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

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Journal of Gastrointestinal Surgery Aims and scope

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).

Conclusion

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.

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References

  1. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 2002; 45:962–966

    Article  PubMed  CAS  Google Scholar 

  2. Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J, Larson D Complicated diverticulitis: is it time to rethink the rules? Ann of Surg 2005; 242:576–581

    Google Scholar 

  3. Nagorney DM, Adson MA, Pemberton JH Sigmoid diverticulitis with perforation and generalized peritonitis. Dis Colon Rectum 1985; 28:71–75

    Article  PubMed  CAS  Google Scholar 

  4. Salem L, Anaya DA, Roberts KE, Flum DR Hartmann’s colectomy and reversal in diverticulitis: a population-level assessment. Dis Colon Rectum 2005; 48:988–995

    Article  PubMed  Google Scholar 

  5. Jacobs DO Clinical practice. Diverticulitis. N Engl J Med 2007; 357:2057–2066

    Article  PubMed  CAS  Google Scholar 

  6. Horwood J, Akbar F, Maw A Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis Am R Coll Surg Engl; 2009; 91: 681-687

    Article  Google Scholar 

  7. Pasternak I, Dietrich M, Woodman R, Metzger U, Wattchow DA, Zingg U Use of severity classification systems in the surgical decision-making process in emergency laparotomy for perforated diverticulitis. Int J Colorectal Dis 2010; 25:463–470

    Article  PubMed  Google Scholar 

  8. Constantinides V.A., Tekkis P.P., Athanasiou T. Primary resection with anastomosis vs. Hartmann’s Procedure in Nonelective Surgery for Acute Colonic Diverticultitis: A systematic review. Dis Colon Rectum 2006 July; 49; 7:966-81

    Article  PubMed  Google Scholar 

  9. Perathoner A, Klaus A, Mühlmann G Oberwalder M, Margreiter R, Kafka-Ritsch R. Damage control with vacuum therapy (VAC) to manage perforated diverticulitis with advanced generalized peritonitis-a proof of concept. Int J Colorectal Dis 2010; 25:767-774

    Article  PubMed  Google Scholar 

  10. Regner JL, Kobayashi L, Coimbra R. Surgical Strategies for Management of the Open Abdomen. World J Surg. 2011 Aug 17:1-14

    Google Scholar 

  11. Wondberg D, Larusson HJ, Metzger U, Platz A, Zingg U. Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg 2008; 32:2724-9

    Article  PubMed  CAS  Google Scholar 

  12. Perez DG, Loprinzi CL, Barton Dl Bramkamp M, Koehler C, Clavien PA. Prospective evaluation of vacuum assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg 2007; 204:586-92

    Article  Google Scholar 

  13. Alvarez JA, Baldonedo RF, Bear IG, Otero J, Pire G, Alvarez P, Jorge JI. Presentation, management and outcome of acute sigmoid diverticulitis requiring hospitalization. Dig Surg 2007; 24: 471-476

    Article  PubMed  Google Scholar 

  14. Vermeulen J, Akkersdijk GP, Gosselink MP, Hop WC, Mannaerts GH, van der Harst E, Coene PP, Weidema WF, Lange JF. Outcome after emergency surgery for acute perforated diverticulitis in 200 cases. Dig Surg 2007; 24: 361-366

    Article  PubMed  Google Scholar 

  15. Zingg U, Pasternak I, Dietrich M, Seifert B, Oertli D, Metzger U Primary anastomosis vs. Hartmann’s procedure in patients undergoing emergency left colectomy for perforated diverticulitis. Colorectal Dis 2010; 12:54–60

    Article  PubMed  CAS  Google Scholar 

  16. Vermeulen J, Coene PP, Van Hout NM, van der Harst E, Gosselink MP, Mannaerts GH, Weidema WF, Lange JF. Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann’s procedure be considered a one-stage procedure? Colorectal Dis. 2009 Jul;11(6):619-24.

    Article  PubMed  CAS  Google Scholar 

  17. Schilling MK, Maurer CA, Kollmar O, Büchler MW Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 2001; 44:699–70317

    Article  PubMed  CAS  Google Scholar 

  18. Kronborg O (1993) Treatment of perforated sigmoid diverticulitis: a prospective randomized trial. Br J Surg 80:505–507

    Article  PubMed  CAS  Google Scholar 

  19. V. Naraynsingh, R. Maharaj, D. Hassranah Perforated left-sided diverticulitis with faecal peritonitis: is the Hinchey classification the best guide for surgical decision making? Tech Coloproctol 2011; 15:199–203

    Article  PubMed  CAS  Google Scholar 

  20. Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 2008; 95:97–101

    Article  PubMed  CAS  Google Scholar 

  21. Karoui M, Champault A, Pautrat K, Valleur P, Cherqui D, Champault G. Laparoscopic peritoneal lavage or primary anastomosis with defunctioning stoma for Hinchey 3 complicated diverticulitis: results of a comparative study. Dis Colon Rectum. 2009 Apr; 52(4):609-15.

    Article  PubMed  Google Scholar 

  22. Tan K., Hong C., Zhang J. Liu JZ, Sim R. Predicters of outcome following surgery in colonic perforation: An institution experience over 6 years, J Gastrointest Surg 2011 15:277-284

    Article  PubMed  Google Scholar 

  23. Lidor A.O., Schneider E, Segal J. Elective Surgery for diverticulitis is associated with high risk of intestinal diversion and hospital readmission in older adults. J Gastrointest Surg 2010 14:1867-1874

    Article  PubMed  Google Scholar 

  24. Hinchey EJ, Schaal PG, Richards GK Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12:85–109

    PubMed  CAS  Google Scholar 

  25. Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg 1987; 58:84–92

    PubMed  CAS  Google Scholar 

  26. Salem L, Flum DR Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 2004; 47:1953–1964

    Article  PubMed  Google Scholar 

  27. Seetharam S, Paige J, Horgan PG Impact of socioeconomic deprivation and primary pathology on rate of reversal of Hartmann’s procedure. Am J Surg 2003; 186:154–157

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center of Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Reinhold Kafka-Ritsch, Alexander Perathoner, Johann Pratschke & Matthias Zitt

  2. St. Johann in Tirol Hospital, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria

    Franz Birkfellner & Hermann Nehoda

  3. Center of Operative Medicine, Department of Anaesthesiology, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria

    Helmut Raab

Authors
  1. Reinhold Kafka-Ritsch
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  2. Franz Birkfellner
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  3. Alexander Perathoner
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  4. Helmut Raab
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  5. Hermann Nehoda
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  6. Johann Pratschke
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  7. Matthias Zitt
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Correspondence to Reinhold Kafka-Ritsch.

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Kafka-Ritsch, R., Birkfellner, F., Perathoner, A. et al. Damage Control Surgery with Abdominal Vacuum and Delayed Bowel Reconstruction in Patients with Perforated Diverticulitis Hinchey III/IV. J Gastrointest Surg 16, 1915–1922 (2012). https://doi.org/10.1007/s11605-012-1977-4

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  • DOI: https://doi.org/10.1007/s11605-012-1977-4

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