title: Surgical outcomes of a civil war in a neighbouring country.
abstract: OBJECTIVE
  The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey.
  
  
  METHODS
  159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring.
  
  
  RESULTS
  The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients).
  
  
  CONCLUSIONS
  In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: Seckin
authors.initials: S
authors.lastname: Akkucuk
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Aydogan
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Yetim
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Ugur
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Oruc
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Kilic
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Paltaci
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Kaplan
authors.affiliation: Department of General Surgery, Medicine School of Mustafa Kemal University, Hatay, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Temiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D003125:Colostomy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000293:injuries*; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality*; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D010360:Patient Transfer; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality*; D013593:Syria; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014857:Warfare; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery; D014948:Wounds, Gunshot / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: TRAUMA MANAGEMENT