The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-a
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REVIEW
The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis Roberto Cirocchi 1 & Georgi Popivanov 2 & Marina Konaktchieva 3 & Sonia Chipeva 4 & Guglielmo Tellan 5 & Andrea Mingoli 6 & Mauro Zago 7 & Massimo Chiarugi 8 & Gian Andrea Binda 9 & Reinhold Kafka 10 & Gabriele Anania 11 & Annibale Donini 1 & Riccardo Nascimbeni 12 & Mohammed Edilbe 13 & Sorena Afshar 13 Accepted: 9 October 2020 # The Author(s) 2020
Abstract Introduction Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II–IV complicated acute diverticulitis (CAD). Methods A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953). Results Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03784-8) contains supplementary material, which is available to authorized users. * Roberto Cirocchi [email protected]
Gian Andrea Binda [email protected]
Georgi Popivanov [email protected]
Reinhold Kafka [email protected]
Marina Konaktchieva [email protected]
Gabriele Anania [email protected]
Sonia Chipeva [email protected]
Annibale Donini [email protected]
Guglielmo Tellan [email protected]
Riccardo Nascimbeni [email protected]
Andrea Mingoli [email protected] Mauro Zago [email protected] Massimo Chiarugi [email protected]
Mohammed Edilbe [email protected] Sorena Afshar [email protected] Extended author information available on the l
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