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Invited Critique
June 2001

Avoidance of Abdominal Compartment Syndrome in Damage-Control Laparotomy After Trauma—Invited Critique

Arch Surg. 2001;136(6):681. doi:10.1001/archsurg.136.6.681

This review of a 5-year experience with damage-control laparotomy by Offner et al provides concisely recorded data for thoughtful reflection. The results are quite good, yet I fear that avoidance of compartment syndrome at all costs is not an appropriate goal for many cases.

If, during initial exploration, the freshly shed blood clots and there is no ongoing complicating coagulopathy, then clearly the abdomen should be closed without such undo tension as would create a compartment syndrome and its attendant difficulties, ie, acute respiratory distress and/or multiple organ failure. Abdominal closure can thereby be selective and may be based on fascial approximation, mere skin closure, or insertion of some prosthesis, with overlying skin left either open or closed. However, if coagulopathy is overt, only the tamponading effect of an abdomen closed under tension can allay further massive bleeding, can obviate the need for infusion of even greater amounts of blood than would otherwise be required, and thus can permit a more rapid correction of the clotting disorder.

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