One-stage versus two-stage procedure for the surgical management of patients with acute mesenteric ischemia

Abstract

Damage control surgery (planned second look) is preferred by many surgeons in the management of patients with acute mesenteric ischemia (AMI) with established bowel necrosis. However, some surgeons prefer to perform primary anastomosis during the first operation, making the second look only when indicated. Herein, we compare the perioperative outcomes of the previous two approaches in AMI patients. In this prospective, randomized study, AMI was diagnosed in 74 patients who were divided into group A (one-stage approach) and group B (two-stage approach). The one-stage approach spent more operative time compared with the first step of the other approach (110 vs. 70 min, respectively). The planned second look had an average of 75 min, and intestinal resection was done in 35.14% of cases due to advancing ischemia. The incidence of leakage was higher in the one-stage group (32.43%) compared with the other (5.4%), leading to a high reoperation rate in the former. ICU stay was longer with the damage control approach. Nonetheless, no difference was detected regarding the hospitalization period. The one-stage approach was associated with a higher 30-day mortality rate (29.73 vs. 8.11% in the other group). Risk factors for mortality included shock at presentation, prolonged operative time, and postoperative leakage. The application of the damage control approach in patients with AMI is of great benefit as it is associated with low leakage rates, less need for reoperation, and less incidence of 30-day mortality compared with the one-stage approach.