Thomas A Mitchell1, Cynthia L Lauer1, James K Aden2, Kurt D Edwards1, Jeffrey A Bailey2, Christopher E White1, Lorne H Blackbourne1, John B Holcomb3. 1. Department of General Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234. 2. United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, TX 78234-7767. 3. Division of Acute Care Surgery, Department of Surgery, University of Texas Health Sciences Center at Houston, 7000 Fannin Street, Houston, TX 77030.
Abstract
INTRODUCTION: Damage control laparotomy (DCL) in an austere environment is an evolving surgical modality. METHODS: A retrospective evaluation of all patients surviving 24 hours who underwent a laparotomy from 2002 to 2011 in Iraq and Afghanistan was performed. DCL was defined as a patient undergoing laparotomy at two distinct North American Treaty Organization (NATO) Role 2 or 3 medical treatment facilities (MTFs); a NATO Roles 2 and 3 MTFs, and/or having the International Classification of Diseases, 9th Revision, Clinical Modification procedure code 54.12, for reopening of recent laparotomy site. Definitive laparotomy (DL) was defined as patients undergoing one operative procedure at one NATO Role 2 or 3 MTF. Demographic data including injury severity scores, hematological transfusion, mortality, intraperitoneal or retroperitoneal operative interventions, and complications were compared. RESULTS: DCL composed of 26.5% (n = 331) of all 1,248 laparotomies performed between March 2002 and September 2011. Total intra-abdominal, acute respiratory distress syndrome, and thromboembolic complications for DCL versus DL were 8.5% and 5.6% (p = 0.07), 2.1% and 0.8% (p = 0.06), and 1.5% and 0.7% (p = 0.17), respectively. Theater discharge mortality from DCL and DL were 1.5% (n = 5), and 1.4% (n = 13) (p = 0.90), respectively. CONCLUSIONS: In conclusion, excluding deaths with the first 24 hours, DCL and DL had comparable mortality and complication rates at NATO Roles 2 and 3 MTFs. Reprint &
INTRODUCTION: Damage control laparotomy (DCL) in an austere environment is an evolving surgical modality. METHODS: A retrospective evaluation of all patients surviving 24 hours who underwent a laparotomy from 2002 to 2011 in Iraq and Afghanistan was performed. DCL was defined as a patient undergoing laparotomy at two distinct North American Treaty Organization (NATO) Role 2 or 3 medical treatment facilities (MTFs); a NATO Roles 2 and 3 MTFs, and/or having the International Classification of Diseases, 9th Revision, Clinical Modification procedure code 54.12, for reopening of recent laparotomy site. Definitive laparotomy (DL) was defined as patients undergoing one operative procedure at one NATO Role 2 or 3 MTF. Demographic data including injury severity scores, hematological transfusion, mortality, intraperitoneal or retroperitoneal operative interventions, and complications were compared. RESULTS:DCL composed of 26.5% (n = 331) of all 1,248 laparotomies performed between March 2002 and September 2011. Total intra-abdominal, acute respiratory distress syndrome, and thromboembolic complications for DCL versus DL were 8.5% and 5.6% (p = 0.07), 2.1% and 0.8% (p = 0.06), and 1.5% and 0.7% (p = 0.17), respectively. Theater discharge mortality from DCL and DL were 1.5% (n = 5), and 1.4% (n = 13) (p = 0.90), respectively. CONCLUSIONS: In conclusion, excluding deaths with the first 24 hours, DCL and DL had comparable mortality and complication rates at NATO Roles 2 and 3 MTFs. Reprint &
Authors: Igor Khomenko; Vitalii Shapovalov; Ievgen Tsema; Georgii Makarov; Roman Palytsia; Ievgen Zavodovskyi; Ivan Ishchenko; Andrii Dinets; Vladimir Mishalov Journal: Surg Case Rep Date: 2017-08-15
Authors: Maurizio Cardi; Khushal Ibrahim; Shah Wali Alizai; Hamayoun Mohammad; Marco Garatti; Antonio Rainone; Francesco Di Marzo; Giuseppe La Torre; Michela Paschetto; Ludovica Carbonari; Valentina Mingarelli; Andrea Mingoli; Giuseppe S Sica; Simone Sibio Journal: World J Emerg Surg Date: 2019-11-21 Impact factor: 5.469