Temporary rapid bowel ligation as a damage control adjunct improves survival in a hypothermic traumatic shock swine model with multiple bowel perforations

• Published in: The Journal of surgical research 2013, Vol.179 (1), p.e157-e165
• Main Authors: Wang, Pengfei, MD, Ding, Weiwei, MD, Gong, GuanWen, MD, Zhang, Wenbo, MD, Shen, Jing, Li, Yousheng, MD, Xu, Qiuping, MD, Li, Jieshou, MD
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical; Animals; Bowel ligation; Damage control surgery; Female; Gunshot; Hemodynamics - physiology; Hypothermia - etiology; Hypothermia - mortality; Hypothermia - physiopathology; Hypothermic traumatic shock; Intestinal Perforation - complications; Intestinal Perforation - etiology; Intestines - injuries; Intestines - physiopathology; Intestines - surgery; Ligation; Models, Animal; Shock, Traumatic - etiology; Shock, Traumatic - mortality; Shock, Traumatic - physiopathology; Surgery; Survival Rate; Swine; Time Factors; Water-Electrolyte Balance - physiology; Wounds, Gunshot - complications
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2012.01.035

Abstract Background Primary intestinal anastomosis is not the right choice for multiple bowel perforations under hemodynamically stable conditions. Our group has employed temporary rapid bowel ligation as a damage control procedure in a hypothermic traumatic shock swine model with multiple bowel perforations and hypothesized that damage control treatment would improve survival in the setting of a damage control surgery. Materials and methods The abdomen was shot one time with an experimental modified gun while pigs were hemorrhaged to a mean arterial pressure of 40 mm Hg and maintained in shock for 40 min. Cold lactated Ringer solution was gradually infused to induce hypothermia. Animals were randomized to control (no resuscitation), primary anastomosis (PA), or temporary rapid bowel ligation (damage control group, DC). Animals were resuscitated for 12 h with the shed blood and lactated Ringer solution. Delayed anastomosis was performed in DC animals after resuscitation. Surviving animals were humanely killed 24 h after operation. Systemic hemodynamic parameters were recorded and blood samples were obtained for biochemical assays. The lung and ileum was harvested at the end of the experiment for pathologic evaluation and test of wet/dry weight ratio, TNF-α level, and nuclear factor-κB activations. Results All animals suffered extreme physiologic conditions: hypothermia, severe acidosis, hypotension, and depressed cardiac output. Control animals suffered 100% mortality. Compared with the PA group, DC animals required less resuscitation fluid, normalized lactate levels faster, had lower serum creatine kinase, aspartate amino transferase levels and tissue TNF-α level and nuclear factor-κB activations, suffered less severe histopathology, had greater early survival. Conclusions Multiple bowel perforations under hemodynamically stable conditions seem better managed with DC than with PA. Temporary rapid bowel ligation as a damage control adjunct is important to rapid control of multiple bowel perforations instead of a prolonged operative time.