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Multicenter Study
. 2026 Feb;28(2):e70356.
doi: 10.1111/codi.70356.

Damage control surgery in perforated diverticulitis reduces the stoma rate: A multicentre international retrospective cohort study

Maximilian Sohn  1   2 , Valentin Ritschl  3   4 , Dario Tartaglia  5 , Massimo Chiarugi  5 , Silvia Strambi  5 , Antonio Brillantino  6 , Ayman Agha  7 , Maria May  8 , Mia Kim  9 , Malik Maghames  9 , Ingo Hofmann  9 , Tanja Stamm  3   4 , Johannes Lauscher  10 , Igors Iesalnieks  11 , Jaroslav Presl  12 , Tarkan Jäger  12 , Philipp Schredl  12 , Ramin Raul Ossami Saidy  13   14 , Elisabeth Gasser  15 , Reinhold Kafka-Ritsch  15 , Franz Bader  1 , Alfred Hochrein  16 , Roland Scherer  14 , Sven Jonas  13 , Johann Pratschke  13 , Alexander Perathoner  15   17 , Paul Ritschl  18
Affiliations
Multicenter Study

Damage control surgery in perforated diverticulitis reduces the stoma rate: A multicentre international retrospective cohort study

Maximilian Sohn et al. Colorectal Dis. 2026 Feb.

Abstract

Aim: Perforated diverticulitis of the left colon with peritonitis remains life-threatening. However, the optimal surgical strategy is still under debate. The presented study compares the impact of a routinely applied two-stage damage control strategy (DCS) in perforated purulent or faeculent diverticulitis with currently used non-DCS strategies.

Methods: This international multicentre retrospective cohort study was conducted in nine European hospitals. In five hospitals, the therapeutic algorithm covered the routine application of a two-stage DCS as a surgical standard for treating perforated diverticulitis. Four hospitals performed conventional one-stage surgeries and served as controls. The primary outcome was stoma rate at the end of the initial hospital stay. The key secondary outcomes were morbidity and mortality rates.

Results: Overall, data from 558 patients were included, 365 of whom were from DCS centres with equally distributed sex. Patients treated in DCS centres were significantly younger (67 ± 14 vs. 70 ± 14, p = 0.007) but showed a higher Mannheim peritonitis index (22.3 ± 7.9 vs. 20.4 ± 8.0, p = 0.008). At discharge, patients treated in DCS hospitals had a significantly lower stoma rate (stoma-free: DCS, 45.6% vs. non-DCS, 20.8%; p = 0.001). Secondary outcome parameters showed no differences between the investigated cohorts, in addition to significantly longer ICU stays (7.28 ± 11.13 vs. 5.15 ± 9.60 days; p < 0.001) and an increased number of surgical interventions during the hospital stay in DCS centres (2.64 ± 1.89 vs. 1.51 ± 1.10; p < 0.001).

Conclusion: Patients treated in DCS hospitals for perforated diverticulitis are significantly more likely to be discharged without a stoma than patients treated in hospitals using the current standard treatment.

Keywords: Hartmann's procedure; damage control surgery; perforated diverticulitis; peritonitis.

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References

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