Current treatment of acute perforated diverticulitis: the role of damage control surgery

Zizzo, Maurizio; Manenti, Antonio; Ugoletti, Lara

doi:10.2147/jir.s177481

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Full texts were obtained and reviewed for the remaining 23 studies. 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].…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…A deeper analysis of our results, however, highlights how DCS might have represented overtreatment in good portion of ACD general population. [ 31 , 32 ] Taking into account the small number of patients with sepsis/septic shock/organ failure and the great number of Hinchey III patients, we could assume that many enrolled patients belonged to Hinchey III, being hemodynamically stable and without sepsis/septic shock at clinical presentation. [ 31 , 32 ] Therefore, we deem it possible to assume that Authors have often chosen DCS as an alternative to HP or PADS, rather than considering it as an effective measure to overcome patient's potentially lethal criticality.…”

Section: Discussionmentioning

confidence: 99%

Damage control surgery for the treatment of perforated acute colonic diverticulitis

et al. 2020

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“…Rifaximin has recently been advocated as candidate for secondary prevention of recurrent acute diverticulitis. A retrospective study of 142 patients with symptomatic disease who were treated with rifaximin noted a significant decrease in their symptoms including abdominal pain and tenderness[ 92 ]. A prospective randomized study of 165 patients, assigned to high fiber diet either with and without rifaximin, observed a 9% lower rate of recurrent diverticulitis on follow-up with addition of rifaximin[ 93 ].…”

Section: Secondary Prophylaxismentioning

confidence: 99%

Update on the management of sigmoid diverticulitis

Hanna

Kaiser

2021

WJG

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Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc . ) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.

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Current treatment of acute perforated diverticulitis: the role of damage control surgery

Cited by 6 publications

References 5 publications

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

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

Damage control surgery for the treatment of perforated acute colonic diverticulitis

Update on the management of sigmoid diverticulitis

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