears able to reduce the mortality by 35%. A comparative analysis with larger series is therefore warranted to further confirm the findings.


How to cite this article:
Jusoh AC, Yanzie O. Damage control surgery/laparostomy in nontrauma emergency abdominal surgery: A new concept of care .Saudi Surg J 2014;2:75-79


How to cite this URL:
Jusoh AC, Yanzie O. Damage control surgery/laparostomy in nontrauma emergency abdominal surgery: A new concept of care . Saudi Surg J [serial online] 2014 [cited 2020 Apr 10 ];2:75-79
Available from: http://www.saudisurgj.org/article.asp?issn=2320-3846;year=2014;volume=2;issue=3;spage=75;epage=79;aulast=Jusoh;type=0