Revista Colombiana de Cirugía
Print version ISSN 2011-7582
ORDONEZ DELGADO, Carlos Alberto et al. Clinical results in patients with primary intestinal anastomosis in the damage control operative technique. rev. colomb. cir. [online]. 2007, vol.22, n.1, pp. 4-12. ISSN 2011-7582.
Objective: To report our experience with the application of the damage control technique in exanguinating patients with severe abdominal trauma, and to evaluate the temporary ligature of the the small and large bowel and an intestinal anastomosis as a delayed procedure in the performance of this type of staged surgery. Material and methods: All consecutive patients that underwent damage control technique in the period 1999-2004 were studied. Parameters of morbidity and mortality, UCI stay, and complications were analyzed. Results: The study included 40 patients with average age 34 ± 12.7 years, of which 90% were men; 75% of patients presented open trauma; APACHE II = 15 (4-29), ATI = 32 (7-90), with 75% of patients presenting an ATI score >25. Average UCI stay was 8.5 ±11.8. Packing was used in 38 (95%) of patients. Sepsis developed in 32.5% and multiple organ failure in 45% of all patients. Overall mortality was 45% (CI 95%, 29.6-60.4), 72.3% mortality within the first 72 hours. Thirteen intestinal anastomoses were performed in 12 patients (30%). Univariate analysis showed mortality associated with coagulopathy, acidosis, and multiple organ failure. Conclusions: Overall mortality in this group was 45%, seemingly associated with coagulopathy, acidosis, and multiple organ failure. Delayed primary anastomosis was carried out in 30% of patients, appearing as viable and secure when performed within the context of the staged damaged control operative technique.
Keywords : damage control laparotomy; primary intestinal anastomosis; abdominal injuries.