Abstract Background Peritoneal resuscitation (PR) represents a unique modality of treatment for severely injured trauma patients requiring damage control surgery (DCS). These data represent the outcome of a single institution RCT into the efficacy of PR as a management option in these patients. Study Design From 2011-2015, 103 patients were enrolled in a prospective RCT evaluating the utility of PR in the treatment of patients undergoing DCS compared to conventional resuscitation (CR) alone. Patient demographics, clinical variables and outcomes were collected. Univariate and multivariate analysis was performed with a priori significance at p ≤ 0.05. Results After initial screening 52 randomized to PR group and 51 to the CR group. Age, gender, initial pH, and mechanism of injury were used for randomization. Method of abdominal closure was standardized across groups. Time to definitive abdominal closure was reduced in the PR group compared to the CR group (4.1 ± 2.2 days vs 5.9 ± 3.5 days, p ≤ 0.002). Volume of resuscitation and blood products transfused in the initial 24 hours was not different between the groups. Primary fascial closure rate was higher in the PR group (83% vs. 66%, p ≤ 0.05). Intraabdominal complications were lower in the PR compared to the CR group (8% vs 18%) with abscess formation rate (3% vs 14% , p < 0.05) being significant. Patients in the PR group had lower 30 day mortality despite similar ISS scores (13% vs 28%, p=0.06) Conclusions Peritoneal resuscitation enhances the management of DCS patients via reducing time to definitive abdominal closure, reducing intra-abdominal infections and reducing mortality.