Approach Considerations

Direct peritoneal resuscitation (DPR) is typically performed during a laparotomy, with sterile precautions.^[29]

The stomach should be decompressed with a nasogastric or orogastric tube.

The urinary bladder should be decompressed with a Foley catheter.

The site is prepared with skin antiseptic (chlorhexidine or povidone-iodine) and then draped.

A Blake drain is placed in the left upper lateral quadrant and directed along the left pericolic gutter, around the root of the mesentery and down into the pelvis.

Direct Peritoneal Resuscitation During Damage-Control Surgery

A sterile cover is placed over the abdominal contents but under the fascia.

Next, a sterile operating room towel is placed over this cover, and another drain is put within this towel.

Next, the entire abdomen is covered with an occlusive dressing.

Next, DPR solution is instilled into the left-upper-quadrant drain, initially with a 500-mL bolus followed by 1.5 mL/kg/hr until definitive abdominal closure is achieved.

The towel drain is placed to low pressure suction, resulting in a continuous lavage within the abdomen.

Intravenous blood and crystalloid resuscitation is continued at the surgeon’s discretion.

Complications

The following are potential complications of DPR:

Enterocutaneous fistula
Local or systemic infection, peritonitis
Visceral injury
Bowel perforation
Ileus
Hydrothorax
Hernia
Hematoma
Internal bleeding

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