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Patrick J. Offner, MD,MPH; Almerindo Laurence de Souza, MD; Ernest E. Moore, MD; Walter L. Biffl, MD; Reginald J. Franciose, MD; Jeffrey L. Johnson, MD; Jon M. Burch, MD

Arch Surg. 2001;136:676-681.

Hypothesis  Abdominal compartment syndrome (ACS) is a morbid complication of damage-control laparotomy. Moreover, the technique of abdominal closure influences 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 laparotomy during the 5 years ending December 31, 1999, and who survived longer than 48 hours.

Main Outcome Measures  Abdominal compartment syndrome, acute respiratory distress 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 Severity Score was 28 ± 2. Development of ARDS and/or MOF was seen in 23 patients (44%); ARDS and MOF increased mortality from 12% (3/26) to 42% (11/26). Abdominal compartment syndrome was a common complication (17/52), and was associated with an increase in ARDS and/or MOF (12 patients [71%] vs 11 patients [31%] without ACS; P = .02, ² test) and death (6 [35%] vs 8 patients [23%] without ACS). Primary fascial closure (n = 10) at the initial laparotomy was associated with ACS in 8 (80%) (P = .001, ² test) and ARDS and/or MOF in 9 (90%) (P = .01, ² test); skin closure (n = 25), with ACS in 6 (24%) and ARDS/MOF in 9 (36%); and Bogotá bag closure (n = 17), with ACS in 3 (18%) and ARDS/MOF in 8 (47%).

Conclusions  Damage-control laparotomy is associated with frequent complications. In particular, ACS is a serious complication that increases ARDS and/or MOF and mortality. Avoiding primary fascial closure at the initial laparotomy can minimize the risk for ACS.

From the Department of Surgery, Denver Health Medical Center, Denver, Colo.

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