Our Summary

This study looked at a surgical technique called damage control strategy (DCS) used to treat severe cases of perforated diverticulitis (a condition where small pouches in the colon rupture, causing an infection in the abdomen). DCS is a two-stage procedure, where the initial surgery involves removing the diseased part of the colon and sealing the abdomen with a special closure system. A second surgery is conducted 48 hours later to either reconnect the colon or perform a Hartmann’s procedure (removal of part of the colon and creation of a stoma).

The aim of the study was to see how patients fared if they still had signs of an ongoing infection (peritonitis) at the time of the second surgery. The researchers found that those patients with ongoing peritonitis were more likely to have organ failure, longer operation times, more surgeries overall, longer hospital stays, and higher mortality rates. They also found that patients with infections caused by Enterococcus bacteria or fungi were more likely to have ongoing peritonitis and worse outcomes.

In simple terms, the study suggests that if a patient still has an infection at the time of the second surgery, their prognosis is likely to be worse. Certain types of infections can also negatively affect the patient’s recovery. This information can help doctors make informed decisions about patient care.

FAQs

  1. What is the damage control strategy (DCS) used for in treating severe cases of perforated diverticulitis?
  2. What were the findings of the study regarding patients with ongoing peritonitis at the time of the second surgery?
  3. How does the type of infection affect the patient’s recovery and outcome after the second surgery in the DCS procedure for diverticulitis?

Doctor’s Tip

Therefore, it is important for patients to follow their doctor’s recommendations for managing and treating their diverticulitis before and after surgery to reduce the risk of complications. This may include taking antibiotics as prescribed, maintaining good hygiene practices, and following a specific diet to promote healing. It is also important for patients to communicate any changes in symptoms or concerns with their doctor promptly. By working closely with their healthcare team, patients can improve their chances of a successful recovery after diverticulitis surgery.

Suitable For

Typically, patients who are recommended diverticulitis surgery are those with severe cases of perforated diverticulitis, especially those with ongoing peritonitis at the time of the surgery. Patients with infections caused by Enterococcus bacteria or fungi may also be recommended for surgery due to the increased risk of complications and worse outcomes.

Timeline

Before diverticulitis surgery:

  • Patient may experience symptoms such as abdominal pain, fever, nausea, and changes in bowel habits.
  • Diagnostic tests such as CT scans or colonoscopy may be conducted to confirm the diagnosis of diverticulitis.
  • Antibiotics may be prescribed to treat the infection and reduce inflammation.
  • In some cases, a liquid diet or bowel rest may be recommended to allow the colon to heal.

After diverticulitis surgery:

  • The initial surgery involves removing the diseased part of the colon and sealing the abdomen with a special closure system.
  • If the patient still has signs of ongoing infection (peritonitis) at the time of the second surgery, they may undergo a second procedure to reconnect the colon or perform a Hartmann’s procedure.
  • Patients with ongoing peritonitis may experience organ failure, longer operation times, more surgeries overall, longer hospital stays, and higher mortality rates.
  • Infections caused by Enterococcus bacteria or fungi may increase the likelihood of ongoing peritonitis and poor outcomes.
  • Patients will undergo post-operative care, including pain management, antibiotic therapy, and monitoring for complications such as infection or bowel obstruction.
  • Physical therapy and dietary changes may be recommended to aid in recovery and prevent future diverticulitis episodes.

What to Ask Your Doctor

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

  1. What are the risks and benefits of undergoing surgery for diverticulitis?
  2. What is the success rate of the surgical procedure being recommended?
  3. What is the expected recovery time after surgery?
  4. Will I need a temporary or permanent stoma after surgery?
  5. What are the potential complications of the surgery?
  6. How will ongoing infections or peritonitis impact my surgery and recovery?
  7. How will my overall health and any existing medical conditions affect the surgery and recovery process?
  8. What are the alternatives to surgery for treating diverticulitis?
  9. How many surgeries do you typically perform for diverticulitis each year?
  10. Can you provide me with more information about the specific surgical technique, such as the damage control strategy mentioned in the study?

Reference

Authors: Sohn MA, Agha A, Steiner P, Hochrein A, Komm M, Ruppert R, Ritschl P, Aigner F, Iesalnieks I. Journal: Int J Colorectal Dis. 2018 Jul;33(7):871-878. doi: 10.1007/s00384-018-3025-7. Epub 2018 Mar 13. PMID: 29536238