Search Results (9)

Damage control surgery (DCS) is a staged surgical strategy for rapid control of life-threatening bleeding, followed by physiological stabilization and delayed definitive repair. Abdomino-pelvic packing (APP)—placing compressive material within the pelvis and/or abdomen to tamponade bleeding—is a cornerstone of DCS as a temporizing measure to achieve hemostasis and stabilization in critically unstable patients. This narrative review synthesizes current evidence on DCS with a focus on APP—a technique historically developed in trauma and orthopedic surgery for exsanguinating pelvic bleeding but adaptable to gynecologic and obstetric emergencies. We outline the historical evolution, physiological basis, and stepwise protocol of DCS, adapted to specialty-specific conditions such as postpartum hemorrhage, placenta accreta spectrum, uterine rupture, and hepatic rupture in HELLP syndrome, as well as oncologic surgeries (debulking, exenteration, lymphadenectomy) and benign procedures (trocar-entry injuries in laparoscopy, presacral bleeding in sacrocolpopexy, and retroperitoneal hemorrhage in deep-infiltrating endometriosis). Modern adjuncts—including early tranexamic acid, topical hemostatic agents, and multidisciplinary coordination—have transformed packing from a last-resort maneuver into an integrated component of staged hemorrhage control. In OB/GYN, APP allows for successful hemostasis in 75–90% of cases, with significantly lower mortality rates than trauma surgery. In conclusion, APP as a potentially life-saving maneuver within DCS requires integration into standardized, institution-wide hemorrhage protocols in OB/GYN. Training, simulation, and guideline adoption are critical, particularly in resource-limited settings where advanced interventions for catastrophic bleeding are inaccessible. Full article

This case report describes index pancreatoduodenectomy in a 32-year-old male following a close-range gunshot wound to the abdomen, with consequent 4 cm pancreatic head defect, duodenal and common bile duct perforation, right kidney laceration, and through-and-through inferior vena cava (IVC) injury. Although standard trauma protocols often favor damage control surgery (DCS) with delayed reconstruction in unstable patients, this patient’s hemodynamic stability—attributed to retroperitoneal self-tamponade—enabled a single-stage definitive approach. The rationale for immediate reconstruction was to prevent the risks associated with delayed management, such as ongoing pancreatic and biliary leakage, chemical peritonitis, and subsequent sepsis or hemorrhage. This case highlights that, in select stable patients with severe pancreaticoduodenal trauma, immediate pancreatoduodenectomy may be preferable to DCS, provided care is delivered in a high-volume hepatopancreaticobiliary (HPB) center with appropriate expertise and resources. Full article

Background: The guidelines proposed by the World Society for Emergency Surgery (WSES) in 2020 for the management of Acute Diverticulitis (AD) emphasize the safety of non-operative management (NOM) in selected patients and recommend sigmoid resection (SR) with primary anastomosis (PA) as the surgical technique of choice. Aim: To analyze the clinical outcomes following the implementation of an evidence-based clinical pathway developed by an Acute Care Surgery Unit (ACSu) at a reference center. Methods: For analysis, patients were divided into two groups: pre-guidelines (2018–2019) and post-guidelines (2020–2023), following the May 2020 WSES publication. Patients were classified according to the WSES classification. Results: NOM failure and PA after SR rates by groups were as follows (NOM failure not applicable to III–IV): 0-IA, 2.7% and 94.7%; IB–IIA, 16% and 85.2%; IIB, 7.1% and 50%; III–IV, 75.6%. The global stoma-free rate was 78.8%, with a 15.7% anastomotic leak rate and 14.2% significant morbidity, with an increased rate of anastomosis in unstable patients thanks to Damage Control Surgery (DCS). A logistic regression model was performed to identify factors associated with postoperative morbidity. Patients who underwent primary anastomosis had a lower risk of postoperative morbidity compared to those treated with Hartmann’s procedure (OR = 0.22 (0.04–1.25), p = 0.088). Conclusions: Excellent outcomes in AD healthcare may be achieved if evidence-based recommendations are followed. The ACSu plays a key role in designing and promoting these protocols. Full article

In patients with advanced sepsis from abdominal disease, the open abdomen (OA) technique as part of a damage control surgery (DCS) approach enables relook surgery to control infection, defer intestinal anastomosis, and prevent intra-abdominal hypertension. Limited evidence is available on key outcomes, such as mortality and rate of definitive fascial closure (DFC), which are needed for surgeons to select patients and adequate therapeutic strategies. Abdominal closure with negative pressure wound therapy (NPWT) has shown rates of DFC around 90%. We conducted a retrospective study to evaluate in-hospital survival and factors associated with mortality in acute, non-trauma patients treated using the OA technique and NPWT for sepsis from abdominal disease. Fifty consecutive patients treated using the OA technique and NPWT between February 2015 and July 2022 were included. Overall mortality was 32%. Among surviving patients, 97.7% of cases reached DFC, and the overall complication rate was 58.8%, with one case of entero-atmospheric fistula. At univariable analysis, age (p = 0.009), ASA IV status (<0.001), Mannheim Peritonitis Index > 30 (p = 0.001) and APACHE II score (p < 0.001) were associated with increased mortality. At multivariable analysis, higher APACHE II was a predictor of in-hospital mortality (OR 2.136, 95% CI 1.08–4.22; p = 0.029). Although very resource-intensive, DCS and the OA technique are valuable tools to manage patients with advanced abdominal sepsis, allowing reduced mortality and high DFC rates. Full article

Liver involvement after abdominal blunt trauma must be expected, and in up to 30% of cases, spleen, kidney, and pancreas injuries may coexist. Whenever hemodynamics conditions do not contraindicate the overcoming of the ancient dogma according to which exploratory laparotomy should be performed after every major abdominal trauma, a CT scan has to clarify the liver lesions so as to determine the optimal management strategy. Except for complete vascular avulsion, no liver trauma grade precludes nonoperative management. Every attempt to treat the injured liver by avoiding a strong surgical approach may be considered. Each time, a nonoperative management (NOM) consisting of a basic “wait and see” attitude combined with systemic support and blood replacement are inadequate. Embolization should be considered to stop the bleeding. Percutaneous drainage of collections, endoscopic retrograde cholangiopancreatography (ERCP) with papilla sphincterotomy or stent placement and percutaneous transhepatic biliary drainage (PTBD) may avoid, or at least delay, surgical reconstruction or resection until systemic and hepatic inflammatory remodeling are resolved. The pathophysiological principle sustaining these leanings is based on the opportunity to limit the further release of cell debris fragments acting as damage-associated molecular patterns (DAMPs) and the following stress response associated with the consequent immune suppression after trauma. The main goal will be a faster recovery combined with limited cell death of the liver through the ischemic events that may directly follow the trauma, exacerbated by hemostatic procedures and surgery, in order to reduce the gross distortion of a regenerated liver. Full article

Burn injuries with cutaneous loss result in a severe systemic response when profound injuries exceed 20% of the total body surface area. The management of severely burned patients is a complex and dynamic process. Timely and safe operative interventions are critical components of multidisciplinary care. Effective management of severely burned patients, their cutaneous injuries, and the associated systemic disease requires a comprehensive understanding of the pathophysiologic response to trauma, objective indicators of patient status, and an appreciation for the dynamic nature of these parameters. Progress in both clinical and basic science research has advanced our understanding of these concepts and our approach to the management of burn patients. Incorporating concepts such as early total care, damage control surgery (DCS), and safe definitive surgery (SDS) in the polytraumatized patient may further aid in optimizing outcomes and quality of care for burn patients. This article connects current knowledge of the lethal triad, inflammation, immunosuppression, and eschar-derived toxins, with surgical burn care, especially burn wound debridement. The concepts of DCS and SDS for the care and management of burn patients are strongly advocated. Experimental and clinical studies are encouraged to validate these concepts in an effort to optimize patient outcomes. Full article

The history of staged laparotomy, the basic idea behind the so called “Damage Control Surgery (DCS)” attitude, leans on the experience developed during the treatment of major hepatic trauma that was sustained by Pringle’s pioneering attempts to achieve hemostasis on liver wounds via packing in 1908 [...] Full article

Study Design: Studies on the concept of Damage Control Surgery (DCS) in the management of firearm injuries to the oral and maxillofacial region are still scarce, hence the basis for the current study. Objectives: The objectives of the current study is to share our experience in the management of maxillofacial gunshot injuries with emphasis on DCS and early definitive surgery. Methods: This was a retrospective study of combatant Yemeni patients with maxillofacial injuries who were transferred across the border fromYemen to Najran, Kingdomof Saudi Arabia. Demographics and etiology of injuries were stored. Paths of entry and exit of the projectiles were also noted. Also recorded were types of gunshot injury and treatment protocols adopted. Data was stored and analyzed using IBM SPSS Statistics forWindows Version 25 (Armonk, NY: IBM Corp). Results: A total of 408 victims, all males, were seen during the study period with 173 (42.4%) males sustaining gunshot injuries to the maxillofacial region. Their ages ranged from 21 to 56 years with mean ± SD (27.5 ± 7.6) years. One hundred and twenty-one (70.0%) victims had extraoral bullet entry, while 53 (30.0%) victims had intraoral entry route. Ocular injuries, consisting of 25 (14.5%) cases of ruptured globe and 6 (3.5%) cases of corneal injuries, were the most commonly associated injuries. A total of 78 (45.1%) hemodynamically unstable victims had DCS as the adopted treatment protocol while early definitive surgery was carried out in 47(27.2%) hemodynamically stable victims. ORIF was the treatment modality used for the fractures in 132 (76.3%) of the victims. Conclusions: We observed that 42.4% of the war victims sustained gunshot injuries. DCS with ORIF was the main treatment protocol adopted in the management of the hemodynamically unstable patients. Full article

During surgical treatment for cerebrovascular diseases, cortical hemodynamics are often controlled by bypass graft surgery, temporary occlusion of arteries, and surgical removal of veins. Since the brain is vulnerable to hypoxemia and ischemia, interruption of cerebral blood flow reduces the oxygen supply to tissues and induces irreversible damage to cells and tissues. Monitoring of cerebral hemodynamics and alteration of cellular structure during neurosurgery is thus crucial. Sequential recordings of red-green-blue (RGB) images of in vivo exposed rat brains were made during hyperoxia, normoxia, hypoxia, and anoxia. Monte Carlo simulation of light transport in brain tissue was used to specify relationships among RGB-values and oxygenated hemoglobin concentration (C_HbO), deoxygenated hemoglobin concentration (C_HbR), total hemoglobin concentration (C_HbT), hemoglobin oxygen saturation (StO₂), and scattering power b. Temporal courses of C_HbO, C_HbR, C_HbT, and StO₂ indicated physiological responses to reduced oxygen delivery to cerebral tissue. A rapid decrease in light scattering power b was observed after respiratory arrest, similar to the negative deflection of the extracellular direct current (DC) potential in so-called anoxic depolarization. These results suggest the potential of this method for evaluating pathophysiological conditions and loss of tissue viability. Full article