A SURGICAL technique carried out on casualties of war could significantly reduce mortality from a fatal condition called abdominal compartment syndrome (ACS), a major surgical conference in Dublin was told last weekend.
ACS is caused by a build-up of fluid in the abdomen following major trauma, severe infection or serious illness. This accumulation impairs blood flow to vital organs such as the kidneys and the brain, also putting pressure on the diaphragm, making it difficult to breathe. Left untreated, it can result in death in up to 50 per cent of cases.
One of the speakers at the conference was Col Dr Mark Bowyer, professor of surgery and chief of trauma and combat surgery at the Uniformed Services University in Maryland, US. Col Dr Bower spent six months as chief of trauma at Balad Airforce Theater Hospital in Iraq.
He explained how a relatively new surgical technique known as abdominal decompression and temporary abdominal closure had resulted in a significant reduction in the numbers of war casualties ever developing this life-threatening syndrome.
The technique involves opening the abdomen and inserting a temporary closure so that the pressure is relieved. This is kept in place for a variable period of time, usually a couple of days. The patient is then returned to the operating room and the abdomen is closed once the swelling has gone down.
He said the current practice in the battle zones of Afghanistan and Iraq was to employ “a very aggressive practice” known as “tactical damage control. The idea is to do a short, very focused operation to fix the obvious bleeding injuries and control contamination but not close the abdomen because that is where people get into problems . . . leave it open with a temporary dressing and come back in 24-48 hours to repair and close the abdomen.
“If you look at civilian injuries there is about a 15 per cent chance that very severely injured patients will develop abdominal compartment syndrome. And in those patients that develop it, the mortality could be as high as 50 per cent . . . it’s hard to tell exactly how many lives have been saved by doing this but I am certain there has been a substantial impact.”
The fourth annual World Congress of the World Society in ACS was held in Trinity College Dublin and organised by Mr Michael Sugrue, consultant surgeon at Letterkenny General Hospital and Galway University Hospital.
Mr Sugrue, a leading Irish expert in ACS, has introduced the practice of measuring and monitoring abdomen pressure in patients who may be at risk of developing the syndrome in Letterkenny hospital. While not common practice in the Republic or the UK, it is becoming the standard of care in many European countries.