Usefulness of damage control approach in patients with limited acute mesenteric ischemia: A prospective study of 85 patients
Abstract
To evaluate the efficacy of the damage control approach by two-step surgical procedure in not critical patients (without sepsis or septic shock) with peritonitis from limited acute mesenteric ischemia. From April 2013 to April 2020, 85 patients [49 (57.7%) women and 36 (42.3%) men, median age 69.5 (range 38-92)] were enrolled in this study and underwent emergency surgery. After resection of ischemic bowel, basing on the individual decision of the single surgeon, the patients underwent primary end-to-end anastomosis (Group 1) or damage control approach (Group 2) including primary laparotomy with resection of ischemic bowel, temporary abdominal closure and a second-look procedure at 48 h with re-evaluation of bowel vitality. Forty-seven (55.3%) patients underwent one-stage surgical treatment and 38 (44.7%) patients received a two-step procedure. In the latter group, at second exploration, 8 (21%) patients required a further intestinal resection, due to mesenteric ischemia progression. Both anastomosis dehiscence rate and need for ileostomy in Group 1 patients were significantly higher than in Group 2 (23.4% vs 5.3%: p = 0.03 and 19.1% vs 2.6%: p = 0.03; Fisher's exact test). No significative differences in mortality and morbidity rate were found between the two groups. The damage control approach by two-step surgical procedure may represent a valid innovative option in the management of not critical patients with limited acute mesenteric ischemia, achieving a better clinical outcome if compared with surgical treatment by one-step procedure.
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Serial laparotomies offer better clinical outcomes even in non-critically ill patients.
“Studies have demonstrated that serial laparotomies offer better clinical outcomes even in non-critically ill patients [55].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [55]
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- Authors
- Brillantino, A., Lanza, M., Antropoli, M., Amendola, A., Squillante, S., Bottino, V., Renzi, A., & Castriconi, M.
- Affiliations
- Ospedale Antonio Cardarelli (IT)
- Ospedale Buon Consiglio Fatebenefratelli (IT)
- Corresponding author
- Brillantino, Antonio
- Venue
- Updates in Surgery
- Published
- 2021-10-22
- Volume
- 74
- Issue
- 1
- Pages
- 337-342
- ISSN
- 2038-131X (ISSN-L)
- 2038-3312
- OpenAlex
- W3206808368
- Cited by
- 18
- References
- 25
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 1 · 2022: 4
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Updates in Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- damage control surgery, temporary abdominal closure, second-look laparotomy, bowel resection, anastomotic leakage, ileostomy, peritonitis, emergency surgery
- MeSH terms
- Aged, Female, Humans, Intestines, Laparotomy, Male, Peritonitis, Prospective Studies, Mesenteric Ischemia
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