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Sat Sep 15 18:17:53 BST 2007

I find myself being reflective today while between cases while on in-house  
trauma call.    We just finished a take back on a patient with an  open 
abdomen, needing a washout, and assessment for continued  therapy.   We found what 
everyone is reporting, an enteric  fistula.  We all have seen enteric fistulas 
following trauma for a  long time, and I do not know if the incidence in the 
open abdomen cases is any  less or greater than prior to temporary closure 
methods.  

More than 12 temporary closure options now exist, and each has its  champion. 
   We are increasingly training  surgeons who are more comfortable with 
laparoscopic technology, and when  faced with even a relatively straight forward 
open trauma case, are applying  damage control.   Now my questions.

1.    Are we all applying damage control, open abdomen  techniques, etc. too 
often?
2.    Are we increasing the number of enteric fistulas,  use of expensive 
secondary closure meshes and devices far too often?
3.    Is there a need to return to a swinging back of a  pendulum?

K Mattox

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? Open abdomen techniques overused ? (Cross Posted)