Resection with primary anastomosis <i>vs</i> nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta‐analysis

Gachabayov, Mahir; Oberkofler, Christian E.; Tuech, J J; Hahnloser, Dieter; Bergamaschi, Roberto

doi:10.1111/codi.14237

Cited by 43 publications

(27 citation statements)

References 52 publications

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“…2 Quantitative analyses of a short-term mortality rates in randomized controlled trials, b long-term mortality rates in randomized controlled trials, and c overall mortality rates during follow-up in observational studies the present study, no difference between treatment groups was demonstrated, which is comparable to the outcomes found by Acuna et al [36]. 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].…”

Section: Discussionsupporting

confidence: 84%

“…The present results are generally in line with those from previous meta-analyses. With regard to overall mortality from randomized and observational studies, Gachabayov et al [34] and Shaban et al [35] found PA to be favorable over HP, which was also the case in the present quantitative analysis of mortality within the included observational studies. However, in the subgroup analysis of randomized studies in a b c Fig.…”

Section: Discussionsupporting

confidence: 81%

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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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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 81%

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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“…Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and metaanalysis by Gachabayov M et al 1 Gachabayov M et al [1] present a systematic review on the ongoing hot topic-how to operate on perforated diverticulitis? The primary endpoint of this systematic review was postoperative mortality including overall mortality, mortality after emergency surgery and mortality after ostomy reversal.…”

Section: Editor's Choicementioning

confidence: 99%

Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a “Damage Control Strategy”

et al. 2018

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“…In recent years, results have been published favouring sigmoidectomy with primary anastomosis (PA) over Hartmann's procedure (HP) for the treatment of Hinchey III and IV diverticulitis 8 . Benefits of PA comprise lower short-term morbidity rates after index and reversal procedures, as well as a higher rate of stoma-free survival, including details of cost analyses and clinical outcomes, has been reported previously 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Lambrichts

Bemelman²,

Lange

2020

British Journal of Surgery

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Background: Several studies have been published favouring sigmoidectomy with primary anastomosis over Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis (Hinchey grade III or IV), but cost-related outcomes were rarely reported. The present study aimed to evaluate costs and cost-effectiveness within the DIVA arm of the Ladies trial. Methods: This was a cost-effectiveness analysis of the DIVA arm of the multicentre randomized Ladies trial, comparing primary anastomosis over Hartmann's procedure for Hinchey grade III or IV diverticulitis. During 12-month follow-up, data on resource use, indirect costs (Short Form Health and Labour Questionnaire) and quality of life (EuroQol Five Dimensions) were collected prospectively, and analysed according to the modified intention-to-treat principle. Main outcomes were incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, expressed as the ratio of incremental costs and the incremental probability of being stoma-free or incremental quality-adjusted life-years respectively. Results: Overall, 130 patients were included, of whom 64 were allocated to primary anastomosis (46 and 18 with Hinchey III and IV disease respectively) and 66 to Hartmann's procedure (46 and 20 respectively). Overall mean costs per patient were lower for primary anastomosis (€20 544, 95 per cent c.i. 19 569 to 21 519) than Hartmann's procedure (€28 670, 26 636 to 30 704), with a mean difference of €-8126 (-14 660 to-1592). The ICER was €-39 094 (95 per cent bias-corrected and accelerated (BCa) c.i.-1213 to-116), indicating primary anastomosis to be more cost-effective. The ICUR was €-101 435 (BCa c.i.-1 113 264 to 251 840). Conclusion: Primary anastomosis is more cost-effective than Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis.

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Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta‐analysis

Abstract: This meta-analysis found that organ/space SSI rates as well as ostomy nonreversal rates were decreased in PRA at the cost of prolonging the operating time.

Cited by 43 publications

References 52 publications

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

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

Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a “Damage Control Strategy”

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

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