RESUMO
Damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. In these patients the 'lethal triad' of hypothermia, acidosis, and coagulopathy is presented as a vicious cycle that often can not be interrupted and which marks the limit of the patient's ability to cope with the physiological consequences of injury. The principles of damage control have led to improved survival and to stopped bleeding until the physiologic derangement has been restored and the patient could undergo a prolong operation for definitive repair. Although morbidity is remaining high, it is acceptable if it comes in exchange for improved survival. There are five critical decision-making stages of damage control: I, patient selection and decision to perform damage control; II, operation and intraoperative reassessment of laparotomy; III, resuscitation in the intensive care unit; IV, definitive procedures after returning to the operating room; and V, abdominal wall reconstruction. The purpose of this article is to review the physiology of the components of the 'lethal triad', the indication and principles of abdominal damage control of trauma patients, the reoperation time, and the pathophysiology of abdominal compartment syndrome.
Assuntos
Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/fisiopatologia , Acidose/fisiopatologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Síndromes Compartimentais/etiologia , Tomada de Decisões , Hemorragia/fisiopatologia , Hemorragia/cirurgia , Humanos , Hipotermia/fisiopatologia , Unidades de Terapia Intensiva , Seleção de Pacientes , Complicações Pós-Operatórias , ReoperaçãoRESUMO
Liver surgery has always been associated with blood loss, and the problem of bleeding, transfusions, and associated morbidity is a significant one. We present our experience using the TissueLink radiofrequency-assisted dissector for parenchymal division during hepatectomy. The TissueLink pre-coagulates liver parenchyma and allows for dissection of intrahepatic structures, allowing for near bloodless hepatectomy. We have demonstrated our results in terms of morbidity, mortality, blood loss and need for transfusion, and find that they are comparable with results from high-volume HPB centres. The TissueLink is an acceptable tool for use in hepatic transection and may result in less blood loss and lower transfusion rates than conventional methods of transection.