title: Abbreviated laparotomy or damage control laparotomy: Why, when and how to do it?
abstract: The goal of abbreviated laparotomy is to treat severely injured patients whose condition requires an immediate surgical operation but for whom a prolonged procedure would worsen physiological impairment and metabolic failure. Indeed, in severely injured patients, blood loss and tissue injuries enhance the onset of the "bloody vicious circle", triggered by the triad of acidosis-hypothermia-coagulopathy. Abbreviated laparotomy is a surgical strategy that forgoes the completeness of operation in favor of a physiological approach, the overriding preference going to rapidity and limiting the procedure to control the injuries. Management is based on sequential association of the shortest possible preoperative resuscitation with surgery limited to essential steps to control injury (stop the bleeding and contamination), without definitive repair. The latter will be ensured during a scheduled re-operation after a period of resuscitation aiming to correct physiological abnormalities induced by the trauma and its treatment. This strategy necessitates a pre-defined plan and involvement of the entire medical and nursing staff to reduce time loss to a strict minimum.
authors.affiliation: Centre Hospitalier Lyon-Sud, Service de Chirurgie d'Urgence, 69495 Pierre-Bénite cedex, France; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon-Est, UMR 9405, 69008 Lyon, France. Electronic address: eric.voiglio@chu-lyon.fr.
authors.forename: E J
authors.initials: EJ
authors.lastname: Voiglio
authors.affiliation: CHU de Bordeaux, Hôpital Pellegrin-Tripode, Service de Chirurgie Vasculaire et Générale, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Dubuisson
authors.affiliation: CHU de Nice, Université de Nice Sophia-Antipolis, Hôpital St-Roch, Pôle Urgences-SAMU-SMUR, UCSU Chirurgie, 5, rue Pierre-Dévoluy, CS 81319, 06006 Nice cedex 1, France; Aix-Marseille Université, IFSTTAR, Laboratoire de Biomécanique appliquée LBA, UMRT 24, boulevard Pierre-Dramard, 13005 Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Massalou
authors.affiliation: Hôpital d'instruction des armées Percy, Service de Chirurgie Digestive, 101, avenue Henri-Barbusse, 92140 Clamart, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Baudoin
authors.affiliation: Centre Hospitalier Lyon-Sud, Service de Chirurgie d'Urgence, 69495 Pierre-Bénite cedex, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Caillot
authors.affiliation: CHU A.-Michallon, Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Pôle Digi-DUNE, BP 217, 38043 Grenoble cedex 09, France.
authors.forename: C
authors.initials: C
authors.lastname: Létoublon
authors.affiliation: CHU A.-Michallon, Clinique Universitaire de Chirurgie Digestive et de l'Urgence, Pôle Digi-DUNE, BP 217, 38043 Grenoble cedex 09, France.
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
mesh_terms: D004630:Emergencies; D006470:Hemorrhage / Q000150:complications / Q000601:surgery; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D012086:Reoperation; D012151:Resuscitation; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Abbreviated laparotomy; Damage control; Trauma