Surgery — pause — more surgery: a new way to treat abdominal trauma

BY AMBER SMITH

In the past, patients who arrived at Upstate University Hospital with major abdominal trauma would go straight to the operating room, where surgeons would work for hours to repair their injuries. Already weak from blood loss and impaired organ function, such patients were not in good condition to withstand extensive surgery.

Now the strategy has changed.

Moustafa Hassan, MD

Moustafa Hassan, MD

Trauma surgeons still work swiftly to control internal bleeding and repair life-threatening tears in organs and tissues – but then they pause and send patients to the intensive care unit to be warmed, resuscitated and stabilized. The surgical opening remains open, covered by a special dressing that looks like plastic wrap.

Hours or days later, patients undergo more thorough operations to repair smaller tears and traumatic damage. This may happen multiple times before the surgical opening is finally closed.

The technique is called “damage control surgery.” Moustafa Hassan, MD, director of acute care surgery at Upstate, says it has become the standard of care among trauma surgeons who believe patients fare better with a staged approach than extensive procedures on unstable patients.

The staged approach helped save the life of Peter Corigliano, 60, who was crushed in July 2012 when a 2½-ton magnet pinned him against another piece of equipment at Rome Strip Steel where he worked as an anneal operator.

Corigliano does not remember much about the accident, which left him with a fractured pelvis and ribs, severed iliac artery and urethra, ruptured prostate, torn colon, shredded abdominal muscles and compressed nerves in his elbow.

Doctors at Upstate University Hospital kept him in a coma for almost two weeks, during which time he underwent four surgeries and recovered in the intensive care unit. As his condition improved, Corigliano began rehabilitative therapy at Upstate. He was discharged six or seven weeks after the accident.

The damage control strategy often results in the creation of a temporary hernia, which is later repaired. Hernias develop when part of an organ protrudes from the wall of the cavity where it is contained. This may happen naturally, as a result of a previous operation or through trauma caused by car wrecks or violence.

Regardless of its cause, Hassan says “the ultimate repair for the hernia is to be able to bring the patient’s muscles back together again, to give the patient the ability to function and move around, and also to reinforce the repair, usually from the undersurface, with a mesh or other strong material,” Hassan explains.

For some patients, this may be best accomplished in stages – something he says is best decided by an experienced trauma surgeon.

hloa-art2Layout 1 finalCall 315-464-1800 to reach Upstate’s Acute Care Surgery Clinic. Hear an interview with  Hassan on abdominal trauma repair from Upstate’s “HealthLink on Air.” This article appears in the spring 2016 issue of Upstate Health magazine

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