Role of Damage Control Surgery in Perforated Diverticulitis Management: A Systematic Review

Perforated diverticulitis is a critical surgical emergency that demands immediate attention and intervention. Damage control surgery (DCS) has emerged as an alternative to traditional approaches for managing physiologically unstable and critically ill patients. This systematic review includes 16 articles published between 2015 and 2025, covering randomized controlled trials, observational cohorts, case reports, and guidelines. The inclusion and exclusion criteria focused on human studies published in English that addressed managing perforated diverticulitis with DCS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used to guide article selection, which was further refined using standardized appraisal tools such as A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), the Newcastle-Ottawa Scale (NOS), Joanna Briggs Institute Checklists (JBI), the Cochrane Risk of Bias (RoB) tool, the Appraisal of Guidelines for Research and Evaluation II (AGREE II), and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). This review highlights DCS as an effective approach for managing perforated diverticulitis. Patient management with DCS showed significant improvement compared to traditional methods such as Hartmann's procedure. Physiological stabilization reduced complications such as stoma formation and improved anastomosis rates, as supported by the included studies. The findings suggest that DCS reduces morbidity and mortality, lowers the need for a stoma, and enhances bowel continuity in patients with perforated diverticulitis. Several studies also employed negative pressure therapy for temporary abdominal closure. The main prognostic factors identified were ongoing peritonitis and hemodynamic instability, which characterize critically ill patients. These findings underscore the importance of prioritizing patient stability and controlling disease severity at the outset, before proceeding to definitive therapy once the patient is stable. Further high-quality, multicenter studies with larger sample sizes are needed to develop standardized treatment guidelines.