Current Approaches to Damage Control Surgery and Open Abdomen Management

Background

Acute diverticulitis can lead to life-threatening conditions such as perforated colonic diverticulitis with peritonitis. Surgical management is critical, especially in unstable patients. Understanding current practices is essential for improving outcomes in this high-risk population.

Data Highlights

Recent studies indicate that the mortality rate for patients undergoing surgery for perforated diverticulitis can be as high as 20%. The use of damage control surgery (DCS) has been associated with reduced morbidity and mortality in selected patients. A systematic review found that DCS may lead to shorter hospital stays and lower rates of postoperative complications compared to traditional surgical approaches.

Key Findings

• Surveyed surgeons reported varying levels of awareness and experience with DCS and OA strategies.

• There is significant heterogeneity in the selection criteria and techniques used for DCS among institutions.

• Many surgeons still favor traditional methods like Hartmann's procedure.

• Risks associated with OA include complications such as enteroatmospheric fistula and failure of fascial closure.

• Guidelines recommend DCS for selected unstable patients but caution against routine OA use.

Clinical Implications

Surgeons should be aware of the evolving landscape of surgical management for Hinchey III–IV diverticulitis.

Conclusion

The survey highlights the variability in managing complicated diverticulitis, particularly regarding DCS and OA strategies.

Related Resources & Content

1. Outcomes of damage control surgery in perforated sigmoid diverticulitis: a comparison before and after implementing a new treatment algorithm, Updates in Surgery, 2026 -- https://link.springer.com/article/10.1007/s13304-026-02572-3

2. Evaluating the Impact of Damage Control Surgery on Perforated Colonic Diverticulitis: A Systematic Review and Meta-Analysis, Techniques in Coloproctology, 2020 -- https://link.springer.com/article/10.1007/s00384-020-03784-8

3. Approaches to Treating Perforated Diverticulitis Accompanied by Generalized Peritonitis: A Comprehensive Review and Expert Consensus, Techniques in Coloproctology, 2020 -- https://link.springer.com/article/10.1007/s10151-020-02346-y

4. Management Approaches for Acute Diverticulitis: Trends Among Surgeons in Italy Based on a Survey by the Italian Society of Colorectal Surgery (SICCR), Updates in Surgery, 2024 -- https://link.springer.com/article/10.1007/s13304-024-01927-y

5. Guideline EAES Rapid Guideline: Surgical management of complicated diverticulitis – with ESCP participation, European Association for Endoscopic Surgery, 2024 -- https://files.magicapp.org/guideline/0ab645ef-8307-4501-a627-03c9ab48c925/published_guideline_7490-1_0.pdf

6. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Left-Sided Colonic Diverticulitis - PubMed, 2026 -- https://pubmed.ncbi.nlm.nih.gov/42478484/

7. The open abdomen in trauma and non-trauma patients: WSES guidelines - PMC, 2023 -- https://pmc.ncbi.nlm.nih.gov/articles/PMC5797335/?utm_source=openai

8. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines - PMC, 2023 -- https://pmc.ncbi.nlm.nih.gov/articles/PMC10362628/?utm_source=openai

9. Outcomes of damage control surgery in perforated sigmoid diverticulitis: a comparison before and after implementing a new treatment algorithm

10. Evaluating the Impact of Damage Control Surgery on Perforated Colonic Diverticulitis: A Systematic Review and Meta-Analysis

11. Techniques in Coloproctology — Approaches to Treating Perforated Diverticulitis Accompanied by Generalized Peritonitis: A Comprehensive Review and Expert Consensus

12. Updates in Surgery — Management Approaches for Acute Diverticulitis: Trends Among Surgeons in Italy Based on a Survey by the Italian Society of Colorectal Surgery (SICCR)

13. Guideline EAES Rapid Guideline: Surgical management of complicated diverticulitis – with ESCP participation

14. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Left-Sided Colonic Diverticulitis - PubMed

15. The open abdomen in trauma and non-trauma patients: WSES guidelines - PMC

16. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines - PMC

17. Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial - PubMed

18. Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: The SCANDIV Randomized Clinical Trial | Surgery | JAMA | JAMA Network

19. The surgical management of perforated diverticulitis Hinchey III: a systematic review and meta-analysis.

20. Emergency minimally invasive versus open left-sided colonic resection for complicated diverticulitis: a systematic review and meta-analysis - PubMed

21. Outcomes of damage control surgery in perforated sigmoid diverticulitis: a comparison before and after implementing a new treatment algorithm | Updates in Surgery | Springer Nature Link