Damage control laparotomy has transformed the practice of trauma and acute care surgery in the modern era.1 However, its indications and implementation remain more art than science. Although damage control laparotomy can be lifesaving for the right patient, poor patient selection and suboptimal management after the index operation can diminish the benefits of this strategy.
The timely article by Bradley et al2 clearly demonstrates that damage control laparotomy carries a significant risk. Through a large, multi-institutional effort, Bradley et al2 found that colon resection, large-volume fluid resuscitation, and an increasing number of reexplorations independently predict the development of an enteric fistula or abdominal sepsis in 111 of 517 patients (21.5%). Furthermore, these investigators2 also recently reported that severe injury (defined as having an Injury Severity Score of >15), multiple reoperations, acute renal failure, abdominal sepsis, bloodstream infection, and enteric fistula predict failure to achieve fascial closure, which, in turn, carried a significantly higher mortality rate (28.5% vs 7.7%).3