Damage Control Surgery Beyond Trauma: Current Evidence, Expanding Indications, and Clinical Outcomes in Emergency General Surgery

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Abstract
Damage control surgery (DCS) has evolved from a trauma-focused strategy into an essential component of modern emergency general surgery for selected patients with non-traumatic abdominal emergencies. This review aimed to analyze the current scientific evidence regarding the expanding indications, physiological rationale, perioperative management, and clinical outcomes associated with DCS in conditions such as abdominal sepsis, acute mesenteric ischemia, severe acute pancreatitis, massive gastrointestinal hemorrhage, abdominal compartment syndrome, and vascular emergencies. A structured narrative literature review was conducted using the scientific method. Relevant publications were identified through PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, prioritizing systematic reviews, meta-analyses, clinical guidelines, international consensus statements, and high-quality observational studies. The reviewed evidence demonstrated that DCS is primarily indicated in patients with profound physiological instability characterized by hemodynamic compromise, metabolic acidosis, coagulopathy, hypothermia, severe intra-abdominal contamination, or uncertain bowel viability. Across the analyzed studies, the staged approach consisting of abbreviated surgery, temporary abdominal closure when required, intensive care resuscitation, planned re-exploration, and delayed definitive reconstruction was consistently associated with improved physiological recovery in carefully selected patients. However, postoperative complications including surgical-site infection, respiratory dysfunction, ventral hernia, and enteroatmospheric fistula remain important challenges requiring multidisciplinary management. Although current evidence supports the expanding role of DCS in non-traumatic emergencies, additional prospective multicenter studies are needed to standardize patient selection criteria and optimize clinical protocols. Overall, damage control surgery represents a physiology-guided strategy that has broadened therapeutic possibilities in emergency abdominal surgery while emphasizing individualized clinical decision-making and coordinated multidisciplinary care.