A patient with penetrating abdominal trauma undergoes damage control laparotomy. After packing and temporary closure, he is returned to ICU for resuscitation. In the staged approach (damage control surgery), what is the primary goal of the initial damage control laparotomy?

• A Complete repair of all visceral injuries in a single sitting
• B Primary anastomosis of bowel injuries to prevent contamination during ICU phase
• C Insertion of abdominal drains to monitor ongoing hemorrhage
• D Hemorrhage control, contamination control, and temporary abdominal closure — deferring definitive repair until physiology normalizes ✓

Explanation

Damage control surgery (DCS) involves three phases: Phase I — abbreviated laparotomy for hemorrhage control (packing, vascular shunting) and contamination control (bowel clamping without anastomosis); Phase II — ICU resuscitation targeting normothermia, correction of coagulopathy and acidosis; Phase III — planned return to theatre for definitive repair once the 'lethal triad' is corrected. Primary anastomosis in a coagulopathic, hypothermic patient carries high leak rates. The concept, based on Stone et al.'s 1983 work, was popularized by Rotondo and Schwab. DCS is indicated when the triad of acidosis (pH <7.2), hypothermia (<35°C), and coagulopathy coexist.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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