IntroductionDamage control laparotomy (DCL) has been a major advance in modern trauma care. The principles of damage control which include truncation of operation to correct acidosis, hypothermia, and coagulopathy with subsequent planned definitive repair are applicable in managing patients undergoing abdominal operations. In order to define indications, technique, and outcome we undertook a retrospective review and analysis of pancreatic surgery patients in whom DCL was utilized.MethodsIn a cohort of 835 patients who underwent elective pancreatic operations at the Medical University of South Carolina from 2001-2007, 8 patients were identified who required DCL. Under Institutional Review Board approval records were reviewed to define intraoperative blood loss, acidosis, hypothermia, coagulopathy, operative techniques, timing of definitive operation, and hospital outcome.ResultsThere were 5 men and 3 women with a mean age of 51 years. The diagnosis was chronic pancreatitis in 7 patients and cancer in 1. The index operation was pancreatoduodenectomy in 5 patients and distal pancreatectomy in 3. In 4 patients undergoing elective pancreatic resection intraoperative portal vein hemorrhage initiated damage control laparotomy. Four patients had damage control utilized at re-operation for abdominal sepsis (2) and hemorrhage (2). DCL techniques included external tube drainage (8), abdominal packing (7), staple closure of open bowel (4), and rapid abdominal closure (4). Operative blood loss ranged from 300 to 12,000 cc. Operative transfusions ranged from 0 to 44 units of packed red cells. Intraoperative INR was greater than 1.5 in 4 patients, pH ranged from 7.08 to 7.45, and temperature ranged from 34.8 to 38.8 degrees centigrade. Laparotomy for pack removal and intestinal reconstruction was undertaken 1 to 7 days after DCL. Length of hospital stay ranged from 7 to 80 days. Hospital mortality was zero.ConclusionPatients with exsanguinating hemorrhage and severe sepsis related to pancreatic surgery can be successfully managed with principles of DCL. Truncation of operation with abdominal packing, bowel closure, external drainage of bile and pancreatic ducts, rapid abdominal closure with planned subsequent completion laparotomy should be considered in pancreatic operations when patients risk intraoperative acidosis, hypothermia and coagulopathy due to sepsis or hemorrhage.