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Damage control strategy in perforated diverticulitis with generalized peritonitis

BACKGROUND: The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann’s procedure (HP), laparoscopic lavage (LL) and damage control...

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Autores principales: Sohn, Maximilian, Agha, Ayman, Iesalnieks, Igors, Gundling, Felix, Presl, Jaroslav, Hochrein, Alfred, Tartaglia, Dario, Brillantino, Antonio, Perathoner, Alexander, Pratschke, Johann, Aigner, Felix, Ritschl, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968247/
https://www.ncbi.nlm.nih.gov/pubmed/33726727
http://dx.doi.org/10.1186/s12893-021-01130-5
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author Sohn, Maximilian
Agha, Ayman
Iesalnieks, Igors
Gundling, Felix
Presl, Jaroslav
Hochrein, Alfred
Tartaglia, Dario
Brillantino, Antonio
Perathoner, Alexander
Pratschke, Johann
Aigner, Felix
Ritschl, Paul
author_facet Sohn, Maximilian
Agha, Ayman
Iesalnieks, Igors
Gundling, Felix
Presl, Jaroslav
Hochrein, Alfred
Tartaglia, Dario
Brillantino, Antonio
Perathoner, Alexander
Pratschke, Johann
Aigner, Felix
Ritschl, Paul
author_sort Sohn, Maximilian
collection PubMed
description BACKGROUND: The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann’s procedure (HP), laparoscopic lavage (LL) and damage control surgery (DCS). This review intends to systematically analyze the current literature on DCS. METHODS: DCS consists of two stages. Emergency surgery: limited resection of the diseased colon, oral and aboral closure, lavage, vacuum-assisted abdominal closure. Second look surgery after 24–48 h: definite reconstruction with colorectal anastomosis (−/ + DI) or HP after adequate resuscitation. The review was conducted in accordance to the PRISMA-P Statement. PubMed/MEDLINE, Cochrane central register of controlled trials (CENTRAL) and EMBASE were searched using the following term: (Damage control surgery) AND (Diverticulitis OR Diverticulum OR Peritonitis). RESULTS: Eight retrospective studies including 256 patients met the inclusion criteria. No randomized trial was available. 67% of the included patients had purulent, 30% feculent peritonitis. In 3% Hinchey stage II diverticulitis was found. In 49% the Mannheim peritonitis index (MPI) was greater than 26. Colorectal anastomosis was constructed during the course of the second surgery in 73%. In 15% of the latter DI was applied. The remaining 27% received HP. Postoperative mortality was 9%, morbidity 31% respectively. The anastomotic leak rate was 13%. 55% of patients were discharged without a stoma. CONCLUSION: DCS is a safe technique for the treatment of acute perforated diverticulitis with generalized peritonitis, allowing a high rate of colorectal anastomosis and stoma-free hospital discharge in more than half of the patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-021-01130-5.
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spelling pubmed-79682472021-03-22 Damage control strategy in perforated diverticulitis with generalized peritonitis Sohn, Maximilian Agha, Ayman Iesalnieks, Igors Gundling, Felix Presl, Jaroslav Hochrein, Alfred Tartaglia, Dario Brillantino, Antonio Perathoner, Alexander Pratschke, Johann Aigner, Felix Ritschl, Paul BMC Surg Research Article BACKGROUND: The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann’s procedure (HP), laparoscopic lavage (LL) and damage control surgery (DCS). This review intends to systematically analyze the current literature on DCS. METHODS: DCS consists of two stages. Emergency surgery: limited resection of the diseased colon, oral and aboral closure, lavage, vacuum-assisted abdominal closure. Second look surgery after 24–48 h: definite reconstruction with colorectal anastomosis (−/ + DI) or HP after adequate resuscitation. The review was conducted in accordance to the PRISMA-P Statement. PubMed/MEDLINE, Cochrane central register of controlled trials (CENTRAL) and EMBASE were searched using the following term: (Damage control surgery) AND (Diverticulitis OR Diverticulum OR Peritonitis). RESULTS: Eight retrospective studies including 256 patients met the inclusion criteria. No randomized trial was available. 67% of the included patients had purulent, 30% feculent peritonitis. In 3% Hinchey stage II diverticulitis was found. In 49% the Mannheim peritonitis index (MPI) was greater than 26. Colorectal anastomosis was constructed during the course of the second surgery in 73%. In 15% of the latter DI was applied. The remaining 27% received HP. Postoperative mortality was 9%, morbidity 31% respectively. The anastomotic leak rate was 13%. 55% of patients were discharged without a stoma. CONCLUSION: DCS is a safe technique for the treatment of acute perforated diverticulitis with generalized peritonitis, allowing a high rate of colorectal anastomosis and stoma-free hospital discharge in more than half of the patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-021-01130-5. BioMed Central 2021-03-16 /pmc/articles/PMC7968247/ /pubmed/33726727 http://dx.doi.org/10.1186/s12893-021-01130-5 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Sohn, Maximilian
Agha, Ayman
Iesalnieks, Igors
Gundling, Felix
Presl, Jaroslav
Hochrein, Alfred
Tartaglia, Dario
Brillantino, Antonio
Perathoner, Alexander
Pratschke, Johann
Aigner, Felix
Ritschl, Paul
Damage control strategy in perforated diverticulitis with generalized peritonitis
title Damage control strategy in perforated diverticulitis with generalized peritonitis
title_full Damage control strategy in perforated diverticulitis with generalized peritonitis
title_fullStr Damage control strategy in perforated diverticulitis with generalized peritonitis
title_full_unstemmed Damage control strategy in perforated diverticulitis with generalized peritonitis
title_short Damage control strategy in perforated diverticulitis with generalized peritonitis
title_sort damage control strategy in perforated diverticulitis with generalized peritonitis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968247/
https://www.ncbi.nlm.nih.gov/pubmed/33726727
http://dx.doi.org/10.1186/s12893-021-01130-5
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