Outcomes of Damage Control Laparotomy in Resource-Limited Settings: A Systematic Review and Meta-analysis

Background Damage control laparotomy (DCL) is an established life-saving strategy for patients with severe abdominal trauma or profound physiological derangement. The majority of evidence supporting its use originates from high-income, well-resourced trauma systems. In contrast, the effectiveness, feasibility, and complications of DCL in resource-limited settings (RLS), including low- and middle-income countries (LMICs) and hospitals with constrained intensive care capacity, have not been comprehensively synthesized [1, 2]. Methods This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. The study protocol was prospectively registered in PROSPERO (CRD420261282585). We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL from inception to 10 January 2026, supplemented by grey-literature searches. Eligible studies reported clinical outcomes of DCL or open-abdomen management performed in resource-limited hospitals. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-I or RoB 2.0, as appropriate. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) length of stay, hospital length of stay, definitive fascial closure, entero-atmospheric fistula (EAF), surgical site infection, ventilator days, and re-operation rates. Random-effects meta-analyses were planned where data permitted [2, 3, 4]. Results The available literature from RLS was heterogeneous and predominantly comprised retrospective single-centre cohorts and case series from tertiary hospitals in LMICs. Reported in-hospital mortality following damage control laparotomy ranged from approximately 29% to 55%, reflecting substantial heterogeneity in patient severity, injury mechanism, and institutional capacity. Physiological derangement on admission, high injury severity scores, major vascular injury, and large transfusion requirements were consistently associated with worse outcomes. Temporary abdominal closure techniques varied according to resource availability, most commonly including the Bogotá bag, improvised vacuum systems, and, where available, commercial negative-pressure wound therapy. Primary fascial closure and complication rates differed substantially between studies. Quantitative pooling was limited by inconsistent outcome definitions and incomplete reporting in several series [2, 5, 6]. Conclusion Damage control laparotomy is widely practiced in resource-limited settings and can be life-saving when supported by adequate resuscitation and critical care resources. However, outcomes remain highly variable and strongly dependent on physiological status at presentation and institutional capacity. Standardised outcome reporting and prospective, multicentre data from RLS are urgently needed to generate more reliable pooled estimates and to guide context-appropriate practice [3, 7].