J.Jpn. Surg. Soc.. 120(3): 297-303, 2019

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Feature topic

DAMAGE CONTROL SURGERY

Damage control surgery (DCS) is an “urgent evacuative surgery” that controls hemorrhage and limits further contamination from gastrointestinal injury in a short time. What is required of the surgeon is how to quickly complete DCS while making full use of hemostatic techniques such as packing, vascular clamping, and suturing. The introduction and popularization of this concept have dramatically decreased the mortality rate of severe trauma patients. The three well-known criteria for DCS implementation are hypothermia of ＜34℃, metabolic acidosis of pH ＜7.2, and bleeding tendency of PT/APTT ＞1.5 INR, but when these three criteria are met, patients are often already in a state of unrecoverable coagulopathy. Therefore, performing DCS before the failure of the coagulation function has been recommended, although complications due to early DCS decisions have recently been reported and reexamination of excessive application has begun. Currently, a randomized, controlled, prospective trial is being conducted, and there is no doubt that there will be strong interest in the results. Even in such a situation, the secret of DCS, which is “once withdrawing and stabilizing the patient’s condition, then going back on the offensive again,” is universally understood as a treatment strategy for trauma surgery. The “courage to withdraw” is the key point in successful DCS.

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