Features of abdominal surgery in combat injuries, our experience

Abstract

The research was carried out in the hospital of the qualified surgical aid stage, where the patients were transferred immediately after receiving first aid from the battlefield. Immediately after admission, all the patients were examined by triage specialists, respiratory and hemodynamic indicators were evaluated according to accepted standards. Most of the injuries were combined polytraumas with severe hemorrhagic shock. All the injured patients were urgently operated. In first group patients who had isolated injuries or combined injuries, but relatively stable hemodynamic parameters, a volume of interventions was performed, which does not require relaparotomy (definitive surgery). Second group patients had combined severe injuries; hemodynamic indicators were unstable. The surgical approach was in accordance with the principle of “damage control”. The organization of work in the mentioned way made it possible to provide qualified medical care without interruption and on time, depending on the flow intensity of patients and the volume of available resources. For the next stages of medical evacuation, the strategy we chose was understandable, due to which it was possible to avoid additional double surgical aggression in case of first group patients, only by applying the “relaparotomy on demand” principle. In case of second group patients, in some cases, it was possible to postpone the “programmed relaparotomy” and to carry it out in more favorable conditions for the patient. In all cases, when providing qualified surgical care, it should always be taken into account that the intervention performed in this stage should be predictable for the surgeons working at next stage, that is they should understand what principle we have applied, so that they can continue the treatment with the same principle.