Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Brillantino, Antonio; Andreano, Mauro; Lanza, Michele; D'Ambrosio, Vito; Fusco, Ferdinando; Antropoli, Massimo; Lucia, Antonella; Zito, Enzo Saverio; Forner, Anna Flo; Ambrosino, Francesco; Monte, Giovanni; Cricrì, Antonio Maria; Robustelli, Umberto; Masi, Alessandro De; Calce, Rosario; Ciardiello, Giovanna; Renzi, Adolfo; Castriconi, Maurizio

doi:10.1177/1553350619857561

Cited by 19 publications

(15 citation statements)

References 29 publications

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“…With DCS in IAS, anastomosis was possible in 60–70 per cent, as shown in the present study with 68 per cent of patients having an anastomosis at discharge (including 3 per cent with protective stoma and considering a mortality rate of 26 per cent). This has been described in previous studies with anastomosis rates between 62 and 83 per cent of patients in perforated diverticulitis and additional protective ileostomy in 7–29 per cent (anastomotic leak rate 5–10 per cent) 5 , 26 , 28 , 52 , 53 .…”

Section: Discussionsupporting

confidence: 70%

Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series

et al. 2021

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Background Severe intra-abdominal sepsis (IAS) is associated with high mortality and stoma rates. A two-stage approach with initial damage-control surgery (DCS) and subsequent reconstruction might decrease stoma and mortality rates but requires standardization. Methods A standardized two-stage damage-control algorithm for IAS was implemented in April 2016 and applied systematically. Results Some 203 consecutive patients (median age 70 years, 62 per cent ASA score greater than 3) had DCS for severe IAS. Median operation time was 82 minutes, 60 per cent performed during night-time. Median intraoperative noradrenaline doses were 20 (i.q.r. 26) µg/min and blood gas analysis (ABG) was abnormal (metabolic acidosis) in 90 per cent of patients. The second-stage operation allowed definitive surgery in 76 per cent of patients, 24 per cent had up to four re-DCSs until definitive surgery. The in-hospital mortality rate was 26 per cent. At hospital discharge, 65 per cent of patients were stoma free. Risk factors for in-hospital death were noradrenaline (odds ratio 4.25 (95 per cent c.i. 1.72 to 12.83)), abnormal ABG (pH: odds ratio 2.72 (1.24 to 6.65); lactate: odds ratio 6.77 (3.20 to 15.78)), male gender (odds ratio 2.40 (1.24 to 4.85)), ASA score greater than 3 (odds ratio 5.75 (2.58 to 14.68)), mesenteric ischaemia (odds ratio 3.27 (1.71 to 6.46)) and type of resection (odds ratio 2.95 (1.24 to 8.21)). Risk factors for stoma at discharge were ASA score greater than 3 (odds ratio 2.76 (95 per cent c.i. 1.38 to 5.73)), type of resection (odds ratio 30.91 (6.29 to 559.3)) and longer operation time (odds ratio 2.441 (1.22 to 5.06)). Conclusion Initial DCS followed by secondary reconstruction of bowel continuity for IAS within 48 hours in a tertiary teaching hospital was feasible and safe, following a clear algorithm.

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Section: Discussionsupporting

confidence: 70%

Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series

et al. 2021

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“…The present analysis revealed a weighted rate of the septic shock of approximately 35.1%, with substantial heterogeneity of the included studies, and 28.9% of the cases had Hinchey IV peritonitis. Only Tartaglia [35], Perathoner [37], and Deenichin [39] reported the presence of septic shock in all cases of their series, differently Brillantino et al in only 1 of 30 [36] and Sohn in 14 of 74 [34]. No patients with septic shock were reported in the series from Gasser et al [33].…”

Section: Discussionmentioning

confidence: 94%

“…One ongoing study (NCT04220840, first posted at January 7, 2020, with the title "The Damage Control Strategy for the Treatment of Perforated Diverticulitis of the Sigmoid Colon With Diffuse Peritonitis") [18] and thirteen studies were excluded based on reasons listed in the SDC 2 [19][20][21][22][23][24][25][26][27][28][29][30][31]. Nine studies were included in this systematic review and meta-analysis [32][33][34][35][36][37][38][39][40]. The NCT04220840 is an ongoing study, first posted at January 7, 2020, with the title "The Damage Control Strategy for the Treatment of Perforated Diverticulitis of the Sigmoid Colon With Diffuse Peritonitis."…”

Section: Resultsmentioning

confidence: 99%

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The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis

Cirocchi

Popivanov

Konaktchieva

et al. 2020

Int J Colorectal Dis

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Introduction Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II–IV complicated acute diverticulitis (CAD). Methods A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953). Results Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I of DCS. In those patients who underwent DCS, the most common method of temporary abdominal closure (TAC) was the negative pressure wound therapy (NPWT) (97.8%). The RPA was performed in 62.1% [95% CI 40.8 to 83.3%] and the 22.7% [95% CI 15.1 to 30.3%]: 12.8% during phase I and 87.2% during phase III. A covering ileostomy was performed in 6.9% [95% CI 1.5 to 12.2%]. In patients with RPA, the overall leak was 7.3% [95% CI 4.3 to 10.4%] and the major anastomotic leaks were 4.7% [95% CI 2.0 to 7.4%]; the rate of postoperative mortality was estimated to be 9.2% [95% CI 6.0 to 12.4%]. Conclusions The present meta-analysis revealed an approximately 62.1% weighted rate of achieving GI continuity with the DCS approach to generalized peritonitis in Hinchey III and IV with major leaks of 4.7% and overall mortality of 9.2%. Despite the promising results, we are aware of the limitations related to the significant heterogeneity of inclusion criteria. Importantly, the low rate of reported septic shock may point toward selection bias. Further studies are needed to evaluate the clinical advantages and cost-effectiveness of the DCS approach.

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“…Overall, six retrospective cohort studies and two prospective observational studies from five centers, referring to five different study cohorts, met the inclusion criteria [ 20 – 27 ] (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Damage control strategy in perforated diverticulitis with generalized peritonitis

et al. 2021

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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.

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Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease

Cited by 19 publications

References 29 publications

Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series

Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series

The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis

Damage control strategy in perforated diverticulitis with generalized peritonitis

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