Damage control surgery and open abdomen in Hinchey III–IV acute diverticulitis: current practice from a nationwide Italian survey

Abstract Introduction Damage control surgery (DCS) with staged reconstruction may offer an alternative to Hartmann’s procedure in selected unstable patients with generalized peritonitis from acute diverticulitis, but its adoption in routine practice is uncertain. Methods A nationwide web-based survey explored management of Hinchey III-IV acute diverticulitis, institutional use of open abdomen, and knowledge and application of DCS. Categorical data were summarized as n (%). The survey was endorsed by Italian Society of Emergency and Trauma Surgery (SICUT). Results Among 175 respondents, 71.4% reported using Hartmann’s procedure in at least half of severe cases, whereas 37.7% used primary anastomosis in at least one-quarter. Open abdomen was available in 82.3% of institutions. Awareness of DCS was reported by 148/174 (85.1%), and 116/168 (69.0%) had used it for severe diverticulitis; however, only 33/147 (22.4%) used a clinical score. Hemodynamic instability (83.1%), severe peritoneal contamination (73.2%), and the opportunity for delayed anastomosis (64.1%) were the main indications. Respondents with greater emergency surgery commitment more often reported primary anastomosis (48.1% vs. 20.9%; P < 0.001), open abdomen availability (93.5% vs. 64.2%; P < 0.001), and previous DCS use (75.5% vs. 58.1%; P = 0.024). Conclusion DCS is familiar to and has been used by most respondents, but selection and implementation remain heterogeneous and rarely score-based. Standardized criteria, shared terminology, and prospective outcome evaluation are needed.

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Journal
Updates in Surgery
Published
2026-09-10
DOI
https://doi.org/10.1007/s13304-026-02834-0
Primary Topic
Diverticular Disease and Complications
Type
article
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article

Damage control surgery and open abdomen in Hinchey III–IV acute diverticulitis: current practice from a nationwide Italian survey

Hayato Kurihara, Diego Mariani, Giuseppe Brisinda, Massimiliano Ardu et al.
Updates in Surgery
Diverticular Disease and Complications
article

Damage control surgery and open abdomen in Hinchey III–IV acute diverticulitis: current practice from a nationwide Italian survey

Hayato Kurihara, Diego Mariani, Giuseppe Brisinda, Massimiliano Ardu, Luca Ferrario, Michele Benedetti, Marcello Della Corte, Barbara Frezza, Simone Targa, Valentina Miacci, Andrea Martina Guida, Giovanni Maria Garbarino, Giulio Iacob, Domenico Spoletini, Alessandra Lucchetta, Giovanni Damiani, Corrado Rispoli, Giovanni Bellanova, Luigi Cobuccio, Massimo Antropoli, Paolo Beltempo, Andrea Divizia, Genoveffa Balducci, Anna Angrisano, Valerio Cozza, Martina Ceolin, Tommaso Fontana, Massimo Chiarugi, Manuela Mastronardi, Marco Ceresoli, Daniele Delogu, Federico Tomassini, Savino Occhionorelli, Fabio Rondelli, Pietro Anoldo, La Greca A, Paola Fugazzola, Luca Lepre, Camilla Cremonini, Carlo Bergamini, Eugenio Cucinotta, Gabriele Bellio, Simone Squillante, Chiara Cipressi, G.P. Da Pozzo, Mauro Montuori, Antonio Brillantino, Roberto Cirocchi, Emilio Gentile Warschauer, Simone Sebastiani, Marco De Prizio, Alessia Malagnino, Stefano Ferfoglia, Diletta Cassini, Bruno Cirillo, Valentina Di Paola, Stefano Magnone, Paolo Mercantini, Andrea Mingoli, Silvia Strambi, Federico Mariani, Christian Galatioto, Kurihara Hayato, Gianluca Baiocchi, Mauro Zago, Alessio GIORDANO, Giuseppe Evola, Gianluca Costa, Maximilian Scheiterle, Sabina Magalini, Fabrizio Sammartano, DCS Collaborative group, Stefano Valente, Leonardo Delogu, Filippo Carannante, Dario Iadicola, Miriam Vitrano, Piero Venezia, Giovanni Casciaro, Fausto Rosa, Federico Coccolini, Nicolo Mariani, Gianluca Liotta, Stefano Cioffi, Pietro Fransvea, Chiara Miligi, Dario Tartaglia, Luca Ghirardelli, Pietro Bisagni, Livio Mortati, Paola Addariochieco, Paolo Prosperi, Simonetta Iacovitti, Mauro Santarelli, Alan Biloslavo, Claudia Zaghi, Giovanni Giglielmo Iaracca, Ilaria Martire
article en

Abstract

Abstract Introduction Damage control surgery (DCS) with staged reconstruction may offer an alternative to Hartmann’s procedure in selected unstable patients with generalized peritonitis from acute diverticulitis, but its adoption in routine practice is uncertain. Methods A nationwide web-based survey explored management of Hinchey III-IV acute diverticulitis, institutional use of open abdomen, and knowledge and application of DCS. Categorical data were summarized as n (%). The survey was endorsed by Italian Society of Emergency and Trauma Surgery (SICUT). Results Among 175 respondents, 71.4% reported using Hartmann’s procedure in at least half of severe cases, whereas 37.7% used primary anastomosis in at least one-quarter. Open abdomen was available in 82.3% of institutions. Awareness of DCS was reported by 148/174 (85.1%), and 116/168 (69.0%) had used it for severe diverticulitis; however, only 33/147 (22.4%) used a clinical score. Hemodynamic instability (83.1%), severe peritoneal contamination (73.2%), and the opportunity for delayed anastomosis (64.1%) were the main indications. Respondents with greater emergency surgery commitment more often reported primary anastomosis (48.1% vs. 20.9%; P < 0.001), open abdomen availability (93.5% vs. 64.2%; P < 0.001), and previous DCS use (75.5% vs. 58.1%; P = 0.024). Conclusion DCS is familiar to and has been used by most respondents, but selection and implementation remain heterogeneous and rarely score-based. Standardized criteria, shared terminology, and prospective outcome evaluation are needed.

Updates in Surgery
University of Pisa (IT), University of Messina (IT), University of Trieste (IT), University of Perugia (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Ospedale Santa Chiara (IT), Alessandro Manzoni Hospital (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Azienda Ospedaliera Universitaria Pisana (IT), Link Campus University (IT), Sapienza University of Rome (IT)
Good health and well-being
Openalex Percentile: Top 8%
Diverticular Disease and Complications
DOIOpen Access PDFOpenAlex
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