| Abstract: AIM: Damage control laparotomy(DCL) has been utilized for over 2 decades as a means for improved survival in severely injured trauma patients. DCL is often used to prevent the development of abdominal compartment syndrome(ACS) and its resultant morbidities. The goal of this review is to characterize the mortality and morbidity associated with an “open abdomen” following DCL and following temporary abdominal closure with the artificial burr device.The artificial burr device (Wittmann PatchTM) is a Velcro-like device which provides for delayed primary fascial closure.
METHODS: This is a prospective observational study involving patients undergoing DCL at one Level 1 trauma center. Mortality and abdominal complication rate were compared from 2 periods, a 3 year period utilizing the burr device or other attempts at primary closure(2001-2004), and the preceding 2 years(1999-2001) utilizing the open abdomen technique with later abdominal reconstruction.
RESULTS: A total of 25 DCL were done in the first period (pre-burr). There were 5 deaths (20%), and an abdominal complication rate of 36% with 1 evisceration, 1 parastomal abscess, and 7 GI fistulas. During the second period(post-burr) there were 11 DCL, 3 utilizing the burr device, 4 closed primarily on return to the OR(burr not indicated), and 4 deaths from associated injuries. Another early death occurred in one patient with the burr device, making a total of five(45%) deaths attributed to associated injuries. There was 1(9%) abdominal complication (pelvic abscess) in this post-burr group.
DISCUSSION: No conclusions can be drawn from the mortality rate given the small sample size and observational aspect of this study. The rate of abdominal complications, particularly fistulas, is lower in the group where primary closure, or delayed primary closure with the artificial burr is obtained. Avoidance of the open abdominal defect in the late stages of damage control, while preventing the development of abdominal compartment syndrome during the early stages appears to offer the advantage of decreasing the number of abdominal complications such as fistulas. This warrants further study in a prospective manner.
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