Damage Control Surgery Over the World in Acute Diverticul... | NCT06428370

Description Module

Detailed Description

Hartmann procedure (HP) is still widely performed in the treatment of purulent or fecal generalized peritonitis as a consequence of a complicated acute large bowel diverticulitis (the so labeled III and IV grade of the Hinchey's classification). More than half of those patients do not undergo to stoma reversal because of its association with significant morbidity and mortality. To date, the use of resection with primary anastomosis (PA) should be preferred, as it is reported in the literature that it is more favorable than HP in terms of morbidity, mortality, and length of postoperative stay. However, PA is often reserved for younger patients with few co-morbidities and a lesser degree of peritoneal contamination while HP is performed in the elderly. Initially described for the treatment of major abdominal injuries, indications for Damage Control Surgery (DCS) have subsequently been extended to septic shock, abdominal compartment syndrome and impossibility to perform a primary closure. In the last decade, DCS has emerged as a valid alternative to HP and Resection-Anastomosis (RA) in patients presenting a severe sepsis caused by purulent or fecal peritonitis in acute diverticulitis. Although DCS is cited as an option in case of impaired hemodynamic status in face of perforated acute diverticulitis, there is still no consensus about such use of DCS. Previous study demonstrated that DCS reduce the Hartmann rate in patients otherwise scheduled for such procedure.

The aim of this study was to describe the potential rationale and outcome of the Damage Control Surgery in patients with purulent and fecal peritonitis.

Name	Type	Description	Arm Group Labels	Other Names
Damage Control Surgery	Procedure	Simple resection, drop, and open abdomen in case of Hinchey III-IV

Measure	Description	Time Frame
Mortality	Mortality rate related to treatment	60 days
Morbidity	Morbidity rate defined by the presence of at least one grade of the Clavien-Dindo Classification scoring system	60 days
Total morbidity	Morbidity calculated by means of the Comprehensive Complication Index	60 days

Measure	Description	Time Frame
Upfront Hartmann rate	Observed to expected (O:E) ratio of Hartmann's procedures	60 days
Length of stay (LOS)	Days of stay as inpatient

Name	Role	Phone	Extension	Email
Gianluca Costa, Prof.	Contact	+39 06 22541 8851		g.costa@unilink.it
Giuseppina Catanzaro, Prof.	Contact			g.catanzaro@unilink.it

Name	Affiliation	Role
Gianluca Costa, Prof.	Link Campus University	Study Director

Facility	Status	City	State	ZIP	Country	Contacts
Hospital de Urgencia Asistencia Publica	Enrolling by invitation	Santiago			Chile

References Module

Citations

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Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago. World J Emerg Surg. 2024 Apr 16;19(1):14. doi: 10.1186/s13017-024-00543-w.

ID	Term
D004238	Diverticulitis
D012772	Shock, Septic

ID	Term
D000076385	Diverticular Diseases
D005759	Gastroenteritis
D005767	Gastrointestinal Diseases
D004066	Digestive System Diseases