Aim of damage control laparatomy are
DAMAGE CONTROL SURGERY (Abbreted laparotomy) Following major injury, protracted surgery in the physiologically unstable patient can in itself prove fatal. Patients with the 'deadly triad' (hypothermia, acidosis and coagulopathy) are those at highest risk. 'Damage control' or 'damage limitation surgery' is a concept that originated from naval ship- building strategy, whereby ships were designed so that the damage was kept 'local' and which allowed only the minimal repairs needed to prevent it from sinking, while definitive repairs waited until it had reached po. The technique has been adopted following major trauma, and includes initial care and resuscitation (damage control resuscitation) and the surgical correction of the injury (damage control surgery). The minimum amount of surgery needed to stabilise the patient's condition may be the safest course until the physiological derangement can be corrected. Damage control surgery is restricted to only two goals: * stopping any active surgical bleeding; * controlling any contamination. Once these goals have been achieved then the operation is suspended and the abdomen temporarily closed. The patient's resuscitation then continues in the intensive care unit, where other therapeutic interventions can take place.Once the physiology has been corrected, the patient warmed and the coagulopathy corrected, the patient is returned to the operating theatre for any definitive surgery. Indications for Damage control surgery Anatomical Inability to achieve haemostasis Complex abdominal injury, e.g. liver and pancreas Combined vascular, solid and hollow organ injury, e.g. aoic or caval injury Inaccessible major venous injury, e.g. retrohepatic vena cava Demand for non-operative control of other injuries, e.g. fractured pelvis Anticipated need for a time-consuming procedure Physiological (decline of physiological reserve) Temperature <34oC pH <7.2 Serum lactate >5 mmol/L (normal: <2.5 mmol/L) Prothrombin time (PT) >16 s Paial thromboplastin time (PTT) >60 s >10 units blood transfused Systolic blood pressure <90 mmHg for >60 min Environmental Operating time >60 min (core temperature loss in usually 2degC/h) Inability to approximate the abdominal incision Desire to reassess the intra-abdominal contents (directed relook) Ref: Bailey and love 27th edition Pgno : 379
Provide fascial closure
Arrest haemorrhage
Control contamination
Prevent infection
Urology