Hartmann’s Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients

Lee, Jae Moo; Chang, Jun Bai P; Hechi, Majed El; Kongkaewpaisan, Napaporn; Bonde, Alexander; Mendoza, April E.; Saillant, Noelle; Fagenholz, Peter J.; Velmahos, George C.; Kaafarani, Haytham M.A.

doi:10.1016/j.jamcollsurg.2019.03.007

Cited by 68 publications

(59 citation statements)

References 14 publications

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“…We thank Dr Dellinger for his interest in our paper 1 and agree with many of the comments in his letter. The 2 main points raised in his letter are addressed below: differences in efficacy between different beta-lactam (b-lactam) antibiotics, and the role of mechanical bowel preparation.…”

supporting

confidence: 67%

“…We appreciate the comments by Palumbo and colleagues about our article comparing 30-day mortality and morbidity of acute diverticulitis patients undergoing emergent Hartmann's procedure vs primary anastomosis with diverting loop ileostomy. 1 Dr Palumbo and colleagues proposed the use of "virtual ileostomy" (VI) for low-risk patients to avoid ileostomies and associated morbidity in the future, and even suggested a role for routine early endoscopy to diagnose subclinical leaks that would prompt maturing the ostomy.…”

mentioning

confidence: 99%

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Difference in Efficacy among β-Lactam Antibiotics and the Role of Mechanical Bowel Preparation

Kuriakose

Karmakar

et al. 2020

Journal of the American College of Surgeons

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supporting

confidence: 67%

mentioning

confidence: 99%

Difference in Efficacy among β-Lactam Antibiotics and the Role of Mechanical Bowel Preparation

Kuriakose

Karmakar

et al. 2020

Journal of the American College of Surgeons

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“…Furthermore, Acuna et al [36] and Gachabayov et al [34] both demonstrated PA patients to be more likely to undergo stoma reversal and be stoma free during follow-up, which is similar to the present results. Recently, two population-based analyses of patients who underwent emergency surgery for acute diverticulitis in the USA were published by Lee et al [37] and Gawlick et al [38]. Although these studies were not included in this metaanalysis due to the lack of specification on Hinchey grades of included patients, their outcomes provide context to the present findings.…”

Section: Discussionmentioning

confidence: 89%

Sigmoid resection with primary anastomosis versus the Hartmann’s procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis

Lambrichts

Edomskis

Bogt

et al. 2020

Int J Colorectal Dis

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Purpose The optimal surgical approach for perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV) remains debated. In recent years, accumulating evidence comparing sigmoid resection with primary anastomosis (PA) with the Hartmann's procedure (HP) was presented. Therefore, the aim was to provide an updated and extensive synthesis of the available evidence. Methods A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies comparing PA to HP for adult patients with Hinchey III or IV diverticulitis were included. Data on mortality, morbidity, stoma reversal, and patient-reported and cost-related outcomes were extracted. Random effects models were used to pool data and estimate odds ratios (ORs). Results From a total of 1560 articles, four randomized controlled trials and ten observational studies were identified, reporting on 1066 Hinchey III/IV patients. Based on trial outcomes, PAwas found to be favorable over HP in terms of stoma reversal rates (OR 2.62, 95% CI 1.29, 5.31) and reversal-related morbidity (OR 0.33, 95% CI 0.16, 0.69). No differences in mortality (OR 0.83, 95% CI 0.32, 2.19), morbidity (OR 0.99, 95% CI 0.65, 1.51), and reintervention rates (OR 0.90, 95% CI 0.39, 2.11) after the index procedure were demonstrated. Data on patient-reported and cost-related outcomes were scarce, as well as outcomes in PA patients with or without ileostomy construction and Hinchey IV patients. Conclusion Although between-study heterogeneity needs to be taken into account, the present results indicate that primary anastomosis seems to be the preferred option over Hartmann's procedure in selected patients with Hinchey III or IV diverticulitis.

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“…There are various tips and tricks for managing postoperative challenges; however, every procedure has its own limitations and strengths. Primary anastomosis with diverting loop ileostomy appears to be a safe alternative to Hartmann’s procedure in emergent cases [18]. The primary treating surgeon felt that performing primary anastomosis with diverting ileostomy was appropriate in our patient at that point; alternatively, a two-stage Hartmann’s procedure could also have been performed.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of an Endoscopic OverStitch Suturing System for Managing Anastomotic Dehiscence – A Case Report

Patil

Iyer

Dalal

et al. 2020

GE Port J Gastroenterol

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Anastomotic dehiscence (AD) after colorectal surgery contributes to poor outcomes resulting in multiple postoperative complications. Conventional management would be a repeat laparotomy and tension suturing. But owing to the unhealthy vicinities near the suture lines, there is a significant risk of technical failure which further increases postoperative morbidity and mortality. A 60-year-old male, with a history of hypertension, ischemic heart disease, and previous percutaneous transluminal coronary angioplasty, underwent sigmoid colectomy with colorectal anastomosis for complicated sigmoid diverticulitis. He then developed anastomotic site leak for which an ileostomy was done. Prior to the ileostomy revision, he was referred for colonoscopic evaluation which showed the persistence of a partial AD. We decided to close the defect endoscopically with the Apollo OverStitch device. Initial tissue preparation was done by creating a surgical surface using argon plasma coagulation at the perimeter of the leak site. A double channel therapeutic endoscope with the OverStitch assembly was passed to take full-thickness running sutures across the rent to facilitate full closure. The area examined showed good suture approximation and complete closure. The procedure was successful with no immediate or delayed postprocedural complications. Repeat endoscopic evaluation at about two weeks showed well-approximated edges with intact suture lines, and there was complete resolution of the leak. The patient subsequently underwent revision surgery after a month. The patient is under close follow-up and doing well. The Apollo OverStitch device has certainly opened new avenues in flexible endoscopic surgery which need further exploratory studies to add to existing promising results.

show abstract

Hartmann’s Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients

Cited by 68 publications

References 14 publications

Difference in Efficacy among β-Lactam Antibiotics and the Role of Mechanical Bowel Preparation

Difference in Efficacy among β-Lactam Antibiotics and the Role of Mechanical Bowel Preparation

Sigmoid resection with primary anastomosis versus the Hartmann’s procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis

The Usefulness of an Endoscopic OverStitch Suturing System for Managing Anastomotic Dehiscence – A Case Report

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