Place et technique de la laparotomie écourtée (LAPEC) ou « damage control laparotomy »

Abbreviated laparotomy is aimed at the most severely injuried patients whose condition requires an immediate surgical operation but in whom lengthening of the procedure would worsen physiological impairments and metabolic failure. Indeed, in most severely injuried patients, blood losses and tissue injuries enable the setting of a “bloody vicious circle” started by an acidosis-hypothermia-coagulopathy triad. This surgical strategy sacrifices the completeness of the operation in favour of an action guided by a physiologic approach, with a preference to rapidity and limited to control of injuries. It takes place in a sequential management that associates the shortest preoperative intensive resuscitation to a surgical step limited to injuries control (stop the bleeding and contamination control) without definitive repair. The latter will be ensured during a scheduled reoperation after a period of resuscitation aimed to correct physiological abnormalities induced by trauma and its treatment. This strategy necessitates a predefined plan and involvement of all medical and nurse staff to reduce at most loss of time.