Harikrishnan Samyuktha, Neelakantan Ramaswamy Sanathanan, Agarwal Yashasvi, Bhatt Nehal K, Chand Shalvin, Bendagiri Matam Manvitha, Mohammed Lubna
College of Medicine, Gulf Medical University, Ajman, ARE.
Internal Medicine, Government Erode Medical College and Hospital, Erode, IND.
Cureus. 2025 Aug 10;17(8):e89740. doi: 10.7759/cureus.89740. eCollection 2025 Aug.
Perforated diverticulitis is a critical surgical emergency that demands immediate attention and intervention. Damage control surgery (DCS) has emerged as an alternative to traditional approaches for managing physiologically unstable and critically ill patients. This systematic review includes 16 articles published between 2015 and 2025, covering randomized controlled trials, observational cohorts, case reports, and guidelines. The inclusion and exclusion criteria focused on human studies published in English that addressed managing perforated diverticulitis with DCS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were used to guide article selection, which was further refined using standardized appraisal tools such as A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), the Newcastle-Ottawa Scale (NOS), Joanna Briggs Institute Checklists (JBI), the Cochrane Risk of Bias (RoB) tool, the Appraisal of Guidelines for Research and Evaluation II (AGREE II), and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). This review highlights DCS as an effective approach for managing perforated diverticulitis. Patient management with DCS showed significant improvement compared to traditional methods such as Hartmann's procedure. Physiological stabilization reduced complications such as stoma formation and improved anastomosis rates, as supported by the included studies. The findings suggest that DCS reduces morbidity and mortality, lowers the need for a stoma, and enhances bowel continuity in patients with perforated diverticulitis. Several studies also employed negative pressure therapy for temporary abdominal closure. The main prognostic factors identified were ongoing peritonitis and hemodynamic instability, which characterize critically ill patients. These findings underscore the importance of prioritizing patient stability and controlling disease severity at the outset, before proceeding to definitive therapy once the patient is stable. Further high-quality, multicenter studies with larger sample sizes are needed to develop standardized treatment guidelines.
穿孔性憩室炎是一种严重的外科急症，需要立即关注和干预。损伤控制手术（DCS）已成为管理生理不稳定和危重症患者的传统方法的替代方案。本系统评价纳入了2015年至2025年间发表的16篇文章，涵盖随机对照试验、观察性队列研究、病例报告和指南。纳入和排除标准聚焦于以英文发表的关于用DCS治疗穿孔性憩室炎的人体研究。使用系统评价和Meta分析的首选报告项目（PRISMA）2020指南指导文章选择，并使用标准化评估工具进一步完善，如系统评价评估测量工具2（AMSTAR 2）、纽卡斯尔-渥太华量表（NOS）、乔安娜·布里格斯研究所核对清单（JBI）、Cochrane偏倚风险（RoB）工具、研究与评价指南评估II（AGREE II）以及互联网电子调查结果报告核对清单（CHERRIES）。本评价强调DCS是治疗穿孔性憩室炎的有效方法。与传统方法如哈特曼手术相比，采用DCS进行患者管理显示出显著改善。纳入研究表明，生理稳定减少了诸如造口形成等并发症，并提高了吻合率。研究结果表明，DCS可降低穿孔性憩室炎患者的发病率和死亡率，减少造口需求，并增强肠道连续性。几项研究还采用负压疗法进行临时腹壁关闭。确定的主要预后因素是持续性腹膜炎和血流动力学不稳定，这是危重症患者的特征。这些发现强调了在患者稳定后进行确定性治疗之前，从一开始就优先考虑患者稳定性和控制疾病严重程度的重要性。需要进一步开展高质量、多中心、大样本量的研究以制定标准化治疗指南。
