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Damage Control Surgery may be a Safe Option for Severe Non-Trauma Peritonitis Management: Proposal of a New Decision-Making Algorithm

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Abstract

Background

Damage control surgery (DCS) has emerged as a new option in the management of non-traumatic peritonitis patients to increase survival in critically ill patients. The purpose of this study was to compare DCS with conventional strategy (anastomosis/ostomies in the index laparotomy) for severe non-traumatic peritonitis regarding postoperative complications, ostomy rate, and mortality and to propose a useful algorithm in the clinical practice.

Methods

Patients who underwent an urgent laparotomy for non-trauma peritonitis at a single level I trauma center in Colombia between January 2003 and December 2018, were retrospectively included. We compared patients who had DCS management versus definitive initial surgical management (DISM) group. We evaluated clinical outcomes and morbidities among groups.

Results

290 patients were included; 81 patients were treated with DCS and 209 patients underwent DISM. Patients treated with DCS had a worse critical status before surgery with higher SOFA score [median, DCS group: 5 (IQR: 3–8) vs. DISM group: 3 (IQR: 1–6), p < 0.001]. The length of hospital stay and overall mortality rate of DCS group were not significant statistical differences with DISM group. Complications rate related to primary anastomosis or primary ostomy was similar. There is not difference in ostomy rate among groups. At multivariate analysis, SOFA > 6 points and APACHE-II > 20 points correlated with a higher probability of DCS.

Conclusion

DCS in severe non-trauma peritonitis patients is feasible and safe as surgical strategy management without increasing mortality, length hospital of stay, or complications. DCS principles might be applied in the non-trauma scenarios without increase the stoma rate.

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Authors and Affiliations

  1. Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali, 760032, Colombia

    Carlos A. Ordoñez, Alberto García, Fernando Rodríguez, José Julián Serna, Alexander Salcedo, Josefa Franco, Luis Eduardo Toro & Gonzalo Aristizábal

  2. Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle – Hospital Universitario del Valle, Cali, Colombia

    Carlos A. Ordoñez, Alberto García, José Julián Serna, Alexander Salcedo, Juliana Ordoñez & Luis Fernando Pino

  3. Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL, USA

    Michael Parra

  4. Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No. 18 - 49, Cali, 760032, Colombia

    Yaset Caicedo & Mónica Guzmán

  5. Center for Surgery and Public Health, Department of Surgery, Harvard Medical School & Harvard T.H. Chan School of Public Health, Brigham & Women’s Hospital, Boston, MA, USA

    Claudia Orlas & Juan Pablo Herrera

  6. Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy

    Francesco Pata

  7. La Sapienza University, Rome, Italy

    Francesco Pata

  8. Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Salomone Di Saverio

Authors
  1. Carlos A. Ordoñez
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  2. Michael Parra
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  3. Alberto García
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  4. Fernando Rodríguez
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  6. José Julián Serna
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  7. Alexander Salcedo
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  8. Josefa Franco
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  9. Luis Eduardo Toro
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  10. Juliana Ordoñez
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  11. Luis Fernando Pino
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  12. Mónica Guzmán
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  13. Claudia Orlas
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  14. Juan Pablo Herrera
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  15. Gonzalo Aristizábal
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  16. Francesco Pata
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  17. Salomone Di Saverio
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Corresponding author

Correspondence to Carlos A. Ordoñez.

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The authors declare that they have no conflict of interest.

Animals or human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional research committee from Fundación Valle del Lili under the number 554 in 2014 and has been updated annually since its approval.

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Ordoñez, C.A., Parra, M., García, A. et al. Damage Control Surgery may be a Safe Option for Severe Non-Trauma Peritonitis Management: Proposal of a New Decision-Making Algorithm. World J Surg 45, 1043–1052 (2021). https://doi.org/10.1007/s00268-020-05854-y

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  • DOI: https://doi.org/10.1007/s00268-020-05854-y

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