Techniques in Coloproctology

, Volume 22, Issue 7, pp 565–566 | Cite as

Authors reply: Damage control surgery in patients with generalized peritonitis secondary to perforated diverticulitis—the risk of overtreatment

  • M. SohnEmail author
  • I. Iesalnieks
Author’s Reply

Dear Sir,

We highly appreciate the comments by Zizzo and his coworkers. Two years after publishing our study in Techniques of Coloproctology, we can share some additional experience in using damage control surgery (DCS) in patients with perforated diverticulitis. In 2018, we published a retrospective multicenter study evaluating safety and feasibility of the method [1, 2]. In this retrospective analysis, 58 consecutive patients had DCS for perforated diverticular disease, complicated by generalized peritonitis at four surgical centers. At the end of the hospital stay, 29 patients (50%) were free of stoma. The overall morbidity rate was 34%. Six patients(10.3%) developed anastomotic leak. The mortality rate was 9%. At the end of the follow-up, 83% of all patients had their intestinal continuity restored. Thus, we were able to confirm the results of our previous study. At all the four centers in this study, DCS was used in all patients with generalized purulent and feculent peritonitis...


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Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sohn MA, Agha A, Steiner P, Hochrein A, Komm M, Ruppert R et al (2018) Damage control surgery in perforated diverticulitis: ongoing peritonitis at second surgery predicts a worse outcome. Int J Colorectal Dis. Mar 13Google Scholar
  2. 2.
    Sohn M, Iesalnieks I, Agha A, Steiner P, Hochrein A, Pratschke J et al (2018) Perforated diverticulitis with generalized peritonitis: low stoma rate using a “Damage Control Strategy.” World J Surg 1–7Google Scholar
  3. 3.
    Galetin T, Galetin A, Vestweber K-H, Rink AD (2018 Mar) Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis 33(3):261–272. CrossRefPubMedGoogle Scholar
  4. 4.
    Cirocchi R, Afshar S, Shaban F, Nascimbeni R, Vettoretto N, Di Saverio S, Randolph J, Zago M, Chiarugi M, Binda GA (2018) Perforated sigmoid diverticulitis: Hartmann’s procedure or resection with primary anastomosis—a systematic review and meta-analysis of randomised control trials. Tech Coloproctol. PubMedCrossRefGoogle Scholar
  5. 5.
    Gachabayov M, Oberkofler CE, Tuech JJ, Hahnloser D, Bergamaschi R (2018) Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Colorectal Dis. CrossRefPubMedGoogle Scholar
  6. 6.
    Binda GA, Karas JR, Serventi A, Sokmen S, Amato A, Hydo L et al (2012) Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial. Colorectal Dis 14(11):1403–1410CrossRefPubMedGoogle Scholar
  7. 7.
    Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Villiger P, Buchli C et al (2012) A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 256(5):819–826CrossRefPubMedGoogle Scholar
  8. 8.
    Bridoux V, Regimbeau JM, Ouaissi M, Mathonnet M, Mauvais F, Houivet E et al (2017) Hartmann’s procedure or primary anastomosis for generalized peritonitis due to perforated diverticulitis: a prospective multicenter randomized trial (DIVERTI). J Am Coll Surg 225(6):798–805CrossRefPubMedGoogle Scholar
  9. 9.
    O’Sullivan GC, Murphy D, O’Brien MG, Ireland A (1996) Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. Am J Surg 171(4):432–434CrossRefPubMedGoogle Scholar
  10. 10.
    Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95(1):97–101CrossRefPubMedGoogle Scholar
  11. 11.
    Angenete E, Thornell A, Burcharth J, Pommergaard H-C, Skullman S, Bisgaard T et al (2014) Laparoscopic lavage is feasible and safe for the treatment of perforated diverticulitis with purulent peritonitis: the first results from the randomized controlled trial DILALA. Ann Surg 263(1):117–221. CrossRefGoogle Scholar
  12. 12.
    Schultz JK, Yaqub S, Wallon C, Blecic L, Forsmo HM, Folkesson J et al (2015) Laparoscopic lavage vs primary resection for acute perforated diverticulitis: the SCANDIV randomized clinical trial. JAMA 6(13):1364–1375CrossRefGoogle Scholar
  13. 13.
    Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH et al (2015) Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet Lond Engl 26(10000):1269–1277CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic for General, Visceral, Endocrine, and Minimally Invasive SurgeryBogenhausen HospitalMunichGermany

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