%0 Journal Article
%T Abbreviated emergency laparotomy in the non-trauma setting
%A Benjamin Person
%A Tatiana Dorfman
%A Hany Bahouth
%A Amira Osman
%A Ahmad Assalia
%A Yoram Kluger
%J World Journal of Emergency Surgery
%D 2009
%I BioMed Central
%R 10.1186/1749-7922-4-41
%X A retrospective analysis of data from non-trauma patients who underwent emergency laparotomy between May 2006 and December 2008. Demographics, indications for surgery and outcome of patients who had definitive laparotomies (DL) and patients who had abbreviated laparotomies (AL) were compared. Appendectomies were excluded.Two-hundred ninety-one patients (55% males) were included. Thirty-one (10.7%) underwent AL (58% males). Mean age of patients who had DL and AL was 65 and 62.8 years respectively. Peritonitis and mesenteric ischemia were more common indications in patients with AL than DL: 48.4% vs. 30.4% (p = 0.04) and 32.3% vs. 3.5% (p < 0.0001) respectively. Only 29% of patients who had AL were hemodynamically unstable. Mortality rates were 54.8% and 16.5% in patients with AL and DL respectively (p < 0.0001). Patients who died after AL and DL were significantly older than patients who survived (75 vs. 47.3 and 74 vs. 63 years respectively, p < 0.0001). Median hospital stay was 21 and 9 days for patients with AL and DL respectively (p < 0.05). Patients who underwent AL had significantly more wound infections, sepsis and multi-organ failure.The philosophy of damage control surgery is applied to non-trauma patients as some of the prerequisites for the decision to elect this strategy are the same. Peritonitis is the most common indication for AL in non-trauma patients.Since the earliest descriptions of intentionally abbreviated laparotomy more than 20 years ago [1-3], damage-control laparotomy has been widely applied in severely traumatized patients and extensively scrutinized in the literature. The realization that correction of metabolic failure rather than anatomic perfection is mandatory for immediate survival led to the development of this approach. The "lethal triad" of hypothermia, acidosis, and coagulopathy was viewed as a vicious cycle that often could not be interrupted and which marked the limit of the patient's ability to cope with the physiological conseq
%U http://www.wjes.org/content/4/1/41