Outcomes of damage control surgery in perforated sigmoid diverticulitis: a comparison before and after implementing a new treatment algorithm

BACKGROUND: Non-restorative resection (NRR) is the most common procedure for perforated diverticulitis, but frequently leads to permanent stoma and morbidity related to stoma reversal. For selected patients, primary anastomosis (PRA) is another option. Damage control surgery (DCS) may be an alternative, potentially offering a greater likelihood of stoma-free discharge. We compared DCS to conventional surgical treatment in terms of stoma-free discharge and postoperative complications. METHODS: This single center trial compared patients treated before and after the introduction of a new treatment algorithm based on DCS. The prospective study group underwent surgery from 2022 to 2024, following implementation of a DCS-based treatment algorithm. The retrospective control group underwent operation from 2020 to 2022 (pre-algorithm). The primary outcome was stoma presence at 12 months. Secondary outcomes included stoma at discharge, complications, length of hospitalization, costs, and complications after stoma reversal. RESULTS: In the control group, 29/30 patients (97%) underwent NRR. In the study group, 22/26 (85%) underwent DCS, among these 4/22 (18%) required conversion to NRR, and 18/22 (82%) achieved anastomosis during the second-look. Demographics, length of hospitalization, post-operative complications, and complications after stoma reversal were similar. The control group exhibited higher rates of stoma at 12 months (37% vs. 8%, P = 0.003). Multivariate analysis revealed that treatment before the algorithm was independently associated with increased stoma presence at 12 months (Hazard ratio 10.65, P = 0.013). CONCLUSIONS: DCS appears to be a safe and effective strategy, yielding significantly lower rates of stoma at 12 months compared to conventional treatment for perforated diverticulitis.