title: Role of damage control surgery in the treatment of Hinchey III and IV sigmoid diverticulitis: a tailored strategy.
abstract: Many of the treatment strategies for sigmoid diverticulitis are actually focusing on nonoperative and minimally invasive approaches. The aim of this systematic review was to evaluate the actual role of damage control surgery (DCS) in the treatment of generalized peritonitis caused by perforated sigmoid diverticulitis.A literature search was performed in PubMed and Google Scholar for articles published from 1960 to July 2013. Comparative and noncomparative studies that included patients who underwent DCS for complicated diverticulitis were considered.Acute Physiology and Chronic Health Evaluation score, duration of open abdomen, intensive care unit length of stay, reoperation, bowel resection performed at first operation, fecal diversion, method, and timing of closure of abdominal wall were the main outcomes of interest.According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm for the literature search and review, 10 studies were included in this systematic review. DCS was exclusively performed in diverticulitis patients with septic shock or requiring vasopressors intraoperatively. Two surgical different approaches were highlighted: limited resection of the diseased colonic segment with or without stoma or reconstruction in situ, and laparoscopic washing and drainage without colonic resection.Despite the heterogeneity of patient groups, clinical settings, and interventions included in this review, DCS appears to be a promising strategy for the treatment of Hinchey III and IV diverticulitis, complicated by septic shock. A tailored approach to each patient seems to be appropriate.
authors.affiliation: From the Department of Digestive Surgery (RC, JD, ST, AP), St. Maria Hospital, University of Perugia, Terni; Department of Surgical Sciences (AA), University of Turin, Turin; Laparoscopic Surgical Unit (NV), M. Mellini Hospital, Chiari; Department of Surgical Oncology (DC), Forlì; Department of HPB and Digestive Surgery (EF), Ospedale Mauriziano Umberto I, Turin; Department of General and Oncologic Surgery (CR, GC, FB), University of Perugia, Perugia; Department of Mininvasive and Robotic Surgery (FF), St. Maria Hospital, University of Perugia, Terni, Italy; Athens First Department of Surgery (Prof Leandros) (AF), Hippokration University Hospital, University of Athens, Athens, Greece; and Section for Surgical Research (Prof Uranues) (AF), Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.forename: Nereo
authors.initials: N
authors.lastname: Vettoretto
authors.forename: Davide
authors.initials: D
authors.lastname: Cavaliere
authors.forename: Eriberto
authors.initials: E
authors.lastname: Farinella
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.forename: Gaspare
authors.initials: G
authors.lastname: Cannata
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Federico
authors.initials: F
authors.lastname: Farinacci
authors.forename: Francesco
authors.initials: F
authors.lastname: Barberini
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D018806:APACHE; D000208:Acute Disease; D012809:Colon, Sigmoid; D004238:Diverticulitis / Q000150:complications*; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications*; D007902:Length of Stay; D010538:Peritonitis / Q000209:etiology* / Q000601:surgery*; D013997:Time Factors