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Erschienen in:
01.10.2012 | Original Article
Damage Control Surgery with Abdominal Vacuum and Delayed Bowel Reconstruction in Patients with Perforated Diverticulitis Hinchey III/IV
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 10/2012
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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.