title: Contemporary damage control surgery outcomes: 80 patients with severe abdominal injuries in the right upper quadrant analyzed.
abstract: BACKGROUND
  Damage control laparotomy (DCL) is a well-established surgical strategy in the management of the severely injured abdominal trauma patients. The selection of patients by intra-abdominal organs involvement for DCL remains controversial. The aim of this study was to assess the injury to the abdominal organs that causing severe metabolic failure, needing DCL.
  
  
  METHODS
  Severely injured abdominal trauma patients with a complex pattern of injuries were reviewed over a 52-month period. They were divided into DCL and definitive repair (DR) group according to the operative strategy. Factors identifying patients who underwent a DCL were analyzed and evaluated.
  
  
  RESULTS
  Twenty-five patients underwent a DCL, and 55 patients had DR. Two patients died before or during surgery. The number and severity of overall injuries were equally distributed in the two groups of patients. Patients who underwent a DCL presented more frequently hemodynamically unstable (p = 0.02), required more units of blood (p < 0.0001) and intubation to secure the airway (p < 0.0001). The onset of metabolic failure was more profound in these group of patients than DR group. The mean Basedeficit was - 7.0 and - 3.8, respectively, (p = 0.003). Abdominal vascular (p = 0.001) and major liver injuries (p = 0.006) were more frequently diagnosed in the DCL group. The mortality, complications (p < 0.0001), hospital (p < 0.0001), and ICU stay (p < 0.009) were also higher in patients with DCL.
  
  
  CONCLUSIONS
  In severely injured with an intricate pattern of injuries, 31% of the patients required a DCL with 92% survival rate. Severe metabolic failure following significant liver and abdominal vascular injuries dictates the need for a DCL and improves outcome in the current era.
authors.affiliation: Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. Martijn.Hommes@triemli.zuerich.ch.|Department of Surgery, University of Cape Town, Cape Town, South Africa. Martijn.Hommes@triemli.zuerich.ch.|Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Martijn.Hommes@triemli.zuerich.ch.|Triemli City Hospital Zürich, Birmendorfstrasse 497, 8063, Zurich, Switzerland. Martijn.Hommes@triemli.zuerich.ch.
authors.forename: M
authors.initials: M
authors.lastname: Hommes
authors.affiliation: Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.|Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Chowdhury
authors.affiliation: Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.|Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Visconti
authors.affiliation: Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.|Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
authors.affiliation: Department of Surgery, University of Cape Town, Cape Town, South Africa.|Surgical Gastroenterology, Hepatopancreaticobiliary Unit, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: J E J
authors.initials: JEJ
authors.lastname: Krige
authors.affiliation: Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.|Triemli City Hospital Zürich, Birmendorfstrasse 497, 8063, Zurich, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Cadosch
authors.affiliation: Department of Surgery, Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.|Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: A J
authors.initials: AJ
authors.lastname: Nicol
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003422:Critical Care; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012769:Shock / Q000401:mortality; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*; D055815:Young Adult