[Abbreviated laparotomy for treatment of severe abdominal trauma: use in austere settings].
Abbreviated laparotomy is a recent technique for management of patients with severe abdominal trauma. It is based on a unified approach taking into account the overall extent of injury and the victim's physiologic potential to respond to hemorrhage. It is the first step in a multi-modal strategy. The second step is the critical care phase. The third step consists of "second-look" laparotomy that should ideally be performed on an elective basis within 48 hours and is aimed at definitive treatment of lesions. The goal of abbreviated laparotomy is damage control using temporary quick-fix procedures limited to conspicuous lesions and rapid hemostasis and/or viscerostasis procedures so that the patient can survive the acute critical period. Tension-free closure of the abdominal wall, if necessary using laparostomy, is essential to avoid abdominal compartment syndrome. With reported survival rates of about 50% in Europe and the United States, this simple life-saving technique that requires limited resources should be introduced in Africa where severe abdominal trauma often involves young patients.
Balandraud
P
P
Service de chirurgie viscérale, Hôpital d'instruction des armées Laveran, Marseille. balandraudp@yahoo.fr
Biance
N
N
Peycru
T
T
Savoie
P H
PH
Avaro
J P
JP
Tardat
E
E
Pourrière
M
M
Cador
L
L
D000007:Abdominal Injuries / Q000601:surgery*; D006487:Hemostasis; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods*; D024162:Second-Look Surgery