Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-07-22

AUTHORS

M. Sohn, A. Agha, W. Heitland, F. Gundling, P. Steiner, I. Iesalnieks

ABSTRACT

BackgroundThe best surgical strategy for the management of perforated diverticulitis with generalized peritonitis of the sigmoid colon is not clearly defined. The aim of this retrospective cohort study was to evaluate the value of a damage control strategy. MethodsAll patients who underwent emergency laparotomy for perforated diverticular disease of the sigmoid colon with generalized peritonitis between 2010 and 2015 were included. The damage control strategy (study group), included a two- stage procedure: limited resection of the diseased colonic segment, closure of proximal colon and distal stump, and application of an abdominal vacuum at the initial surgery followed by second-look laparotomy 24–48 h later At this point a choice was made between anastomosis and Hartmann’s procedure. The control group consisted of patients receiving definitive reconstruction (anastomosis or Hartmann’s procedure) at the initial operation. ResultsThirty-seven patients were included in the study. Damage control strategy was applied in 19 patients and the control group consisted of 18 patients. Both groups were comparable in terms of demographics, severity of peritonitis, and comorbidities. The overall postoperative mortality was 11 % (n = 4). There were no statistically significant differences between both groups regarding postoperative morbidity and mortality; however, a significantly higher proportion of patients in the control group had a stoma after the initial hospital stay (83 vs. 47 %, p = 0.038). This difference was still significant after adjustment for sex, age, Mannheim Peritonitis Index, American Society of Anesthesiologists class and presence of septic shock at presentation. At the end of the follow-up period, 15 of 17 survivors in the study group and 13 of 16 survivors in the control group had their intestinal continuity restored (p = 0.66).ConclusionsDamage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate after the initial hospital stay without an increased risk of postoperative morbidity. More... »

PAGES

577-583

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10151-016-1506-7

DOI

http://dx.doi.org/10.1007/s10151-016-1506-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1029277978

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27448296


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105 reconstruction
106 resection
107 retrospective cohort study
108 risk
109 segments
110 septic shock
111 severity
112 severity of peritonitis
113 sex
114 shock
115 sigmoid colon
116 significant differences
117 society
118 stay
119 stoma rate
120 stomata
121 strategies
122 study
123 study group
124 stump
125 surgery
126 surgical strategy
127 survivors
128 terms
129 terms of demographics
130 treatment
131 two-stage procedure
132 vacuum
133 values
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