? Open abdomen techniques overused ? (Cross Posted)

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1.    Are we all applying damage control, open abdomen  techniques, etc. too

often?  I think the answer to this question is clearly yes but I'm not sure
that this is a bad thing.
2.    Are we increasing the number of enteric fistulas, use of expensive 
secondary closure meshes and devices far too often?  I'm not sure.  I think
that this relates to my earlier question about the etiology of these
fistulas.  I don't understand the physiology. Are the fistulae secondary to
ischemia?  Poor technique or other factors?

3.    Is there a need to return to a swinging back of a  pendulum?  Without
answering the above questions, I don't think that we can address this
question.

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

 
Everyone deserves to make an informed decision
                                - Errington Thompson, MD


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Saturday, September 15, 2007 1:18 PM
To: SURGINET at LISTSERV.UTORONTO.CA
Cc: trauma-list at trauma.org
Subject: ? Open abdomen techniques overused ? (Cross Posted)

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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