Evaluation of damage-control surgery in cases of acute mesenteric ischemia for salvaging small bowel length

Abstract

Background: In the context of acute mesenteric ischemia (AMI), the extent of bowel resection poses a surgical complexity due to the potential exacerbation of mesenteric ischemia postsurgery. Consequently, employing damage-control surgery (DCS) alongside a subsequent second-look operation presents an opportunity to effectively address the critical state of the patient and evaluate bowel viability after resuscitative measures.Objectives: Evaluate the role of DCS in salvaging small bowel segments that were doubtful during the primary operation after resection of the necrotic bowel. Assess the role of DCS in overall morbidity and mortality.Patients and Methods: A prospective cohort study conducted at Ain-Shams University Hospitals. A total of 29 patients were admitted to our department with the diagnosis of AMI and underwent DCS. Twenty-two patients were hemodynamically unstable intraoperatively, and seven patients were stable. They were evaluated regarding saving bowel length from resection and overall morbidity and mortality.Results: A total of 29 patients underwent DCS for diffuse mesenteric ischemia with ill-defined margins for gangrenous bowel; all patients passed without stump blowout, and further resection of previously query ischemic segments done in 22 (75.9%) patients, saving bowel length from resection reaching up to 18 cm. Three (10.3%) patients had anastomotic leakage that has been managed conservatively; one of them had an enterocutaneous fistula that resolved over 6 weeks.Conclusion: The DCS strategy (abbreviated laparotomy) offers significant advantages and demonstrates commendable outcomes among patients with AMI with diffuse and indistinct margins. This approach notably contributes to preserving bowel length and reducing the overall morbidity and mortality rates in affected patients.