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01-10-2012 | Original Article

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

Authors: Reinhold Kafka-Ritsch, Franz Birkfellner, Alexander Perathoner, Helmut Raab, Hermann Nehoda, Johann Pratschke, Matthias Zitt

Published in: Journal of Gastrointestinal Surgery | Issue 10/2012

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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Title: Damage Control Surgery with Abdominal Vacuum and Delayed Bowel Reconstruction in Patients with Perforated Diverticulitis Hinchey III/IV
Authors: Reinhold Kafka-Ritsch
Franz Birkfellner
Alexander Perathoner
Helmut Raab
Hermann Nehoda
Johann Pratschke
Matthias Zitt
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1977-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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