General

Damage Control Laparotomy

DAMAGE CONTROL LAPAROTOMY

Indication: Life-threatening abdominal injury or severe septic emergency in a physiologically compromised patient with hypothermia, coagulopathy, and acidosis (the 'lethal triad'). Abbreviated surgery to control haemorrhage and contamination, with planned return to theatre after resuscitation.

Patient Position: Supine.

Anaesthesia: General (rapid sequence induction).

Prophylactic Antibiotics: Broad-spectrum immediately.

Incision: Rapid midline laparotomy.

Phase 1 — Damage Control Surgery (abbreviated):
1. Rapid haemorrhage control: manual compression, packing of solid organ injuries (liver, spleen, pelvis) with laparotomy swabs. Major vessel control by direct pressure, clamps, or temporary shunts (damage control vascular surgery).
2. Contamination control: bowel perforations rapidly controlled with staples, ties, or clamps. Ends not anastomosed at this stage.
3. Packing left in situ. Abdomen temporarily closed: Bogota bag, vacuum-assisted temporary closure (VAC), or running all layers with heavy suture to prevent abdominal compartment syndrome while allowing re-access.

Phase 2 — ICU Resuscitation:
- Warming, correction of coagulopathy with blood products, acidosis correction, haemodynamic optimisation.

Phase 3 — Return to Theatre (24–72 hours later):
1. Packs removed. Reassessment of all injuries.
2. Bowel continuity restored or stoma formed.
3. Definitive haemostasis.
4. Peritoneal lavage.
5. Abdomen closed primarily or with staged fascial closure technique.

Finding(s): [Indication. Injuries identified. Swabs placed: __ packs — location. Bowel discontinuity: ends controlled — anastomosis deferred. Temporary closure: type applied.]

Complications Noted: [Abdominal compartment syndrome — managed / specify.]

Postoperative Instructions: ITU. Staged re-look planned at 24–72 hours. Damage-control philosophy continued until physiology corrected.