Does damage control surgery for abdominal trauma have a real impact on survival benefit in major trauma patients? A systematic review of literature with meta-analysis

Background: Trauma remains a principal cause of mortality across all age groups, particularly in cases of major abdominal trauma and hemorrhage, which can lead to the 'lethal triad' of coagulopathy, metabolic acidosis, and hypothermia. This systematic review explores the efficacy of Damage Control Laparotomy (DCL) compared to definitive surgery (DEF) in major abdominal trauma. Methods: A systematic literature search following PRISMA and MOOSE guidelines was conducted across Medline, Cochrane Library, and Embase databases. Results: Seven studies were found, including one randomized controlled trial (RCT) and six observational studies (OS). Mortality rates varied, with one observational study indicating higher 24-h mortality in the DCS group (OR 1.49, 95% CI 0.48, 4.68, I2 = 86%), while the RCT showed a significantly lower 30-day mortality rate (OR 0.05 (95% CI 0.00, 0.99 P = 0.010). Notably, major complications did not differ significantly between the two approaches (RCT OR 0.75, 95% CI 0.20, 2.77; OS OR 0.75, 95% CI 0.20, 2.77). The overall certainty of evidence was rated low, reflecting heterogeneous outcomes and inconsistent reporting. Conclusion: Although DCS is frequently utilized in trauma care, its superiority over definitive surgery remains unestablished, with ethical considerations complicating randomized trials. This review suggests that while DCS may be beneficial under specific conditions, robust multicentric studies are essential to clarify its impact on mortality and health outcomes compared to conventional surgery in abdominal trauma.