Damage control surgery for perforated diverticulitis with diffuse peritonitis: saves lives and reduces ostomy

Area of Science:

• Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Damage control surgery (DCS) is increasingly used for abdominal infections and sepsis.
• The role of DCS in acute perforated diverticulitis remains debated.
• This study evaluates DCS outcomes in severe perforated diverticulitis (Hinchey's grade III and IV).

Purpose of the Study:

• To assess the feasibility and outcomes of DCS for Hinchey's grade III and IV perforated diverticulitis.
• To evaluate mortality, morbidity, and bowel continuity restoration rates.
• To identify factors influencing the choice between bowel reconstruction and colostomy.

Main Methods:

• Multi-institutional retrospective study of 34 patients (2011-2017).
• Patients underwent limited resection, lavage, and negative pressure wound therapy (NPWT).
• Second-look laparotomy after 24-48 hours for resuscitation and further management.

Main Results:

• Mean age 66.9 years; 62% Hinchey's stage IV.
• 71% achieved bowel continuity restoration; 29% had Hartmann's procedure.
• Mortality rate was 12%; mean hospital stay was 21.9 days. Male gender and higher MPI correlated with Hartmann's procedure.

Conclusions:

• DCS is a feasible approach for generalized peritonitis from perforated diverticulitis.
• DCS is associated with a higher rate of successful bowel reconstruction.
• Intensive care and mechanical ventilation are often necessary post-DCS for these critically ill patients.