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摘要

We appreciate Dr Misery's letter and comments. The point about the role of damage control in critically injured patients is well taken. Damage control was indeed performed with packing of the abdomen and temporary abdominal wall closure. Reconstruction of the pancreas and common bile duct at this stage is a judgment call, and there are advantages and disadvantages to delayed reconstruction. I personally prefer to do the reconstruction at the acute stage, if it can be done expeditiously. The pancreatic anastomosis becomes much more difficult 24 to 48 hours after the initial operation because of excessive edema, necrosis, and fragile tissues. Also,'I prefer to establish continuity of the bowel in all patients with damage control, because stapling off of the bowel results in complete obstruction, dilation, and aggravation of the already compromised blood supply. We have seen proximal bowel necrosis of the small bowel after distal stapling.