title: Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV.
abstract: OBJECTIVE
  With the use of abdominal vacuum therapy, we have developed a damage control concept for patients with perforated diverticulitis and generalized peritonitis. The primary aim of this concept was to enhance recovery and allow bowel reconstruction in a second-look operation.
  
  
  METHODS
  A total of 51 patients (28 female, 55%) with a median (range) age of 69 (28-87) years, with perforated diverticulitis Hinchey III (n = 40, 78%) or Hinchey IV (n = 11, 22%) and a median (range) Mannheim peritonitis index of 26 (12-39), admitted between October 2006 and September 2011, were prospectively enrolled in the study. At initial operation, limited resection of the diseased segment, lavage, and application of abdominal vacuum-assisted closure dressing was performed. After patient resuscitation, a second look was performed in an elective setting.
  
  
  RESULTS
  Hospital mortality rate was 9.8%; 35 (76%) of patients were discharged with reconstructed colon, and 93% of patients live without a stoma at follow-up. Risk factors for mortality were American Society of Anesthesiologist score (p = 0.01), organ failure at initial presentation (p = 0.03), cardiac comorbidity (p = 0.05), and a Hartmann procedure at second look (p = 0.00).
  
  
  CONCLUSIONS
  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.
authors: Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. reinhold.kafka-ritsch@uki.at
authors: Reinhold
authors: R
authors: Kafka-Ritsch
authors: Franz
authors: F
authors: Birkfellner
authors: Alexander
authors: A
authors: Perathoner
authors: Helmut
authors: H
authors: Raab
authors: Hermann
authors: H
authors: Nehoda
authors: Johann
authors: J
authors: Pratschke
authors: Matthias
authors: M
authors: Zitt
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D024162:Second-Look Surgery; D016896:Treatment Outcome