“Genuine” Damage Control Laparotomy in Peritonitis: A Twenty-Year Review
Joao Rezende-Neto*, Ori Rotstein
Department of Surgery, University of Toronto and Division of General Surgery, St. Michael’s Hospital, Toronto, Canada
*Corresponding author: Joao Rezende-Neto, Department of Surgery, University of Toronto and Division of General Surgery, St. Michael’s Hospital, 3073B Donnelly Wing, 30 Bond St. Toronto, Ontario, Canada. Tel: +1 647-290-0404; Fax: +1 416-642-5284; Email: rezendenetoj@smh.ca
Received
Date: 16 November, 2017; Accepted Date: 15 December, 2017; Published Date: 22 December, 2017
Citation: Rezende-Neto J, Rotstein O (2017) “Genuine” Damage Control Laparotomy in Peritonitis: A Twenty-Year Review. J Surg 2017: 189. DOI: 10.29011/2575-9760.000189
1. Background
The term “damage control laparotomy” was first coined by Rotondo et al. in 1993. However, this approach was described more than 10 years earlier as an alternative surgical strategy in the management of severe liver injuries. [1-3] Rather than pursuing prolonged attempts at definitive management of major vascular, solid organ, or visceral injury in the setting of hypotension, acidemia, hypothermia, and multisystem trauma, those surgeons performed an abbreviated laparotomy with a view to controlling hemorrhage and preventing further intestinal contamination of the peritoneum. This strategy was expected to prevent patients from entering a downward spiral into the lethal triad of hypothermia, hypotension, and coagulopathy. In their case control study, Rotondo et al. reported survival rate of 77% in the damage control surgery group compared to 11% in the definitive laparotomy group [2]. That initial report spawned literally hundreds of subsequent publications extolling the virtues of this approach in practically every region of the body such that damage control has now become an integral part of modern trauma care [4-9].
Given the favorable results of damage control strategy in trauma, similar approach has been adopted in the surgical treatment of severe abdominal sepsis. However, there is much confusion in the terminology and the use of damage control strategy in this setting. At the outset, the terms, “open abdomen”, abbreviated laparotomy, “peritoneal toilet”, second look operation, planned and on-demand laparotomy have recently been labeled damage control surgery in several publications pertaining to abdominal sepsis [10-15]. However, these surgical strategies encompass only certain aspects of damage control strategy. Moreover, the situations that would trigger the application of damage control principles in the setting of severe peritonitis and acute care surgery in general, are for the most part, different from those in the trauma setting [16-21]. To address the aforementioned issues, we performed a systematic review of studies that describe the use of damage control surgery in the non-trauma setting focusing on patients with peritonitis.
2. Methods
All studies included in our literature review were obtained using an electronic search of the National Library of Medicine MEDLINE (PubMed Entrez) and EMBASE databases. The citations in English were identified during the period of January 1997 through September 2017. The search pertained to the following specific topics:
·
Open abdomens,
damage control surgery, and damage control laparotomy in non-trauma patients.
· Intra-abdominal infections, sepsis, and peritonitis.
The search excluded case reports, letters to the editor, experimental studies, pediatric patient population, cases not related to acute care general surgery, and duplicates. Of the 141 articles captured in the search, 91 did not relate to damage control in the setting of peritonitis and abdominal sepsis, and hence were not included in the study. The remaining 50 articles were reviewed by the authors.
2.1. Principles of Damage Control Surgery in Trauma
The main principles underlying "damage control" approach in trauma surgery are:
1.
Initial
laparotomy focusing on control of major bleeding and source of contamination.
2.
Temporary Abdominal
Closure (TAC)
3.
Correction of
abnormal physiological parameters, a process that usually takes place in the
Intensive Care Unit (ICU) setting.
4.
Planned abdominal
re-exploration for definitive treatment of the underlying problem.
5. Definitive abdominal wall closure.
These five principles of damage control surgery are
managed in a sequential staged manner:
Stage one focuses on gaining control of a complex situation in an unstable patient. In abdominal trauma, the primary objective is to control blood loss. This is achieved through:
·
ligation of
obvious bleeding vessels
·
repairing or shunting
of vessels not amenable to ligation
·
packing of
hemorrhage in vital organs amenable to tamponade
· packing of non-surgical sources of bleeding.
Control of ongoing peritoneal contamination is achieved by over sewing or stapling holes in the GI tract, by resecting any dead or devascularized bowel, and by leaving behind “blind loops” of the bowel without anastomosis or stomas. At this stage, removal of unsalvageable non-vital organs may be performed. Subsequently temporary abdominal wall closure is performed with the intent of reoperative surgery for definitive management. Total operative time should be less than 90 minutes in this phase [22].
Stage two centers on stabilizing the patient in the
ICU. The initial phase of this process takes in average 24 to 72h. It includes
rewarming, improving hemodynamics to restore tissue perfusion, addressing
acid-base imbalance, and normalizing coagulation parameters. Finally, in stage
three, the patient is returned to the operating room for definitive repair of
vascular injuries, removal of pack sponges, and definitive management of the
injuries. This may involve primary anastomosis or stoma formation depending on local
and systemic findings. If possible, primary abdominal wall closure is performed
at this point. However, patients often require multiple surgical interventions
before final closure of the abdominal wall is achieved. The notion that damage
control surgery might be applicable to non-trauma/acute care surgery patients
presenting with an abdominal catastrophe is perfectly suitable and would, in
general terms, follow the same staged approach. Specifically, initial care
aimed at establishing control of hemorrhage and/or intra-abdominal infection
would be followed by a period in the intensive care unit for stabilization, in
preparation for a return to the operating room for definitive management and
potential closure of the abdominal wall. However, in the context of peritonitis,
it is important to distinguish this approach from two surgical strategies that
frequently go under the misnomer of damage control.
The first is the use of scheduled repeat laparotomy/staged
abdominal reconstruction aimed at preventing residual or recurrent infection in
patients with severe intra-abdominal sepsis. This strategy is based on the
logistical advantage of leaving the abdomen open with Temporary Abdominal
Coverage (TAC) to facilitated multiple interventions to achieve complete source
control [23-26]. Despite the advantages of
scheduled repeat laparotomy/Staged Abdominal Reconstruction (STAR) this
strategy, if not appropriately indicated, could expose patients to the risks of
leaving the abdomen open unnecessarily [12,13,14,27].
Accordingly, in prospective randomized clinical trial 40 patients with severe
secondary peritonitis were randomly allocated to two groups after the initial
laparotomy; group “A” open abdomen and group “B” closed abdomen [28]. Even though the difference in mortality between
groups A and B did not reach statistical significance (respectively, 55% vs.
30%), the relative risk and the odds ratio for death were 1.83 and 2.85 times higher
for group A compared to group B. Thus, the study was prematurely interrupted
after the first interim analysis. In spite of that, a prospective nonrandomized
trial involving a total of 239 patients with severe peritonitis showed no
significant difference in mortality between patients managed with an open abdomen
(44% mortality) compared to those managed with closed abdomen after the initial
operation (31% mortality) [29].
In a larger study, a meta-analysis of planned
relaparotomy and on-demand laparotomy looking at in-hospital mortality as the
main outcome captured a total of 1266 patient; respectively 298 planned
relaparotomy and 980 on-demand cases. The overall evidence of this study was
inconclusive and showed no statistically significant difference in mortality
between the groups [30]. This notion was substantiated
in a randomized trial that showed no difference in mortality and morbidity
between scheduled repeat laparotomy (leaving the abdomen open) and on-demand
laparotomy (preemptively closing the abdomen), based on clinical and
radiological parameters [31]. However, patients
managed with on-demand laparotomy had shorter intensive care unit stays,
shorter hospital stays, and lower direct medical costs compared to scheduled
relaparotomy group [31]. The key feature of this
study was that surgeons felt that definitive surgical treatment could be
performed at the initial operation challenging the need for scheduled
relaparotomy, hence leaving the abdomen open [31].
Furthermore, in another study published by the same group it was shown that the
cause of peritonitis and the operative findings during the initial operation
were poor indicators for relaparotomy [32]. In
that study, the best indicators for a relaparotomy were markers of progressive
or persistent organ failure in the early postoperative period [32].
Timing of abdominal re-exploration is also critical in patients with peritonitis. Previous research showed that patients with peritonitis managed with on-demand laparotomy who underwent re-exploration more than 48h after the initial operation had significantly higher mortality rate than those re-explored within the first 48h; respectively 76.5% vs. 28% (p = 0.0001) [33]. This finding demonstrates that timely re-exploration is important, whereas procrastination can lead to persistent septic insult with serious complications [11, 34-41]. The second surgical strategy that is distinct from actual damage control surgery is referred to as "second look" laparotomy. This approach is used when there is concern about the viability of the bowel during the initial operation. One of the main advantages of a "second look" laparotomy is to provide means to reassess the vascular viability of the bowel, preventing unnecessary resection of healthy segments. “Second look” laparotomies are also used in intra-abdominal vascular emergencies [42]. Appropriate application of damage control principles in peritonitis, in contrast to “Second look” laparotomies and STAR/re-laparotomy as previously described, involve postponing definitive surgical treatment based on hemodynamic instability and poor tissue perfusion. These findings along with profound metabolic acidosis, elevated lactate levels, severe sepsis, coagulopathy, and septic shock result in overwhelming Systemic Inflammatory Response Syndrome (SIRS). The damage control approach in these conditions calls for source control, hemorrhage control, and interruption of the operation in lieu of a standard procedure. Our review showed that the literature pertaining to damage control laparotomy in peritonitis used under the aforementioned scope is limited in quantity and quality, and the term damage control surgery is often used interchangeably with the open abdomen, “second look” laparotomies, planned and on-demand laparotomy [43-49].
2.2. Use of Damage Control Surgery in The Setting of Peritonitis
One
of the few studies in which actual damage control was employed in the setting
of peritonitis involved 67 patients with complicated acute colonic diverticulitis
(Hinchey III/IV) and 2 cases of severe bleeding. Damage control approach
defined by source control, leaving the colon in discontinuity, and patient transfer
to intensive care unit for stabilization, was only used in 4% of the cases.
Whereas 45% underwent one stage management (resection and primary colonic
anastomosis) [50]. Similarly, in a cohort of 835
patients who underwent elective pancreatic surgery only eight required actual
damage control surgery [51]. In only two of
those patients the indication for classic damage control was intra-abdominal
sepsis [51-53]. Our review disclosed only 12 additional
studies that specifically described the use of damage control strategy in the
setting of profound abdominal sepsis, bleeding, ischemic bowel, or necrotizing pancreatitis
in emergency general surgery (Table 1).
One of the most recent studies in our review compared two distinct surgical approaches. Damage control encompassing rapid source control laparotomy with planned re-exploration of the open abdomen (n=53 patients) versus single intervention with on-demand re-laparotomy (n=162 patients) [54]. Results showed that, in contrast to the trauma setting, patients who presented with acidosis (pH ≤ 7.25), coagulopathy, and hypothermia had similar mortality rates regardless of the surgical strategy used. However, multivariate logistic regression model confirmed that patients with severe sepsis/septic shock causing SIRS, men over the age of 70, lactate ≥ 3, and three or more comorbidities showed survival benefit if managed with rapid source control laparotomy and planned re-exploration (damage control strategy). Interestingly, approximately 50% of patients with severe sepsis/septic shock in the “on-demand” re-laparotomy group, actually required re-exploration [54]. Unfortunately, the most recent study in our investigation involving 164 patients did not specify the type of damage control procedure employed in each case, despite being prospectively done [55].
In a study involving 16 patients who met the criteria for damage control surgery, namely hypothermia, coagulopathy and acidosis, the average number of surgical re-interventions in the abdomen after the initial operation for peritonitis was 2.44 (range 1-4) [53]. In this study, the mortality rate of patients who underwent damage control surgery was 43 percent. This was lower that the predicted mortalities of 60 percent and 75 percent based on the APACHE II and POSSUM scores respectively [53]. Similarly, a report on 8 patients who underwent a damage control surgery for peritonitis and sepsis related to GI perforation showed that all patients underwent bowel resection at the initial procedure without anastomosis or stoma formation [52]. At the second operation, six of those patients underwent anastomosis of the ends of the bowel that were previously left stapled-off in the abdominal cavity; the remaining two patients were ostomized [52]. The overall patient mortality rate was 7 percent, which was considerably less than the 64.5% predicted mortality using the POSSUM score and the 49.6% predicted mortality as per the Portsmouth predictor equation (P-POSSUM) [52]. These studies underscore the benefits of the appropriate use of damage control surgery in the setting of peritonitis. Moreover, they also show that primary anastomosis of the discontinuous gastrointestinal tract can be safely performed at repeat surgery in patients with intra-abdominal sepsis who had resection without anastomosis at the initial operation, so-called definitive Deferred Primary Anastomosis (DPA).
This strategy was validated in a study that reported a treatment algorithm that included 15 patients with Hinchey III/IV perforated diverticulitis on inotropic support, profound edema of peritoneal tissues, and generalized peritonitis [56]. The surgical treatment in these patients consisted of abdominal washout (source control), limited resection of the affected colonic segment, and stapled-off ends of the remaining colon left in discontinuity in the abdomen. Temporary abdominal closure was performed with a vacuum-assisted closure device [56]. Following stabilization, patients returned to the operating room. In 9 patients, local conditions and the systemic state were considered adequate to perform primary anastomosis. The remaining 6 underwent a Hartmann’s procedure. In the anastomosis group, there was 1 anastomotic leak which resulted in death. In the Hartmann’s procedure group, two of the patients subsequently died with sepsis. Importantly, primary closure of the abdominal wall was achieved in all 15 patients. In this study, the overall mortality was 26 percent and the mortality directly linked to the perforation of the colon was 15 percent. Furthermore, 52% percent of the patients underwent primary anastomosis, and survived without a stoma [56].
Deferred Primary Anastomosis (DPA) was also investigated in the setting of secondary peritonitis caused by various intraabdominal conditions [57]. The authors retrospectively investigated septic patients with peritonitis and hemodynamic instability who required bowel resection and were subjected to a second laparotomy as part of damage control procedure [57]. The outcomes of patients who underwent bowel resection followed by an ostomy were compared to those of patients who underwent deferred primary anastomosis. In both groups the abdomens were left open after the first laparotomy and definitive closure was performed when septic sources were controlled, and abdominal closure considered appropriate [57]. The decision regarding treatment arm was made by the operating surgeon with no effort towards randomization. Interestingly, the trauma surgeons at the institution tended to use the deferred primary anastomosis approach, while the non-trauma surgeons (at the same hospital) uniformly performed resection with diversion [57]. A total of 112 patients were considered eligible for analysis with the ratio of DPA to stoma of approximately 30:70. However, 23 patients sustained trauma, thus only 89 patients had non-traumatic cause of peritonitis [57]. The two groups were comparable in their demographics including age, gender, APACHE II and source of peritonitis. In the DPA group, the surgeons were able to successfully perform an anastomosis in more than 80% of the patients and failure to do so was related to technical reasons. The rate of anastomosis did not differ whether the colon or the small bowel were considered. The overall outcome between the two approaches was remarkably similar. The rates of fistulas and leaks were also similar between the groups, 8.8% in the DPA group and 5.1% in the stoma group. In the latter group, the majority (3/4) of the events were due to leakage related to the stoma [57]. This particular complication in the stoma groups underscores the challenges involved in creating stomas in these patients, including considerable abdominal wall thickness due to obesity, intestinal edema and mesenteric shortening, all of which make it difficult to easily exteriorize the intestinal ends in this setting. This study also did not report on long-term outcomes related to re-establishment of intestinal continuity in those patients, which must be factored into the overall decision making regarding this approach. Obviously, the paper is methodologically weak, but it supports the findings from several reports demonstrating that primary anastomosis is a treatment option after adequate indications of damage control strategy [57]. One of the few prospective studies in our review described damage surgery in patients with peritonitis caused by diverticulitis (Hinchey III and IV) [58]. Results of this study showed that 76% of the patients underwent a successful colonic anastomosis before discharge. Interestingly, primary fascial closure was performed in all patients [58].
A study by Person et al. set out to evaluate abbreviated laparotomy (damage control surgery) versus Definitive Laparotomy (DL) in the non-trauma setting [59]. Unfortunately, the procedures performed in the abbreviated laparotomy group were not described. Thus, the application of actual damage control strategy is unknown. This retrospective analysis included 291 patients. Abbreviated laparotomy (AL) was used in 10.7% of patients, and Definitive Laparotomy (DL) in the remainder. In this report, the criteria guiding the decision to treat a patient using AL were not well defined. The only listed difference between the two groups was that all patients in the DL group were stable at admission, whereas 29% of patients in the AL group were hemodynamically unstable at admission [59]. Peritonitis and mesenteric ischemia were significantly more common indications in patients in the AL group than in the DL group (48.4% vs. 30.4% and 32.3% vs. 3.5% respectively). Moreover, 9.7% of patients with AL displayed profound gastrointestinal bleeding compared to 3.1% of patients in the DL group. However, this difference was not statistically significant. Patients in the AL group were significantly more likely to develop sepsis, multi-organ failure, and wound infection. The AL group displayed a mortality of 54.8%, which was significantly higher than the 16.5% mortality in the DL group. The mortality in both groups occurred predominately due to sepsis [59]. At face value, these outcomes would argue in favor of definitive laparotomy as being the preferred approach. However, the nature of patient selection preferentially allocated sicker patients to the AL arm and therefore, the poorer outcome was predictable. The authors did not study outcome relative to defined stratification systems such as APACHE II or POSSUM scores [59].
A retrospective study reviewed the indications for damage control laparotomy in the non-trauma setting in 42 patients during a three-year period [60]. The authors reported that peritonitis was the third most common reason for a damage control procedure; ischemic bowel and bleeding were respectively the first and second causes [60]. As previously mentioned herein, the strategy used in ischemic bowel cases was actually a second look operation, not damage control surgery.
2.3. Management of The Open Abdomen in The Setting of Peritonitis
Management of the open abdomen is an integral part of damage control surgery in both trauma and acute care surgery settings. The ultimate goal is to achieve definitive abdominal wall closure. A prospective multi-center study on open abdomens showed that delays in returning to the operating room beyond 24 hours after the initial damage control procedure, were associated with a 1.1% hourly decrease in the likelihood of successful primary fascial closure in trauma patients [61]. This study also showed that primary fascial closure at the first take back significantly reduced the incidence of intra-abdominal complications [61]. Management of the open abdomen in acute care surgery is, for the most part, even more challenging than in the context of trauma. Particularly when the primary indication for the open abdomen occurs in the setting of peritonitis and intra-abdominal sepsis [62-65]. Closure of the abdominal wall with synthetic mesh under these conditions is associated with high incidence of infection and fistula formation [66-71]. Moreover, it is ill advised to perform extensive undermining of the subcutaneous tissue or component separation to achieve primary fascial closure before resolution of the intra-abdominal infection and tissue edema. These maneuvers facilitate the propagation of the infectious process through the undermined tissue and cause serious systemic and local infectious complications. Previous studies showed that performing abdominal wall reconstruction and component separation in the setting of peritoneal infection resulted in overall complication rates as high as 60% [72,73]. Furthermore, successful primary fascial closure rate was lower in patients who underwent Staged Abdominal Reconstruction (STAR) for peritonitis compared to patients who underwent the same procedure for reasons different than peritonitis [74-76].
Direct comparison of closure of the open abdomen in the settings of trauma, gastrointestinal sepsis, and pancreatitis were investigated in another study [77]. Results showed that the need for mesh was more common in patients with gastrointestinal sepsis and that inability to close was more frequent in pancreatitis. Successful primary fascial closures were more likely in trauma patients who underwent damage control surgery. Moreover, patients with open abdomens in the setting of pancreatitis required more re-interventions than those in the other two groups. Interestingly, definitive fascial closure in this study was achieved in only 29% of the patients [77]. Closure rates based on the etiology of the open abdomen was also investigated in a systematic review. This study showed a 65% fascial closure rate in series that included only trauma cases and 50% closure rate in peritonitis-only series [78]. Similarly, a more recent systematic review and meta-analysis of the “open abdomen” and temporary abdominal closure techniques involving more than 3400 patients with peritonitis showed an overall weighted rate of delayed fascial closure of 50.2% [43]. These findings were also confirmed in a retrospective review of 42 non-trauma patients who underwent damage control laparotomies [60]. The overall primary fascial closure rate in this study was 57%. However, significantly lower rates were observed when the indication for damage control surgery involved peritonitis. The authors also showed that delayed abdominal closure (> 7 days) was associated with higher rates of septic complications and residual intra-abdominal abscesses [60]. Interestingly, these complications were more common among the patients than respiratory failure. Several other studies underscored the significant challenges involved in the managing the open abdomen in peritonitis [79-81]. The most important contributors to this problem were residual intra-abdominal abscesses, enterocutaneous fistulae, prolonged duration the open abdomen, and the need for multiple abdominal explorations [82-97].
3. Summary
In summary, damage control surgery in the non-trauma
setting appears to be feasible, but its effectiveness has not been clearly
established in the literature. Our review showed that the use of damage control
procedures for the treatment of severe intraabdominal infections is uncommon.
Moreover, procedures referred to as damage control are actually staged
laparotomy for control of residual intraabdominal infection and the second look
operation in the setting of ischemic GI tract. Nonetheless, damage control
surgery for the treatment of profound intra-abdominal infection with associated
hemodynamic and metabolic instability may improve mortality. This conclusion is
based primarily on outcome comparison to patient stratification themes. However,
patients with intra-abdominal sepsis who undergo damage control surgery have
high morbidity both prior to definitive repair as well as after abdominal closure.
Therefore, indications for this procedure in the setting of severe
intraabdominal sepsis need to be better defined. The studies do raise the
intriguing possibility that, with the use of a damage control approach, patients
might be spared of stomas by virtue of being able to have a definitive GI
anastomosis. Clearly, further clinical studies are warranted to investigate
this possibility.
Author
|
Year |
Study type |
No of Cases |
Indications for Damage Control Surgery |
Damage Control Procedures |
Filicori et al. |
2010 |
Retrospective |
8 |
Hemorrhage |
Packing; Hartmann’s procedure (1) |
Finlay et al. |
2004 |
Prospective |
14 |
Peritonitis (9) Hemorrhage (5) |
Bowel in discontinuity (8) Hartman’s procedure (1) Packing (5) |
Goussous et al. |
2013 |
Retrospective |
111 |
Peritonitis/Sepsis (79) Hemorrhage (32) |
Not specified |
Kafka-Ritsch et al. |
2012 |
Prospective |
51 |
Peritonitis (51) |
Colon resection w/ blind loops (45) Interrupted suture of the perforation (6) |
Khan et al. |
2013 |
Retrospective |
42 |
Peritonitis (10) Hemorrhage (13) Bowel ischemia (13) Physiological reason (6) |
Not specified |
Morgan et al. |
2010 |
Retrospective |
8 |
Peritonitis/sepsis (2) Hemorrhage (6) |
Bowel in discontinuity (1); drainage (2) Packing (6); drainage (3); bowel in discontinuity (3) |
Becher et al. |
2016 |
Retrospective |
53 |
Peritonitis/sepsis (53) |
Rapid source control (53) |
Ordóñez et al. |
2010 |
Retrospective |
30 |
Peritonitis (30) |
Bowel in discontinuity (30) |
Person et al. |
2009 |
Retrospective |
31 |
Peritonitis (15) Bowel ischemia (10) Bowel obstruction (2) Bleeding (3), other (1) |
Not specified |
Perathoner et al. |
2010 |
Prospective |
15 |
Peritonitis/sepsis (15) |
Bowel in discontinuity; lavage; VAC (15) |
Stawicki et al. |
2008 |
Retrospective |
16 |
Peritonitis/sepsis (6) Bleeding/Intra-op. (5) Bowel ischemia (3) Pancreatitis (2) |
Not specified |
Subramanian et al. |
2010 |
Retrospective |
64* |
Peritonitis/sepsis (30) Ischemia/obstruction (21) Pancreatitis (11) Hemorrhage (2) |
Not specified |
Tamijmarane et al. |
2006 |
Retrospective |
25 |
Pancreatic leak/bleeding (20) Bleeding (5) |
Completion pancreatectomy (25); Not specified (packing, splenectomy, angiographic embolization) |
Girard et al. |
2017 |
Prospective |
164 |
Peritonitis (23) Bleeding (14) |
Not specified |
Table 1: Publications pertaining to actual use of damage control surgery in the setting of intra-abdominal infections.
- Calne R, McMaster P, Pentlow B (1978) The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment. Br. J Surg 66: 338-339.
- Rotondo MF, Schwab W,
McGonigal MD, Phillips GR 3rd, Fruchterman TM, et al. (1993) Damage control: An
approach for improved survival in exsanguinating penetrating abdominal injury.
J Trauma 35: 375-383.
- Stone H, Strom P, Mullins R
(1983) Management of the major coagulopathy with onset during laparotomy. Ann
Surg 197: 532-535.
- Hildebrand F, Giannoudis P, Krettek C, Pape HC (2004)
Damage control: extremities. Injury 35: 678-689.
- Germanos S, Gourgiotis S,
Villias C, Bertucci M, Dimopoulos N, et al. (2008) Damage control surgery in
the abdomen: an approach for the management of severe injured patients. Int J
Surg 6: 246-252.
- Giannoudis PV and Pape HC
(2004) Damage control orthopaedics in unstable pelvic ring injuries. Injury 35:
671-677.
- Rezende-Neto J, Marques AC,
Guedes LJ, Teixeira LC (2008) Damage control principles applied to penetrating
neck and mandibular injury. J Trauma 64: 1142-1143.
- Rosenfeld JV (2004) Damage control neurosurgery.
Injury 35: 655-660.
- Rotondo MF and Bard MR (2004) Damage control surgery
for thoracic injuries. Injury 35: 649-654.
- Kiewiet JJ, van Ruller O, Boermeester MA, Reitsma JB
(2013) A decision rule to aid selection of patients with abdominal sepsis
requiring a relaparotomy. BMC Surg 13: 28.
- Kreis BE, van Otterloo JCAM,
Kreis RW (2013) Open abdomen management: A review of its history and a proposed
management algorithm. Med Sci Monit 19: 524-533.
- Sartelli MA (2010) A focus on intra-abdominal
infections. World J Emerg Surg 5: 9.
- Sartelli M, Abu-Zidan FM, Ansaloni
L, Bala M, Beltrán MA, et al. (2015) The role of the open abdomen procedure in
managing severe abdominal sepsis: WSES position paper. World J Emerg Surg 10:
35.
- Schein M (2002) Surgical management of
intra-abdominal infection: is there any evidence? Langenbecks Arch Surg 387:
1-7.
- Waterman NG, Walsky R, Kasdan
ML, Abrams BL (1968) The treatment of acute hemorrhagic pancreatitis by sump
drainage. Surg Gynecol Obstet 126: 963-971.
- Ball CG, Correa-Gallego C, Howard TJ, Zyromski NJ,
Lillemoe KD (2010) Damage control principles for pancreatic surgery. J
Gastrointest Surg 14: 1632-1633.
- Burch JM, Ortiz VB, Richardson
RJ, Martin RR, Mattox KL, et al. (1992) Abbreviated laparotomy and planned
reoperation for critically injured patients. Ann Surg 215: 476-483.
- Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM,
et al. (2008) Surviving sepsis campaign: international guidelines for
management of severe sepsis and septic shock. Crit Care Med 36: 296-327.
- Higa G, Friese R, O’Keeffe T, Wynne J, Bowlby P, et
al. (2010) Damage control laparotomy: A vital tool once overused. J Trauma 69:
53-59.
- Moore LJ and Moore FA (2012) Epidemiology of sepsis
in surgical patients. Surg Clin North Am 92: 1425-1443.
- Morris Jr JA, Eddy VA, Blinman
TA, Rutherford EJ, Sharp KW (1993) The staged celiotomy for trauma. Issues in
unpacking and reconstruction. Ann Surg 217: 576-584.
- Sagraves SG, Toschlog EA,
Rotondo MF (2006) Damage control surgery – the intensivist’s role. J Intensive
Care Med 21: 5-16.
- Cinquepalmi L, Boni L, Dionigi
G, Rovera F, Diurni M, et al. (2006) Long-term results and quality of life of
patients undergoing sequential surgical treatment for severe acute pancreatitis
complicated by infected pancreatic necrosis. Surg Infec (Larchmt) 7: S113-S116.
- D'Hondt M, Devriendt D, Van
Rooy F, Vansteenkiste F (2007) Systemic peritoneal cavity lavage: a new
strategy for treatment of the open septic abdomen. Acta Chir Belg 107: 583-587.
- Radenkovic DV, Bajec DD,
Tsiotos GG, Karamarkovic AR, Milic NM, et al. (2005) Planned staged reoperative
necrosectomy using an abdominal zipper in the treatment of necrotizing
pancreatitis. Surg Today 35: 833-840.
- Rezende-Neto J, Rice T, Abreu
ES, Rotstein O, Rizoli S (2016) Anatomical, physiological and logistical
indications for the open abdomen: a proposal for a new classification system.
World J Emerg Surg 11:28.
- Yuan Y, Ren J, He Y (2013)
Current status of the open abdomen treatment for intra-abdominal infection.
Gastroenterol Res Pract 2013: 532013.
- Robledo FA, Luque-de-León E,
Suárez R, Sánchez P, de-la-Fuente M, et al. (2007) Open versus closed
management of the open abdomen in the surgical treatment of severe secondary
peritonitis: a randomized clinical trial. Surg Infect 8: 63-72.
- Christou NV, Barie PS, Dellinger EP, Waymack JP,
Stone HH (1993) Surgical infection society intra-abdominal infection study.
Prospective evaluation of management techniques and outcomes. Arch Surg 128:
193.
- Lamme B, Boermeester MA, Reitsma JB, Mahler CW,
Obertop H, et al. (2002) Meta-analysis of relapatoromy for secondary
peritonitis. Br J Surg 89: 1516-1524.
- van Ruler O, Mahler CW, Boer
KR, Reuland EA, Gooszen HG, et al. (2007) Comparison of on-demand vs planned
relaparotomy strategy in patients with severe peritonitis: a randomized trial.
JAMA 298: 865-872.
- van Ruler O, Lamme B, Gouma
DJ, Reitsma JB, Boermeester MA (2007) Variables associated with positive
findings at relaparotomy in patients with secondary peritonitis. Crit Care Med
35: 468-476.
- Koperna T and Schulz F (2000)
Relaparotomy in peritonitis: prognosis and treatment of patients with
persisting intraabdominal infection. World J Surg 24: 32-37.
- Garcia-Sabrido JL, Tallado JM,
Christou NV, Polo JR, Valdecantos E (1988) Treatment of severe intra-abdominal
sepsis and/or necrotic foci by an “open-abdomen” approach. Zipper and
Zipper-mesh techniques. Arch Surg 123: 152-156.
- Holmer C and Kreis ME (2015)
Management of complications following emergency and elective surgery for
diverticulitis. Viszeralmedizin 31: 118-123.
- Ivatury RR, Nallathambi M, Rao
PM, Rohman M, Stahl WM (1989) Open management of the septic abdomen: therapeutic
and prognostic considerations based on APACHE II. Crit Care Med 17: 511-517.
- Penninckx FM, Kerremans RP,
Lauwers PM (1983) Planned relaparotomies in the surgical treatment of severe
generalized peritonitis from intestinal origin. World J Surg 7: 762-766.
- Schein M, Saadia R, Freinkel
Z, Decker G (1988) Aggressive treatment of severe diffuse peritonitis: a
prospective study. Br J Surg 75: 173-176.
- Teichmann W, Wittman D,
Andreone P (1986) Scheduled reoperations (etappenlavage) for diffuse
peritonitis. Arch Surg 121: 147-152.
- van Ruler O, Lamme B, de Vos R, Obertop H, Reitsma
JB, et al. (2008) Decision making for relaparotomy in secondary peritonitis.
Dig Surg 25: 339-346.
- van Ruler O, Kiewiet JJ, Boer
KR, Lamme B, Gouma DJ, et al. (2011) Failure of available scoring systems to
predict ongoing infection in patients with abdominal sepsis after their initial
emergency laparotomy. BMC Surg 11:38.
- Diaz JJ Jr., Culliname DC,
Dutton WD, Jerome R, Bagdonas R, et al.
(2010) The management of the open abdomen in trauma and emergency general
surgery: Part 1 – damage control. J Trauma 68: 1425-1438.
- Atema JJ, Gans SL, Boermeester
MA (2015) Systematic review and meta-analysis of the open abdomen and temporary
abdominal closure techniques in non-trauma patients. World J Surg 39: 912-925.
- Fortelny RH, Hofmann A,
Gruber-Blum S, Petter-Puchner AH, Glaser KS (2014) Delayed closure of open
abdomen in septic patients is facilitated by combined negative pressure wound
therapy and dynamic fascial suture. Surg Endosc 28: 735-740.
- Freeman A and Graham JC (2005)
Damage control surgery and angiography in cases of acute mesenteric ischaemia.
ANZ J Surg 75: 308-314.
- Mayer D, Rancic Z, Meier C, Pfammatter
T, Veith FJ, et al. (2009) Open abdomen treatment following endovascular repair
of ruptured abdominal aortic aneurysms. J Vasc Surg 50: 1-7.
- Mentula P (2011) Non-traumatic
causes and the management of the open abdomen. Minerva Chir 66: 153-163.
- Solomkin JS and Mazuski J
(2009) Intra-abdominal Sepsis: Newer Interventional and Antimicrobial
Therapies. Infect Dis Clin North Am 23: 593-608.
- Waibel BH and Rotondo MM
(2012) Damage control surgery: it’s evolution over the last 20 years. Rev Col
Bras Cir 39: 314-321.
- Demmel N, Kirchdorfer B, Bauer
W, Gunther B (2000) Acute and complicated colonic diverticulitis: Surgical
standard in 500 cases. Coloproctology 22: 92-95.
- Morgan K, Mansker D, Adams DB (2010) Not just for
trauma patients: damage control laparotomy in pancreatic surgery. J
Gastrointest Surg 14: 768-772.
- Finlay IG, Edwards TJ, Lambert AW (2004) Damage
control laparotomy. Br J Surg 91: 83-85.
- Stawicki SP, Brooks A, Bilski T, Scaff D, Gupta R, et
al. (2008) The concept of damage control: extending the paradigm to emergency
general surgery. Injury 39: 93-101.
- Becher RD, Peitzman AB, Sperry
JL, Gallaher JR, Neff LP, et al. (2016) Damage control operations in non-trauma
patients: defining criteria for the staged rapid source control laparotomy in
emergency general surgery. World J Emerg Surg 11: 10.
- Girard E, Abba J, Boussat B, Trilling B, Mancini A, et al. (2017) Damage control surgery for non-traumatic abdominal emergencies. World J Surg 2017. Sep 25. doi: 10.1007/s00268-017-4262-6. [Epub ahead of print].
- Perathoner A, Klaus A, Mühlmann G, Oberwalder M,
Margreiter R, et al. (2010) Damage control with abdominal vacuum therapy (VAC)
to manage perforated diverticulitis with advanced generalized peritonitis-a
proof of concept. Int J Colorectal Dis 25: 767-774.
- Ordóñez CA, Sanchez AL, Pineda
JA, Badiel M, Mesa R, et al. (2010) Deferred primary anastomosis versus
diversion in patients with severe secondary peritonitis managed with staged
laparotomies. World J Surg 34: 169-176.
- Kafka-Ritsch R, Birkfellner F,
Perathoner A, Raab H, Nehoda H, et al. (2012) Damage control surgery with
abdominal vacuum and delayed bowel reconstruction in patients with perforated
diverticulitis Hinchey III/IV. J Gastrointest Surg 16: 1915-1922.
- Person B, Dorfman T, Bahouth
H, Osman A, Assalia A, et al. (2009) Abbreviated emergency laparotomy in the
non-trauma setting. World J Emerg Surgery 4: 41.
- Khan A, Hsee L, Mathur S,
Civil I (2013) Damage-control laparotomy in nontrauma patients: Review of
indications and outcomes. J Trauma Acute Care Surg 75: 365-368.
- Pommerening MJ, DuBose JJ,
Zielinski MD, Phelan HA, Scalea TM, et al. (2014) Time to first take back
surgery predicts successful primary fascial closure in patients undergoing
damage control surgery. Surgery 156: 431-438.
- Bertelsen CA, Fabricius R,
Kleif J, Kristensen B, Gogenur I (2014) Outcome of negative-pressure wound
therapy for open abdomen after nontraumatic lower gastrointestinal surgery:
Analysis of factors affecting delayed fascial closure in 101 patients. World J
Surg 38: 774-781.
- Goussous N, Jenkins DH,
Zielinski MD (2014) Primary fascial closure after damage control laparotomy:
Sepsis vs. haemorrhage. Injury 45: 151-155.
- Ozguç H, Yilmazlar T, Gurluler
E, Ozen Y, Korun N, et al. (2003) Staged abdominal repair in the treatment of
intra-abdominal infection: Analysis of 102 patients. J Gastrointest Surg 7:
646-651.
- Schein M (1991) Planned
reoperations and open management in critical intra-abdominal infections:
Prospective experience in 52 cases. World J Surg 15: 537-545.
- Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon
MJ, et al. (2012) Use of mesh during ventral hernia repair in
clean-contaminated and contaminated cases: outcomes of 33,382 cases. Ann Surg
255: 176-180.
- Collage RD and Rosengart MR (2010) Abdominal wall
infections with in situ mesh. Surg Infect (Larchmt) 11: 311-318.
- Diaz JJ Jr, Cullinane DC,
Khwaja KA, Tyson GH, Ott M, et al. (2013) Eastern Association for the Surgery
of Trauma: Management of the open abdomen, part III – Review of abdominal wall
reconstruction. J Trauma Acute Care Surg 75: 376-386.
- Hedderich GS, Wexler MJ, McLean AP, Meakins JL (1986)
The septic abdomen: open management with marlex mesh with a zipper. Surgery 99:
399-408.
- Sokmen S, Atila K, Bora S,
Astarcioğlu H, Coker A, et al. (2002) Evaluation of prosthetic mesh closure in
semiopen-abdomen patients. Hernia 6: 124-129.
- Voyles CR, Richardson JD,
Bland K, Tobin GR, Flint LM, et al. (1981) Emergency abdominal wall
reconstruction with polypropylene mesh short-term benefits versus long-term
complications. Ann Surg 194: 219-223.
- Joels CS, Vanderveer AS,
Newcomb WL, Lincourt AE, Polhill JL, et al. (2006) Abominal wall reconstruction
after temporary abdominal closure: a ten-year review. Surg Innov 13: 223-230.
- Ko JH, Wang EC, Salvay DM,
Paul BC, Dumanian GA, et al. (2009) Abdominal wall reconstruction: lessons
learned from 200 “components separation” procedures. Arch Surg 144: 1047-1055.
- Kafka-Ritsch R, Matthias Z, Schorn N, Stroemmer S,
Schneeberger S, et al. (2012) Open abdomen treatment with dynamic sutures and
topical negative pressure resulting in a high primary fascial closure rate.
World J Surg 36: 1765-1771.
- Lambertz A, Mihatsch C, Roth
A, Kalverkamp S, Eickhoff R, et al. (2015) Fascial closure after open abdomen:
initial indication and early revisions are decisive factors. Int J Surg 13:
12-16.
- Paul JS and Ridolfi TJ (2012)
A case study in intra-abdominal sepsis. Surg Clin North Am 92: 1661-1677.
- Tsuei BJ, Skinner JC, Bernard
AC, Kearney PA, Boulanger BR (2004) The open peritoneal cavity: etiology
correlates with the likelihood of fascial closure. Am Surg 70: 652-656.
- van Hensbrock PB, Wind J,
Dijkgraaf MGW, Busch ORC, Goslings JC (2009) Temporary closure of the open
abdomen: A systematic review on delayed primary fascial closure in patients
with an open abdomen. World J Surg 33: 199-207.
- Godat L, Kobayashi L,
Costantini T, Coimbra R (2013) Abdominal damage contol surgery and
reconstruction: World society of emergency surgery position paper. World J
Emerg Surg 8: 53.
- Goussous N, Kim BD, Jenkins DH, Zielinski MD (2012)
Factors affecting primary fascial closure of the open abdomen in the nontrauma
patient. Surgery 152: 777-783.
- Sartelli M, Catena F, Ansaloni
L, Coccolini F, Corbella D, et al. (2014) Complicated intra-abdominal
infections worldwide: the definitive data of the CIAOW study. World J Emerg
Surg 9: 37.
- Arhinful E, Jenkins D,
Schiller HJ, Cullinane DC, Smoot DL, et al. (2011) Outcomes of damage control
laparotomy with open abdomen management in the octogenarian population. J
Trauma 70: 616-621.
- D'Hondt M, D'Haeninck A,
Dedrye L, Penninckx F, Aerts R (2011) Can vacuum-assisted closure and
instillation therapy (VAC-Instill therapy) play a role in the treatment of the
infected open abdomen? Tech Coloproctol 15: 75-77.
- Filicori F, Di Saverio S,
Casali M, Biscardi A, Baldoni F, et al. (2010) Packing for damage control of
nontraumatic intra-abdominal massive hemorrhages. World J Surg 34: 2064-2068.
- Gaddnas F, Saarnio J,
Ala-Kokko T, Laurila J, Koivukangas V (2007) Continuous retention suture for
the management of open abdomen: a high rate of delayed fascial closure. Scand J
Surg 96: 301-307.
- Jusoh AC and Yanzie O (2014)
Damage control surgery/laparostomy in nontrauma emergency abdominal surgery: A
new concept of care . Saudi Surg J 2: 75-79.
- Padalino P, Dionigi G, Minoja G, Carcano G, Rovera F,
et al. (2010) Fascia-to-fascia closure with abdominal topical negative pressure
for severe abdominal infections: preliminary results in a department of general
surgery and intensive care unit. Surg Infect (Larchmt) 11: 523-528.
- Pliakos I, Papavramidis TS, Mihalopoulos N, Koulouris
H, Kesisoglou I, et al. (2010) Vacuum-assisted closure in severe abdominal
sepsis with or without retention sutured sequential fascial closure: A clinical
trial. Surgery 148: 947-953.
- Pliakos I, Papavramidis TS, Michalopoulos
N, Deligiannidis N, Kesisoglou I, et al. (2012) The value of vacuum-assisted
closure in septic patients treated with laparostomy. Am Surg 78: 957-961.
- Popovic M, Barisic G, Markovic
V, Petrovic J, Krivokapic Z (2012) Use of vacuum-assisted closure device in a
disastrous form of abdominal sepsis and stoma site infection: systematic review
and report of a case. Acta Chir Iugosl 59: 111-115.
- Shaikh IA, Ballard-Wilson A, Yalamarthi S, Amin AI
(2010) Use of topical negative pressure in assisted abdominal closure does not
lead to high incidence of enteric fistulae. Colorectal Dis 12: 931-934.
- Subramanian A, Balentine C,
Palacio CH, Sansgiry S, Berger DH, et al. (2010) Outcomes of damage-control
celiotomy in elderly nontrauma patients with intra-abdominal catastrophes. Am J
Surg 200: 783-789.
- Tamijmarane A, Ahmed I, Bhati
CS, Mirza DF, Mayer AD, et al. (2006) Role of completion pancreatectomy as a
damage control option for post-pancreatic surgical complications. Dig Surg 23:
229-234.
- Tier BH, Cho SD, Luem N, Riha
G, Mayberry J, et al. (2008) The use of the Wittmann patch facilitates a high
rate of fascial closure in severely injured trauma patients and critically ill
surgery patients. J Trauma 65: 865-870.
- Verdam FJ, Dolmans DE, Loos
MJ, Raber MH, de Wit RJ, et al. (2011) Delayed primary closure of the septic
open abdomen with a dynamic closure system. World J Surg 35: 2348-2355.
- Weber DG, Bendinelli C, Balogh
ZJ (2014) Damage control surgery for abdominal emergencies. Br J Surg 101: e109-118.
- Wondberg D, Larusson HJ, Metzger U, Platz A, Zingg U (2008) Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg 32: 2724-2729.