Protocol for Bedside Laparotomy in Trauma and Emergency General Surgery: A Low Return to the Operating Room

Diaz Jr., Jose J.; Mejia, Vicente; Subhawong, Andrea Proctor; Subhawong, Ty; Miller, Richard S.; O'Neill, Patrick J.; Morris Jr., John A.
November 2005
American Surgeon;Nov/2005, Vol. 71 Issue 11, p986
Academic Journal
Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002 to June 2003 and retrospectively reviewed. Protocol indications for BSL were abdominal compartment syndrome, decompensation due to hemorrhage, washout/closure, and sepsis in a patient too unstable for safe transport to the OR. Primary outcomes were mortality, emergent return to OR, and primary fascial closure (PFC). Trauma operating room charges and OR time were analyzed. One hundred thirty-three BSL were performed on 60 patients with an overall mortality of 23.3 per cent (14/60). There was an average of 2.2 BSL per patient (range 1-8). Indications for BSL were 1) explore/washout (n = 100, 75.2%), 2) decompression (n = 14, 10.5%), 3) infection/abscess (n = 12, 9.0%), 4) hemorrhage (n = 7, 5.3%). Five of 133 BSL (5.8%) were emergently returned to the OR because of perforation or compromised bowel. Trauma OR charges were $5,300 per cases with 2.12 hours per cases. The protocol standardized the conduct of BSL procedure to allow for a low return to OR rate of 5.8 per cent and had an overall in-hospital mortality rate of 23.3 per cent. Primary fascial closure of the abdomen had a significantly reduced hospital stay. BSL allowed trauma OR charges of $5,300 per cases with 2.12 hours per cases savings.


Related Articles

  • Aortic Occlusion Balloon Catheter Technique Is Useful for Uncontrollable Massive Intraabdominal Bleeding After Hepato-Pancreato-Biliary Surgery Miura, Fumihiko; Takada, Tadahiro; Ochiai, Takenori; Asano, Takehide; Kenmochi, Takashi; Amano, Hodaka; Yoshida, Masahiro // Journal of Gastrointestinal Surgery;Apr2006, Vol. 10 Issue 4, p519 

    Massive intraabdominal hemorrhage sometimes requires urgent hemostatic surgical intervention. In such cases, its rapid stabilization is crucial to reestablish a general hemodynamic status. We used an aortic occlusion balloon catheter in patients with massive intraabdominal hemorrhage occurring...

  • Clinical Experiences of Transarterial Embolization after Abdominal Surgery in Trauma Patients. Min Jung Hwang; Ho Kyun Lee; Soo Jin Na Choi; Sang Young Chung // Korean Journal of Vascular & Endovascular Surgery;Nov2012, Vol. 28 Issue 4, p196 

    Purpose: Transarterial embolization has been known as an effective nonsurgical treatment for selected patients with intraabdominal hemorrhage. This study was conducted to evaluate the clinical outcomes of transarterial embolization after emergency operation in the blunt abdominal trauma patients...

  • Angioembolization and laparotomy for patients with concomitant pelvic arterial hemorrhage and blunt abdominal trauma. Jen-Feng Fang; Lih-Yuann Shih; Yon-Cheong Wong; Being-Chuan Lin; Yu-Pao Hsu // Langenbeck's Archives of Surgery;Feb2011, Vol. 396 Issue 2, p243 

    Background: Treatment of patients with concomitant pelvic arterial hemorrhage and blunt abdominal trauma (BAT) is challenging. Controversies remain over the diagnostic approach and the priority of available treatment resources. Methods: Between 1999 and 2008, 545 patients were admitted due to...

  • Hepatic artery embolization for postoperative hemorrhage in upper abdominal surgery. Miyamoto, N.; Kodama, Y.; Endo, H.; Shimizu, T.; Miyasaka, K. // Abdominal Imaging;May/Jun2003, Vol. 28 Issue 3, p0347 

    Background: The purpose of this study was to evaluate angiographic findings and radiologic and clinical results of transcatheter arterial embolization (TAE) of the hepatic artery for hemorrhage after upper abdominal surgery. Methods: Ten patients (nine male, one female, mean age = 63.5 years)...

  • Hyperacute Abdominal Compartment Syndrome: An Unrecognized Complication of Massive Intraoperative Resuscitation for Extra-abdominal Injuries. Rodas, Edgar B.; Malhotra, Ajai K.; Chhitwal, Reena; Aboutanos, Michel B.; Duane, Therese M.; Ivatury, Rao R. // American Surgeon;Nov/2005, Vol. 71 Issue 11, p977 

    Primary and secondary abdominal compartment syndrome (ACS) are well-recognized entities after trauma. The current study describes a "hyperacute" form of secondary ACS (HACS) that develops intraoperativety while repair of extra-abdominal injuries is being carried out simultaneous with massive...

  • Popliteal Artery Injuries. Reyes, David C. // Vascular Surgery;May/Jun1983, Vol. 17 Issue 3, p189 

    It is unfortunate but true that in a world of wars, high speed travel and civilian violence, the repair of major injuries to the vascular system has become an important part of the surgeon's work. At present, injuries of the popliteal artery have the highest amputation rate of all injuries to...

  • Management options in blunt aortic injury: a case series and literature review. Simeone, Alan; Freitas, Marilee; Frankel, Heidi L. // American Surgeon;Jan2006, Vol. 72 Issue 1, p25 

    Blunt aortic injury (BAI) is a devastating consequence of high-energy trauma. The majority of its victims do not survive; those who do generally have significant associated injury. The standard treatment of BAI has been emergent replacement or repair of the damaged aorta via a posterolateral...

  • Spontaneous cerebellar hemorrhage-experience with 57 surgically treated patients and review of the literature. Dammann, Philipp; Asgari, Siamak; Bassiouni, Hischam; Gasser, Thomas; Panagiotopoulos, Vassilis; Gizewski, Elke R.; Stolke, Dietmar; Sure, Ulrich; Sandalcioglu, I. Erol // Neurosurgical Review;Jan2011, Vol. 34 Issue 1, p77 

    The treatment of spontaneous cerebellar hemorrhage is still discussed controversially. We analyzed a series of 57 patients who underwent surgical evacuation of a cerebellar hematoma at our department. Preoperative clinical and radiological parameters were assessed and correlated with the...

  • Cerebellar mutism after spontaneous intratumoral bleeding involving the upper cerebellar vermis: a contribution to the physiopathogenic interpretation. Frassanito, Paolo; Massimi, Luca; Caldarelli, Massimo; Di Rocco, Concezio // Child's Nervous System;Jan2009, Vol. 25 Issue 1, p7 

    Transient mutism as a consequence of posterior fossa surgery is a well-known phenomenon. However, it has rarely been reported after focal nonsurgically induced cerebellar damage. We describe a 7-year-old child affected by a tumor arising from the quadrigeminal plate who developed transient...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics