STAR (Stage abdominal Repair) or
DC&R (Damage Control and Repair)
EXAMPLE CASE: From Abdominal compartment syndrome to final skin closure in 7 days.
The case below demonstrates nicely the power of the method and strategy of Staged Abdominal Repair or Damage Control & Repair to solve desolate cases. The patient came together with his surgeon with a septic abdomen 7 weeks after a missed appendix operation. The surgeon was seeking help because she could not close the abdomen anymore and sutured a Vicryl© mesh into the midline wound and the appendectomy wound. At STAR # 1 entry the bowl looked very inflammatory and edematous cause by a missed huge sub hepatic abscess with the lesser sack which we evacuated. After copious irrigation with R/L we closed using the artificial bur fascia prosthesis and hypopack (not shown here). Subsequent pictures show the healing process during reduction of the inflammatory edema, the technique of opening and closing the bur fascia prosthesis, its trimming to adjust to the narrower opening and, final closure after seven abdominal entries. Note that at final fascial closure a little more tension goes unpunished in the inflammatory tissue with its established local defense as opposed to a normal one time laparotomy with its defenseless virgin tissue. On post STAR day # 1 I discontinued antibiotics, on post Star day #5 there was a bowl movement and on Post STAR day # 6 the patient was discharged. I saw him one year later without evidence of a hernia or other abdominal discomfort.
Damage Control $ Repair DC&R (also known as "staged abdominal
repair (STAR)") is one operation consisting of multiple abdominal
entries planned either before or during the first (index) DC&R
which are performed every 24-48 hours until final fascial closure
is accomplished. The operatice tactic includes: Closing the abdomen
with a dynamic fascial expander prosthesis (Fascia Prosthesis);
Preventing fascial retraction; Controlling intra-abdominal
pressure; Reversing pulmonary, renal, CV, hepatic and intestinal
dysfunction / pathology; Fascial closure after the last abdominal
Although a laparotomy or single abdominal entry is routine for the general surgeon, multiple sequential abdominal entries require more attention to detail with respect to timing, infrastructure & operative manipulations such resections & excisions as well as suturing leaks & anastomoses.
Diffuse peritonitis from anastomotic leaks.
The patient is a 69 year old man with a history of morbid obesity (107kg, 172cm), hypertension and ischemic heart disease who had previously undergone two operations for diverticulitis: read more (Link)
Treated by Dietmar Wittmann, MD, PhD, FACS<
Missed appendix perforation and severe abdominal compartment syndrome
This 13 year old boy had an appendectomy 9 days after onset of symptoms, because his condition was misdiagnosed as influenza. Ten days after resection of the perforated appendix, peritonitis persisted and abdominal re-explorations through a midline incision for multiple intra-abdominal abscesses became necessary. read miore (link)
Treated by Dietmar Wittmann, MD, PhD, FACS