Our Summary

This research paper is a review of several studies that investigated the use of damage control surgery (DCS) for treating severe cases of acute diverticulitis. Acute diverticulitis is a condition where small, bulging pouches in the digestive system (called diverticula) become inflamed or infected. DCS is a method that is often used for managing severe trauma, and recently it has been considered for treating severe intra-abdominal infections as well.

The researchers looked at nine different studies that involved a total of 318 patients who underwent DCS for their diverticulitis. They found that about 35.1% of these patients had septic shock when they arrived at the emergency department. Most of the patients had a severe form of the disease known as Hinchey III (68.3%), while the rest had either Hinchey IV (28.9%) or Hinchey II (2.8%).

In patients who underwent DCS, the most common way to temporarily close the abdominal wound was through negative pressure wound therapy (97.8%). About 62.1% of the patients had a type of surgery called RPA, and 22.7% had it either during the first or third phase of DCS. A smaller percentage (6.9%) had a procedure known as a covering ileostomy.

The researchers found that in patients who had the RPA surgery, the rate of leaks from the surgical site was 7.3%, and the rate of major leaks was 4.7%. The estimated rate of death after surgery was 9.2%.

The results of this review suggest that DCS could be a promising approach for treating severe acute diverticulitis, with about 62.1% of patients achieving gastrointestinal continuity. However, the authors note that their findings should be interpreted with caution due to the significant variability in the studies included in their review. They also suggest that further research is needed to fully understand the benefits and cost-effectiveness of the DCS approach.

FAQs

  1. What is damage control surgery (DCS) and how is it used in treating acute diverticulitis?
  2. What were the most common methods and surgeries used in DCS according to the studies reviewed?
  3. What are the potential benefits and risks of using DCS for treating severe acute diverticulitis, based on this research review?

Doctor’s Tip

One helpful tip a doctor might tell a patient about diverticulitis surgery is to follow all post-operative care instructions carefully. This may include taking prescribed medications, following a specific diet plan, avoiding strenuous activities, and attending follow-up appointments with your healthcare provider. By following these instructions, you can help ensure a successful recovery and reduce the risk of complications.

Suitable For

Patients who are typically recommended diverticulitis surgery are those who have severe cases of acute diverticulitis, especially those with complicated forms of the disease such as Hinchey III or IV. Patients who present with septic shock and require immediate intervention may also be candidates for surgery. Additionally, patients who have failed conservative treatments or have recurrent episodes of diverticulitis may be recommended for surgery as well.

However, it is important to note that surgery is usually considered a last resort for treating diverticulitis, and most cases can be managed through non-surgical means such as antibiotics, dietary changes, and lifestyle modifications. The decision to undergo surgery should be made in consultation with a healthcare provider who can assess the individual patient’s condition and determine the most appropriate course of treatment.

Timeline

Overall, the timeline of a patient’s experience before and after diverticulitis surgery can vary depending on the severity of their condition and the specific treatment plan chosen by their healthcare provider. However, a general timeline may look something like this:

Before surgery:

  1. Patient experiences symptoms of diverticulitis such as abdominal pain, fever, nausea, and changes in bowel habits.
  2. Patient undergoes diagnostic tests such as a physical exam, blood tests, imaging tests (such as CT scans), and possibly a colonoscopy to confirm the diagnosis.
  3. Patient may be treated with antibiotics, a liquid diet, and pain medication to manage symptoms and prevent complications.
  4. If the diverticulitis is severe or recurrent, surgery may be recommended.

After surgery:

  1. Patient undergoes pre-operative preparations such as fasting, bowel preparation, and receiving anesthesia.
  2. Surgery is performed, which may involve removing the affected part of the colon (partial colectomy), creating a colostomy or ileostomy, or other procedures depending on the severity of the condition.
  3. Patient is monitored closely in the hospital for complications such as infection, bleeding, or leaks from the surgical site.
  4. Patient may need to stay in the hospital for a few days to recover before being discharged.
  5. Patient is given instructions for post-operative care, such as wound care, pain management, diet restrictions, and activity limitations.
  6. Patient may need to follow up with their healthcare provider for follow-up appointments, monitoring, and possible further treatment.

Overall, the recovery process after diverticulitis surgery can take several weeks to months, depending on the individual patient’s condition and the type of surgery performed. It is important for patients to follow their healthcare provider’s instructions carefully to ensure a smooth recovery and to prevent complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about diverticulitis surgery include:

  1. What are the risks and potential complications associated with diverticulitis surgery?
  2. What are the expected outcomes and success rates of the surgery?
  3. What is the recovery process like, and how long will it take to fully recover?
  4. Are there any alternative treatments or less invasive procedures that could be considered?
  5. How experienced are you in performing diverticulitis surgery, and what is your success rate?
  6. Will I need to make any changes to my diet or lifestyle after surgery?
  7. How long will I need to stay in the hospital after the surgery?
  8. What type of follow-up care will be needed after the surgery?
  9. Are there any long-term effects or complications that I should be aware of?
  10. Can you explain the different surgical options available for treating diverticulitis, and why you recommend a specific approach for my case?

Reference

Authors: Cirocchi R, Popivanov G, Konaktchieva M, Chipeva S, Tellan G, Mingoli A, Zago M, Chiarugi M, Binda GA, Kafka R, Anania G, Donini A, Nascimbeni R, Edilbe M, Afshar S. Journal: Int J Colorectal Dis. 2021 May;36(5):867-879. doi: 10.1007/s00384-020-03784-8. Epub 2020 Oct 22. PMID: 33089382