[Abbreviated laparotomy].
The decision to perform damage control laparotomy in a critically injured patients depends on the risk of life-threatening coagulopathy. The main decision criteria are: presence of concomitant injuries, patient history, shock, transfusion volume, hypothermia and acidosis. The aim of surgery is to achieve satisfactory hemostasis, limit peritoneal thermal loss, and perform physiological restoration as rapidly as possible in the intensive care unit. This includes gauze packing of major liver or retroperitoneal injuries and ligation of injured blood vessels. Injuries to the intestine and the urinary tract are sutures, stapled or drained. If the skin borders cannot be reapproximated because of excessive abdominal tension, a wall prosthesis should be used to avoid abdominal compartment syndrome. Reoperation is a dangerous procedure in the immediate postoperative period but must be proposed later for reexploration or damage repair.
Service de Chirurgie Générale et Digestive, CHU - Grenoble. carvieux@chu-grenoble.fr
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D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001778:Blood Coagulation Disorders / Q000150:complications; D003161:Compartment Syndromes / Q000150:complications; D004638:Emergency Treatment / Q000379:methods*; D006470:Hemorrhage / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007035:Hypothermia / Q000150:complications; D007813:Laparotomy / Q000379:methods*; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome