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Colon Ascendens Stent Peritonitis CASP - a Standardized Model for Polymicrobial Abdominal Sepsis

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Published on: December 18, 2010

Damage control strategy in perforated diverticulitis with generalized peritonitis.

Maximilian Sohn¹, Ayman Agha¹, Igors Iesalnieks¹

¹Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.

|March 17, 2021

Summary

Damage control surgery (DCS) is a safe and effective treatment for perforated colonic diverticulitis with generalized peritonitis. This approach allows for a high rate of stoma-free discharge, offering a viable alternative to traditional methods.

Keywords:

Damage control surgery Hartmann procedure Laparoscopic lavage Perforated diverticulitis Peritonitis Primary anastomosis

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Area of Science:

Gastroenterology
Surgical Oncology
Emergency Medicine

Background:

Treatment for perforated colonic diverticulitis with generalized peritonitis remains debated.
Current strategies include resection with primary anastomosis (PRA), Hartmann's procedure (HP), laparoscopic lavage (LL), and damage control surgery (DCS).
This review systematically analyzes the literature on DCS for this condition.

Purpose of the Study:

To systematically review the current literature on the efficacy and safety of damage control surgery (DCS) for perforated colonic diverticulitis with generalized peritonitis.

Main Methods:

A systematic literature search was conducted using PRISMA-P guidelines.
Databases searched included PubMed/MEDLINE, CENTRAL, and EMBASE.
Search terms combined "Damage control surgery" with "Diverticulitis" or "Peritonitis".

Main Results:

Eight retrospective studies with 256 patients were included; no randomized trials were available.
Colorectal anastomosis was performed in 73% during the second stage, with 15% requiring diverting ileostomy (DI).
Postoperative mortality was 9%, morbidity 31%, and anastomotic leak rate 13%, with 55% discharged without a stoma.

Conclusions:

Damage control surgery (DCS) is a safe technique for acute perforated diverticulitis with generalized peritonitis.
DCS facilitates a high rate of colorectal anastomosis.
Over half of the patients treated with DCS achieve a stoma-free hospital discharge.