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

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.