Damage Control Laparotomy for Surgical Management of Diverticulitis

Author(s):
Aaron Pinnola; Neal Cooper; James Vogler; Jason Sciarretta; John Davis

Background:

Diverticulitis presents in broad degrees of severity ranging from outpatient management in mild cases to septic shock requiring colonic resection and colostomy formation traditionally in the most advanced instances. Initial studies on Damage Control Laparotomy (DCL) applied for intra-abdominal sepsis failed to show a mortality benefit. However, more recent literature has explored indications for utilizing DCL for acute diverticulitis as a means to avoid colostomy and unplanned re-laparotomy. Furthermore, there has been detailing of preoperative patient characteristics and physiology to guide patient selection for DCL. Encouraged by these results, we sought to implement this technique at our hospital. This retrospective study describes the outcomes of DCL for the surgical management of diverticulitis in a single institution

Hypothesis:

DCL is an effective treatment for complicated diverticulitis.

Methods:

A retrospective chart review of all diverticulitis patients treated over the last four years with DCL and was performed. Patient characteristics including preoperative physiology and comorbidities were collected. Outcomes measures of mortality, postoperative complications, readmission, anastomotic leak rate, and ostomy rate were also obtained.

Results:

Twenty-two patients were identified. The average age was 66.7 years and major comorbidities were 3.25.  Patients were identified by Hinchey Classification (classification, number; I, 1; II, 12; III, 4; IV, 5). The mortality rate was 18%. Final ostomy rate was 68% within the cohort. In 8 patients a colonic anastomosis was attempted with an anastomotic leak identified in 3 of these patients (37.5%). The remainder of post-operative complications are shown in Figure 1. The average length of stay was 19 days with 7.0 days on the ventilator.