Primary Resection With Anastomosis vs . Hartmann's Procedure in Nonelective Surgery for Acute Colonic Diverticulitis: A Systematic Review

Constantinides, Vasilis; Tekkis, Paris; Athanasiou, Thanos; Aziz, Omer; Purkayastha, Sanjay; Remzi, Feza H.; Fazio, Victor W.; Aydin, Nail; Darzi, Ara; Senapati, Asha

doi:10.1007/s10350-006-0547-9

Cited by 207 publications

(126 citation statements)

References 39 publications

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“…Two prematurely interrupted RCTs [163,164] and several studies with weaker methodology [165,166] have demonstrated similar mortality and morbidity after resection with primary anastomosis and non-restorative procedures: it seems highly unlikely that an exhaustive RCT will be performed [167].…”

Section: What Are the Treatment Options For Purulent Peritonitis?mentioning

confidence: 99%

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

et al. 2015

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The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options.

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Section: What Are the Treatment Options For Purulent Peritonitis?mentioning

confidence: 99%

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

et al. 2015

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“…However, none of these studies were randomized and therefore suffer from a high likelihood of selection bias, with fitter, more stable patients being more likely to be selected for primary anastomosis. A comprehensive systematic review and meta-analysis including 963 patients from 15 studies concluded that mortality after primary anastomosis was significantly lower than after Hartmann's procedure in emergency surgery for acute diverticulitis, with comparable mortality rates for grade Hinchey III and IV generalized peritonitis [42]. However, the authors acknowledge the limitations of the conclusions due to considerable selection bias.…”

Section: Primary Anastomosis Versus Hartmann's Proceduresmentioning

confidence: 94%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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“…2,3,7,11,16 Flestar rannsóknir um rof á ristli fjalla um afmarkaðan hluta sjúklinga, ýmist þá sem hafa sömu undirliggjandi orsök eða hafa fengið sömu meðferð. 3,4,6,15,17 Höfundum er ekki kunnugt um að allir sjúk-lingar með rof á ristli, óháð orsökum og meðferð, hafi áður verið skoðaðir saman og það á landsvísu.…”

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