Damage Control Surgery with Abdominal Vacuum and Delayed Bowel Reconstruction in Patients with Perforated Diverticulitis Hinchey III/IV

Kafka-Ritsch, Reinhold; Birkfellner, Franz; Perathoner, Alexander; Raab, H.; Nehoda, Hermann; Pratschke, Johann; Zitt, Matthias

doi:10.1007/s11605-012-1977-4

Cited by 89 publications

(79 citation statements)

References 24 publications

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“…The need for, and role of, a damage control strategy is dependent on the primary pathology and its physiological manifestations. Damage control procedures for acute diverticulitis have been reported successfully by several authors. The abdomen is typically left open to avoid abdominal compartment syndrome, and to facilitate a non‐traumatic re‐entry.…”

Section: Damage Control For Severe Abdominal Sepsismentioning

confidence: 99%

Damage control surgery for abdominal emergencies

Weber

Bendinelli

Balogh

2014

Journal of British Surgery

217

149

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Background: Damage control surgery is a management sequence initiated to reduce the risk of death in severely injured patients presenting with physiological derangement. Damage control principles have emerged as an approach in non-trauma abdominal emergencies in order to reduce mortality compared with primary definitive surgery.Methods: A PubMed/MEDLINE literature review was conducted of data available over the past decade (up to August 2013) to gain information on current understanding of damage control surgery for abdominal surgical emergencies. Future directions for research are discussed.Results: Damage control surgery facilitates a strategy for life-saving intervention for critically ill patients by abbreviated laparotomy with subsequent reoperation for delayed definitive repair after physiological resuscitation. The six-phase strategy (including damage control resuscitation in phase 0) is similar to that for severely injured patients, although non-trauma indications include shock from uncontrolled haemorrhage or sepsis. Minimal evidence exists to validate the benefit of damage control surgery in general surgical abdominal emergencies. The collective published experience over the past decade is limited to 16 studies including a total of 455 (range 3-99) patients, of which the majority are retrospective case series. However, the concept has widespread acceptance by emergency surgeons, and appears a logical extension from pathophysiological principles in trauma to haemorrhage and sepsis. The benefits of this strategy depend on careful patient selection. Damage control surgery has been performed for a wide range of indications, but most frequently for uncontrolled bleeding during elective surgery, haemorrhage from complicated gastroduodenal ulcer disease, generalized peritonitis, acute mesenteric ischaemia and other sources of intra-abdominal sepsis. Conclusion:Damage control surgery is employed in a wide range of abdominal emergencies and is an increasingly recognized life-saving tactic in emergency surgery performed on physiologically deranged patients.

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Section: Damage Control For Severe Abdominal Sepsismentioning

confidence: 99%

Damage control surgery for abdominal emergencies

Weber

Bendinelli

Balogh

2014

Journal of British Surgery

217

149

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“…DCL has also been beneficial in general surgery patients with severe abdominal sepsis, including those with diverticulitis or necrotizing pancreatitis who require serial debridement as well as those with significant blood loss [12,18-22]. Patients with mesenteric ischemia or venous occlusive disease who require staged laparotomies due to questionable bowel viability may also benefit from DCL [23].…”

Section: Reviewmentioning

confidence: 99%

Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper

et al. 2013

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Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure.

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“…In a prospective study of 51 patients with perforated diverticulitis (Hinchey III/IV), patients were initially managed with limited resection, lavage and TAC with vacuum-assisted closure followed by second, reconstructive operation 24−48 hours later [46]. Bowel continuity was restored in 38 patients, with 4 protected by a loop ileostomy.…”

Section: Abbreviated Laparotomy and Deferred Anastomosismentioning

confidence: 99%

Management of abdominal sepsis — a paradigm shift?

Leppäniemi¹,

Kimball²,

Laet³

et al. 2015

Anaesthesiol Intensive Ther

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The abdomen is the second most common source of sepsis and secondary peritonitis. The most common causes of abdominal sepsis are perforation, ischemic necrosis or penetrating injury to the abdominal viscera. Management consists of control of the infection source, restoration of gastrointestinal tract (GI) function, systemic antimicrobial therapy and support of organ function. Mortality after secondary peritonitis is still high. Excluding patient-related factors such as age or co-morbidities that can not be influenced at the time of intervention, delay to surgical intervention and inability to obtain source control are the main determinants of outcome. In patients with severe physiological derangement or difficult intraperitoneal conditions, where a prolonged operation and complete anatomical repair may not be possible or appropriate, it is becoming increasingly popular to utilize a damage control strategy with abbreviated laparotomy and planned reoperations. The main components of damage control laparotomy for secondary peritonitis are postponing the reconstruction of intestinal anastomoses to a second operation (deferred anastomosis) and leaving the abdomen open with some form of temporary abdominal closure (TAC). Advances in the management techniques of the open abdomen and new negative pressure-based TAC-devices have significantly reduced the previously observed prohibitive morbidity associated with open abdomens. These advancements have led to current fascial closure rates after TAC approaching 90%. The cornerstones of appropriate antimicrobial therapy are the timing, spectrum and dosing of antibiotics. Enteral nutrition should be started as soon as possible in hemodynamically stable patients but withheld when the patient is on a significant dose of vasopressors or whenever GI hypoperfusion is suspected. Timely source control with appropriate use of antimicrobial agents and early intensive care offers the best chance of survival for patients with abdominal sepsis. The introduction of the concept of damage control to the management of secondary peritonitis represents a paradigm shift in the same way as in management of major trauma. Although limited and repeated surgical interventions have been shown to be safe, the actual benefits need to be demonstrated in controlled studies.

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Damage Control Surgery with Abdominal Vacuum and Delayed Bowel Reconstruction in Patients with Perforated Diverticulitis Hinchey III/IV

Abstract: With this abdominal vacuum-based damage control concept, an acceptable hospital mortality rate and a high rate of bowel reconstruction at second look were achieved in patients with perforated diverticulitis and generalized peritonitis.

Cited by 89 publications

References 24 publications

Damage control surgery for abdominal emergencies

Damage control surgery for abdominal emergencies

Abdominal damage control surgery and reconstruction: world society of emergency surgery position paper

Management of abdominal sepsis — a paradigm shift?

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