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World Journal of Surgery

, Volume 22, Issue 12, pp 1184–1191 | Cite as

Staged Physiologic Restoration and Damage Control Surgery

  • Ernest E. Moore
  • Jon M. Burch
  • Reginald J. Franciose
  • Patrick J. Offner
  • Walter L. Biffl
Article

Abstract

The fundamental objective of staged laparotomy is to accomplish definitive operative management in a calculated, stepwise fashion based on the patient’s physiologic tolerance. This important concept has emerged from collective experience with massive acute abdominal injuries but clearly extends to elective operative procedures and surgical challenges in other torso compartments. Whereas the inability to achieve hemostasis is due most frequently to a recalcitrant coagulopathy following trauma, other scenarios include inaccessible venous injuries, coexisting extraperitoneal life-threatening injuries, uncertain viability of abdominal contents, and the inability to reapproximate abdominal fascia due to reperfusion-induced visceral edema. There are five critical decision-making phases of staged laparotomy: I, patient selection; II, intraoperative reassessment; III, physiologic restoration in the surgical intensive care unit; IV, return to the operating room for definitive procedures; and V, abdominal wall reconstruction. The abdominal compartment syndrome (ACS) is a common, often insidious complication of staged laparotomy. In fact, during phases II and III there is often a delicate balance between effective pressure tamponade of capillary bleeding and the untoward effects of the ACS. During phases IV and V a frequent dilemma is how to enclose the abdominal contents to reduce protein loss and facilitate patient mobilization.

Keywords

Injury Severity Score Abdominal Compartment Syndrome Intraabdominal Pressure Placenta Accreta Abdominal Wall Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© by the Société Internationale de Chirugie 1998

Authors and Affiliations

  • Ernest E. Moore
    • 1
  • Jon M. Burch
    • 1
  • Reginald J. Franciose
    • 1
  • Patrick J. Offner
    • 1
  • Walter L. Biffl
    • 1
  1. 1.Department of Surgery, Denver Health Medical Center, 777 Bannock Street, Denver Colorado 80204, USAUSA

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