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Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma
  1. Ross D Weale1,
  2. V Y Kong2,
  3. J M Blodgett3,
  4. J Buitendag2,
  5. A Ras,
  6. G Laing,
  7. J L Bruce,
  8. W Bekker,
  9. V Manchev and
  10. D Clarke2,4
  1. 1B Detachment, 256 Field Hospital, London, UK
  2. 2Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, Durban, South Africa
  3. 3Department of Epidemiology, MRC Unit, University College London, London, United Kingdom
  4. 4Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Captain Ross D Weale, 256 Field Hospital, London SE17 3RF, UK; rossweale{at}doctors.org.uk

Abstract

Introduction The modern concept of damage control surgery (DCS) for trauma was first introduced less than three decades ago. This audit aims to describe the spectrum and outcome of patients requiring DCS, to benchmark our experience against that reported from other centres and countries and to distil the pertinent teaching lessons from this experience.

Methods All patients over the age of 15 years undergoing a laparotomy for trauma over the period from December 2012 to July 2016 were retrieved from the trauma registry of the Pietermaritzburg Metropolitan Trauma Service, South Africa. Physiological parameters and visceral injuries were assessed. Statistical analysis was performed using STATA V.15.0.

Results A total of 562 patients underwent trauma laparotomy during the period under review. The mechanism was penetrating trauma in 81% of cases (453/562). A great proportion of trauma victims were male (503/562, 90%), with a mean age of 29.5±10.8. A total of 99 of these (18%) had a DCS procedure versus 463 (82%) non-DCS. Out of the 99 who required DCS, there were 32 mortalities (32%). The mean physiological parameters for the DCS patient demonstrated acidosis (pH 7.28±0.15) with a raised lactate (5.25 mmol/L±3.71). Our primary repair rates for enteric injuries were surprisingly high.

Conclusion Just under 20% of trauma laparotomies require DCS. In this cohort of patients, the mortality rate is just under one-third. Further attention must be paid to refining the appropriate indications for DCS as the margin for error in such a cohort is very small and poor decision-making is difficult to correct. The major lesson from this analysis is that the decision to perform DCS must be made early and communicated appropriately to all those managing the patient.

  • trauma management
  • damage control
  • laparotomy

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Footnotes

  • Contributors All authors contributed to the writing and editing of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (reference: BE207/09 and BCA 221/13).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Any data can be available upon request to the corresponding author.

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