Prior systematic reviews and meta-analyses were ruled out. [1–3] Fifteen to 40% out of these cases involve people younger than 50. Supplemental digital content is available for this article. In accordance to 2016 WSES Guidelines, DCS remains an effective surgical strategy in critically ill patients affected by sepsis/septic shock and hemodynamical unstability. Two-results of the randomized clinical trial DILALA comparing laparoscopic lavage with resection as treatment for perforated diverticulitis. Damage-control surgery. Damage control. [13–18] Just 5 studies reported how many patients underwent reoperations due to surgical complications, whose rate was between 3% and 14%. to maintaining your privacy and will not share your personal information without Damage control resuscitation integrates permissive hypotension, haemostatic resuscitation, and damage control surgery . Patients who had an ostomy at second-look varied between 33% and 79%,[11–18] while those who had a definitive stoma at follow-up were between 0% and 33% (6 out 8 studies). It involves three steps to help the patient. Damage control was first practiced in the American navy where a damaged vessel would receive minimal repair to keep it afloat. Stages of Damage Control Damage control surgery (DCS) is divided into four distinctive stages: the decision to perform DCS, the operation, intensive care unit resuscitation, … Most of the studies were of good quality (see Table, http://links.lww.com/MD/F216, Supplemental Digital Content, which illustrates the Newcastle-Ottawa Quality Assessment Form for included cohort studies). [34]. Addition of a prehospital initial evaluation stage (Ground Zero) and separation of definitive abdominal wall closure occurred as their importance became [1]. Emergency presentations of diverticulitis. [33]. [26]. [1,2] To date, no single treatment strategy has turned out as best method, in terms of efficacy and safety. DAMAGE CONTROL SURGERY B. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. Data curation: Maurizio Zizzo, Carolina Castro Ruiz, Magda Zanelli, Francesca Sanguedolce, Stefano Ascani. [11–15,18] For those rates just living population was taken into account. Damage control operations in non-trauma patients: defining criteria for the staged rapid source control laparotomy in emergency general, [31]. Initially, the DCS has been described in severe liver trauma associated with coagulopathy. DOI 10.1053/j.gastro.2018.12.033. Registered users can save articles, searches, and manage email alerts. [11–18] In order to decide final surgical strategy – primary resection anastomosis (PRA), primary anastomosis with defunctioning stoma (PADS), or Hartmann's procedure (HP) – following aspects were taken into account: patient recovery from septic shock, clearance of peritonitis, comorbidities, and life expectancy. Keyword Highlighting Print. Management of these cases has changed significantly in the last decade with the emergence of a new paradigm termed damage control. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Writing – review & editing: Maurizio Zizzo. [6] At present, such surgical approach is also finding application in non-traumatic emergencies such as perforated ACD.[7]. We considered both comparative and non-comparative studies including adult patients (over 18 years of age) treated for peritonitis by perforated ACD through DCS strategy as defined in “Damage control surgery procedures” paragraph. Gastroenterology 2019;156:1282–98.e1. Damage control surgery means trauma teams perform only the necessary maneuvers to stop bleeding and resuscitate the patient. Int J Colorectal Dis 2010;25:767–74. Sartelli M, Catena F, Ansaloni L, et al. Lancet Gastroenterol Hepatol 2019;4:599–610. Search for Similar Articles [11–18], Table 3 shows available data about DCS strategy. [18]. Methodology: Maurizio Zizzo, Maria Chiara Bassi. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. [2] However, decisions on whether and when to operate ACD patients remain a substantially debated topic while algorithm for the best treatment has not yet been determined. Since then, damage control has gained widespread use throughout North America, Israel, and South Africa. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, November 25, 2020 - Volume 99 - Issue 48 - p e23323, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=186958, MD_2020_11_03_ZIZZO_MD-D-20-06607_SDC1.doc; [Word] (44 KB), Damage control surgery for the treatment of perforated acute colonic diverticulitis: A systematic review, Articles in Google Scholar by Maurizio Zizzo, MD, Other articles in this journal by Maurizio Zizzo, MD. Falls erforderlich, erfolgt ein Durchstich bis ins Cavum uteri. This paper. [19] In stoma reversal analysis, discrepancy among HP patients and PADS ones turned out statistically significant (64.6% vs 96%), while overall morbidity recorded no statistically significant difference (21.2% vs 12.5%). [30]. Thanks to a thorough systematic review of the literature, we aimed at achieving deeper knowledge of both indications and short- and long-term outcomes related to DCS in perforated ACD. The 8 included articles covered an approximately 13 years study period (2006–2018), with a total 359 patient population. [11–18] The general population recorded a slight female prevalence (194/359 = 54%) over males and a median age between 65 and 73 years. Diesbezüglich geben die Umfrageergebnisse von Roberts et al. Each of these phases has defined timing and objectives to ensure best outcomes. Comment. DCS focuses on physiologic optimization rather than anatomic reconstruction. Epilepsy surgery is not the first line of treatment but is considered when at least two anti-seizure medications have failed to control seizures. Damage Control Surgery refers to the initial surgery performed on critically ill or trauma patients. Contemporary damage control surgery outcomes: 80 patients with severe abdominal injuries in the right upper quadrant analyzed. Damage-control surgery. neralized peritonitis should undergo emergency surgery. First, a surgeon repairs the major tears, and the patient is cared for in the intensive care unit. Epilepsy surgery is a procedure that removes or alters an area of your brain where seizures originate. Addition of a prehospital/initial evaluation stage (ground zero) and separation of definitive abdominal wall closure (part 4) occurred as their importance became more evident. [12,14,15,17] In addition, median MPI ranged between 16 and 26. DOI 10.1097/DCR.0000000000001149. Acuna SA, Wood T, Chesney TR, et al. [14]. Your surgeon secures stitches (sutures) in the tissue near the bladder neck. Median length of ICU stay was between 2 and 6 days, while median hospitalization length recorded between 18 and 22 days. Table 4 shows available data about open abdomen and ostomy outcomes. Sohn M, Iesalnieks I, Agha A, et al. [2], LADIES, a multicenter, parallel, randomized, open-label superiority trial identified a 12-month stoma-free rate of 94.6% and 71.4% (Hinchey III: PADS 95.3% vs HP 79.8%; Hinchey IV: PADS 92.2% vs HP 51.9%) with a median interval of reversal of 101 days and 186 days for PADS and HP, respectively. [5]. Each of these phases has defined timing and objectives to ensure best outcomes. [1] It records the highest rate among patients with perforation or abscess. may email you for journal alerts and information, but is committed JAMA 2016;315:801–10. Malgras B, Prunet B, Lesaffre X et al. Tech Coloproctol 2018;22:743–53. 800-638-3030 (within USA), 301-223-2300 (international) Innovation and current utilisation of trauma damage control surgery. Mædica, 2012. The common goal of treating life-threatening conditions first, then treating major pelvic and extremity fractures, requires cooperation among all major disciplines and subspecialties involved in the care of polytrauma patients, and the book is accordingly multidisciplinary in nature. However, correct patient selection is required. A combination of acidosis, hypothermia, and co… Colorectal Dis 2018;20:753–70. [33–35] Some Authors consider laparoscopic lavage as one possible strategy of damage control aimed at representing a bridge to definitive surgery. [1,5], In accordance with current guidelines, patients affected by generalized peritonitis should undergo emergency surgery. One-year results of the SCANDIV randomized clinical trial of laparoscopic lavage versus primary resection for acute perforated diverticulitis. [2], DCS represents a well-established method in treating critically ill patients with traumatic abdomen injuries. [19], Above mentioned findings are in accordance with those gathered by recent meta-analyzes. [27,30] In this case, abbreviated operations allow stabilization, correction, and re-evaluation of physiological imbalances at ICU. Damage control surgery concept (DCS) consists of performing a staged surgery and allowing resuscitation in severe trauma patients who require surgical management. The first step in DCR is limiting blood loss by early and effective hemorrhage control. At presentation, most patients showed III and IV American Society of Anesthesiologists (ASA) score (81.6%) while having Hinchey III perforated ACD (69.9%). Curr Opin Crit Care 2015;21(6):538–543. [35]. Table 1: Keep in mind that Hartmann's reversal is typified by a 49% to 55% morbidity and 20% mortality rates. Schmidt S, Ismail T, Puhan MA, et al. Damage control is well recognized as a surgical strategy that sacrifices the completeness of the immediate repair in order adequately to address the combined physiological impact of trauma and surgery. The first part of the article addresses the changes that are the reasons and the basis for applying damage-control surgery. [27,30], Likewise, patients undergoing general emergency surgery might experience a decompensated, almost irreversible, physiological exhaustion, and subsequent death. Br J Surg 2017;104:1382–92. Cirocchi R, Arezzo A, Vettoretto N, et al. A historical review of. Highlight selected keywords in the article text. Perathoner A, Klaus A, Mühlmann G, et al. [15]. D R B A S H I R Y U N U S S U R G E R Y R E S I D E N T DAMAGE CONTROL SURGERY 2. PLoS Med 2009;6:e1000100DOI 10.1371/journal.pmed.1000100. Optimal literature search for systematic reviews in, [10]. ET Bureau Last Updated: Jan 02, 2021, 08:24 AM IST. Acute colonic diverticulitis (ACD) is defined as an acute inflammation of one or more colonic diverticula. Damage control surgery techniques have evolved within the continuum of military and civilian trauma care since the Napoleonic Wars. Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the intensive care unit (ICU) and subsequent reexploration and definitive repair following restoration of normal physiology. Phase 0 includes the following steps: Stop bleeding using tourniquets or direct pressure. After removing full-text articles not complying with inclusion criteria (34), 8 articles were included into qualitative synthesis. Font Size. 37 Full PDFs related to this paper. [11–18] Three patients died before second-look. Waibel BH, Rotondo MM. [11–18] In selected cases, closure of perforation site was carried out through interrupted sutures, instead of performing colon resection. [8]. DOI 10.1007/s00423-018-1686-x. Just Kafka-Ritsch et al and Gasser et al reported 2 to 3 days median duration of NPWT. Its application to ACD patients seems to offer good outcomes with a lower percentage of patients with definitive ostomy, if compared to HP. Most patients received a limited resection plus vacuum-assisted closure at first-look while about half entire population underwent primary resection anastomosis (PRA) at a second-look. In a world rife with technological glitches – and one in which simply clicking a button can have far-reaching impact – making mistakes is inevitable. Penna M, Markar SR, Mackenzie H, et al. Meta-analysis of surgical strategies in perforated left colonic diverticulitis with generalized peritonitis. [27]. Damage control is a staged approach to severely injured patients predicated on treatment priorities. 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