Objective:

To characterize contemporary management of severe complicated diverticulitis, measure awareness and prior experience with damage control surgery (DCS) and open abdomen (OA), and examine variations in practice based on the proportion of professional activity dedicated to emergency surgery.

Approach:

• Study Design: A cross-sectional, web-based survey was conducted among Italian surgeons engaged in emergency and general surgery.
• Participants: 175 Italian surgeons participated voluntarily, with no patient-level data collected.
• Questionnaire: The structured questionnaire included 25 items covering demographics, surgical practices, and awareness of DCS and OA.
• Statistical Analysis: Categorical data were analyzed using counts and percentages, with exploratory comparisons based on the proportion of emergency surgery in respondents' work.

Key Findings:

• Hartmann’s procedure was the predominant strategy for Hinchey III–IV cases, used by 71.4% of respondents.
• Primary anastomosis was reported in fewer than one-quarter of cases.
• 82.3% of respondents reported institutional use of OA for any indication.
• Commercial negative-pressure systems were the most common temporary abdominal closure method.

Interpretation:

The survey indicates a predominance of Hartmann’s procedure in practice, with limited use of primary anastomosis and significant institutional variation in the application of DCS and OA.

Limitations:

• The survey's response rate could not be determined due to the lack of data on the total number of surgeons reached.
• The study did not require ethics committee approval, as it involved a survey of professional practices without patient data.

Conclusion:

The findings highlight the need for ongoing education and training regarding DCS and OA management among surgeons, as well as the importance of establishing standardized protocols to improve outcomes for patients with Hinchey III–IV acute diverticulitis.