Primary resection anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis

Abstract

Introduction Surgical management of Hinchey III and IV diverticulitis utilizes either Hartmann’s procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. The aim of this meta-analysis is to determine which of the two procedures has a more favorable outcome. Methods A systematic review of the existing literature was performed using the PRISMA guidelines. A meta-analysis was carried out using a Mantel-Haenszel, random effects model, and forest plots were generated. The Newcastle-Ottawa and Jadad scoring tools were used to assess the included studies. Results A total of 25 studies involving 3546 patients were included in this study. The overall mortality in the HP group was 10.8% across the observational studies and 9.4% in the randomized controlled trials (RCTs). The mortality rate in the PRA group was lower than that in the HP group, at 8.2% in the observational studies and 4.3% in the RCTs. A comparison of PRA vs HP demonstrated a 40% lower mortality rate in the PRA group than in the HP (OR 0.60, 95% CI 0.38–0.95, p = 0.03) when analyzing the observational studies. However, meta-analysis of the three RCTs did not demonstrate any difference in mortality, (OR 0.44 (95% CI 0.14–1.34, p = 0.15). Wound infection rates between the two groups were comparable (OR 0.75, 95% CI 0.20–2.78, p = 0.67). Conclusion Analysis of observational studies suggests that PRA may be associated with a lower overall mortality. There were no differences in wound infection rates. Based on the current evidence, both surgical strategies appear to be acceptable.

Hartmann Procedure or Resection With Primary Anastomosis for Treatment of Perforated Diverticulitis? Systematic Review and Meta-Analysis

“…Diverticular disease is a common gastrointestinal disease and found in one third of people over 60 in the Western world 4 . One of its main complications is diverticulitis, and it can be classified as uncomplicated (Hinchey classification I and II), and complicated (Hinchey classification III and IV) 9 . About 25% of patients with acute diverticulitis require emergency intervention, and the standardized treatment for the perforated form with fecal or purulent peritonitis (Hinchey III and IV classification) is emergency surgery 4 , 24 .…”

Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study

“…And hospital stay in the Hartmann group was less than primary anastomosis group in the same admission. Halim et al [ 30 ] analyzed the surgical outcomes from primary anastomosis and Hartmann's procedure and reported that mortality in primary anastomosis group was 40% lower than Hartmann's group. Similarly, a study by Sozen et al [ 31 ] concluded that Hartmann's procedure was associated with increased duration of hospitalization and need of reoperation.…”

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?

“…Since the mid-2000s, there have been many discussions on the proper surgical management for colonic diverticular perforation, but there is still controversy [25]. In a systematic review and meta-analysis by Halim et al [7], 22 of 25 articles reported that PA was associated with lower in-hospital mortality than HP, however, the other 3 articles did not report this finding. Statistically, PA had lower in-hospital mortality than HP.…”

“…Recently, several studies have reported that primary repair (PR) or primary anastomosis (PA) can improve levels of morbidity and mortality compared with HP. However, other studies have reported that PR or PA had no beneficial effect on mortality and morbidity [7].…”