dc.contributor.author
Sohn, Maximilian
dc.contributor.author
Agha, Ayman
dc.contributor.author
Iesalnieks, Igors
dc.contributor.author
Gundling, Felix
dc.contributor.author
Presl, Jaroslav
dc.contributor.author
Hochrein, Alfred
dc.contributor.author
Tartaglia, Dario
dc.contributor.author
Brillantino, Antonio
dc.contributor.author
Perathoner, Alexander
dc.contributor.author
Pratschke, Johann
dc.contributor.author
Aigner, Felix
dc.contributor.author
Ritschl, Paul
dc.date.accessioned
2023-03-14T12:51:49Z
dc.date.available
2023-03-14T12:51:49Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/38367
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-38086
dc.description.abstract
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.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
Perforated diverticulitis
en
dc.subject
Hartmann procedure
en
dc.subject
Laparoscopic lavage
en
dc.subject
Primary anastomosis
en
dc.subject
Damage control surgery
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Damage control strategy in perforated diverticulitis with generalized peritonitis
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.articlenumber
135
dcterms.bibliographicCitation.doi
10.1186/s12893-021-01130-5
dcterms.bibliographicCitation.journaltitle
BMC Surgery
dcterms.bibliographicCitation.originalpublishername
Springer Nature
dcterms.bibliographicCitation.volume
21
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
Springer Nature DEAL
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
33726727
dcterms.isPartOf.eissn
1471-2482