Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy?

Dreifuss, Nicolás H; Harriott, Camila Bras; Schlottmann, Francisco; Bun, Maximiliano; Rotholtz, Nicolás A.

doi:10.1007/s13304-020-00952-x

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Finally, through a path analysis, our study highlights that creation of a diverting stoma was associated with both AL/PA and SAS, independently of the occurrence of AL/PA. Regarding AL/PA, the association between postoperative morbidity and diverting stoma in diverticulitis surgery has already been highlighted [27]. This may be due to the fact that the decision to create a stoma is made in more severe cases of peritonitis in patients at risk of AL and PA.…”

Section: Discussionmentioning

confidence: 99%

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Hamel,

Alves,

Beyer‐Bergot

et al. 2024

Colorectal Disease

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AimThe aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis.MethodThis is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right‐sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage.ResultsOf the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75–6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32–5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19–0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2–4.75 and OR = 12.95, 95% CI = 9.11–18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted.ConclusionAL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.

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Section: Discussionmentioning

confidence: 99%

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Hamel,

Alves,

Beyer‐Bergot

et al. 2024

Colorectal Disease

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“…Stoma-free rate was significantly better for patients undergoing PA compared with HP. patients having a diverting ileostomy without reduction of mortality or anastomotic leakage rates [24]. Furthermore the DIVERTI trial found that overall morbidity and severe complications were significantly lower in their group of patients without ileostomy [19].…”

Section: Discussionmentioning

confidence: 99%

Hartmann’s procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or fecal peritonitis: Three-year follow-up of a randomised controlled trial

Edomskis

Hoek

Stark

et al. 2022

International Journal of Surgery

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Background:The aim of the present study is to present the three years follow-up a randomised controlled trial that compared Hartmann's Procedure (HP) with sigmoidectomy with primary anastomosis (with or without defunctioning ileostomy) (PA) in a randomised design to determine the optimal treatment strategy for perforated diverticulitis with purulent or fecal peritonitis. Methods: Data were prospectively gathered for the first 12 months after randomization and retrospectively collected up to 36 months. The primary long-term endpoint was stoma free rate 36 months after the index procedure. Secondary outcomes were patients with a stoma at 36 months, percentage of stoma reversals, related reinterventions, parastomal/incisional hernia rates, total in hospital days including all readmissions regardless their relation to the intervention, overall morbidity and mortality. Results: Three years follow-up was completed in 119 of the originally 130 included patients, with 57 (48%) in the PA-group and 62 (52%) patients in the HP-group. 36 months stoma free rate was significantly better for patients undergoing PA compared with HP (PA 92% vs HP 81%, hazard ratio 2.326 [95% CI 1.538-3.517]; log-rank p < 0⋅0001). Stoma reversal rates did not significantly differ (PA 31/40(78%) versus HP 45/61(74%), p = 0.814). Overall cumulative morbidity (PA 21/57(36%) versus HP 30/62(48%), p = 0.266) and mortality (PA 6/57(11%) versus HP 7/62 (11%), p = 1.000) did not differ between groups. However, more parastomal hernias occurred in the HP-group (HP 10/62(16%) vs PA 1/57(2%), p = 0.009) and the mean total in hospital days after three years follow-up was significantly lower in the PA-group compared to the HP-group (PA 14 days (IQR 9.5-22.5) versus HP 17 days (IQR 12.5-27.5)), p = 0.025). Conclusion: Long-term results showed that in haemodynamically stable, immunocompetent patients primary anastomosis is superior to Hartmann's procedure as treatment for perforated diverticulitis with respect to longterm stoma free rate, overall hospitalization and parastomal hernias.

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“…The long-term results of the LADIES trial comparing Hartmann's procedure versus resection and primary anastomosis showed that the latter was superior in terms of patients being without a stoma in the long term and overall hospitalization rates, without being associated with more morbidity or mortality after the procedure. Furthermore, a recent meta-analysis [30] showed that, when a decision is made on performing a primary anastomosis on a patient being operated on for perforated diverticulitis, there seems to be no benefit associated with performing a proximal diversion to protect the colorectal anastomosis.…”

Section: Treatment Of Patients With Diffuse Peritonitismentioning

confidence: 99%

Surgical Management of Complicated Diverticulitis

Vaccaro,

Avellaneda

2023

Diverticular Bowel Disease - Diagnosis and Treatment

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Diverticular disease is a prevalent condition that affects more people as they get older. Even though some patients have colonic diverticulosis with no symptoms and then require no treatment, some of the patients affected with this disease present repeated episodes of inflammation and end up requiring surgical treatment in an elective or urgent setting. When an acute episode of diverticulitis arises, it may require surgery, and these procedures are often challenging even for specialized colorectal surgeons. Furthermore, a lot has been written in the last years about what to do in an urgent scenario, ranging from just making a lavage of the abdominal cavity, to making a colonic resection with or without primary anastomosis (which brings more debate into the topic). Therefore, a chapter explaining the evidence-based management of acute colonic diverticulitis seems a relevant topic for this chapter.

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Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy?

Cited by 8 publications

References 26 publications

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Hartmann’s procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or fecal peritonitis: Three-year follow-up of a randomised controlled trial

Surgical Management of Complicated Diverticulitis

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