Hypothesis: Abdominal compartment syndrome (ACS) is a morbid complication o
f damage-control laparotomy. Moreover, the technique of abdominal closure i
nfluences the frequency of ACS.
Design: Retrospective cohort study.
Setting: Urban level I trauma center.
Patients: We studied 52 patients with trauma who required damage-control la
parotomy during the 5 years ending December 31, 1999, and who survived long
er than 48 hours.
Main Outcome Measures: Abdominal compartment syndrome, acute respiratory di
stress syndrome (ARDS), and multiple organ failure (MOF).
Results: Mean (+/- SD) age was 33+/-2 years; 38 (73%) were male. Mechanism
of injury was blunt in 29 patients (56%), and mean (+/-: SD) Injury Severit
y Score was 28 +/- 2. Development of ARDS and/or MOF was seen in 23 patient
s (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). A
bdominal compartment syndrome was a common complication (17/52), and was as
sociated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patie
nts [31%] without ACS; P=.02, chi (2) test) and death (6 [35%] vs 8 patient
s [23%] without ACS). Primary. fascial closure (n=10) at the initial laparo
tomy was associated with ACS in 8 (80%) (P=.001, chi (2) test) and ARDS and
/or MOF in 9 (90%) (P=.01, chi (2) test); skin closure (n=25), with ACS in
6 (24%) and ARDS/MOF in 9 (36%); and Bogota bag closure (n=17), with ACS in
3 (18%) and ARDS/MOF in 8 (47%).
Conclusions: Damage-control laparotomy is associated with frequent complica
tions. In particular, ACS is a serious complication that increases ARDS and
/or MOF and mortality. Avoiding primary fascial closure at the initial lapa
rotomy can minimize the risk for ACS.