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Portolese AC, Jeganathan NA. Contemporary management of diverticulitis. Surg Open Sci 2024; 19:24-27. [PMID: 38585040 PMCID: PMC10995854 DOI: 10.1016/j.sopen.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
The treatment of diverticulitis is experiencing a shift in management due to a number of large scale clinical trials. For instance, clinicians are beginning to recognize that avoidance of antibiotics in uncomplicated diverticulitis is not associated with worse outcomes. Additionally, while the decision to proceed with elective surgical resection for recurrent uncomplicated disease is less conclusive and favors a patient-centric approach, complicated disease with a large abscess denotes more aggressive disease and would likely benefit from elective surgical resection. Lastly, in patient with acutely perforated diverticulitis who require urgent surgical intervention, laparoscopic lavage is generally not recommended due to high re-intervention rates and the preferred surgical procedure is primary anastomosis with or without diversion due to high morbidity and low rates of Hartmann reversal.
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Affiliation(s)
- Austin C. Portolese
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nimalan A. Jeganathan
- Department of Surgery, Division of Colon & Rectal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Rios Diaz AJ, Bevilacqua LA, Habarth-Morales TE, Zalewski A, Metcalfe D, Costanzo C, Yeo CJ, Palazzo F. Primary anastomosis with diverting loop ileostomy vs. Hartmann's procedure for acute diverticulitis: what happens after discharge? Results of a nationwide analysis. Surg Endosc 2024:10.1007/s00464-024-10752-8. [PMID: 38580758 DOI: 10.1007/s00464-024-10752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/14/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Current guidelines recommend resection with primary anastomosis with diverting loop ileostomy over Hartmann's procedure if deemed safe for acute diverticulitis. The primary objective of the current study was to compare the utilization of these strategies and describe nationwide ostomy closure patterns and readmission outcomes within 1 year of discharge. METHODS This was a retrospective, population-based, cohort study of United States Hospitals reporting to the Nationwide Readmissions Database from January 2011 to December 2019. There were 35,774 patients identified undergoing non-elective primary anastomosis with diverting loop ileostomy or Hartmann's procedure for acute diverticulitis. Rates of ostomy closure, unplanned readmissions, and complications were compared. Cox proportional hazards and logistic regression models were used to control for patient and hospital-level confounders as well as severity of disease. RESULTS Of the 35,774 patients identified, 93.5% underwent Hartmann's procedure. Half (47.2%) were aged 46-65 years, 50.8% female, 41.2% publicly insured, and 91.7% underwent open surgery. Primary anastomosis was associated with higher rates of 1-year ostomy closure (83.6% vs. 53.4%, p < 0.001) and shorter time-to-closure [median 72 days (Interquartile range 49-103) vs. 115 (86-160); p < 0.001]. Primary anastomosis was associated with increased unplanned readmissions [Hazard Ratio = 2.83 (95% Confidence Interval 2.83-3.37); p < 0.001], but fewer complications upon stoma closure [Odds Ratio 0.51 (95% 0.42-0.63); p < 0.001]. There were no differences in complications between primary anastomosis and Hartmann's procedure during index admission [Odds Ratio = 1.13 (95% Confidence Interval 0.96-1.33); p = 0.137]. CONCLUSION Patients who undergo primary anastomosis for acute diverticulitis are more likely to undergo ostomy reversal and experience fewer postoperative complications upon stoma reversal. These data support the current national guidelines that recommend primary anastomosis in appropriate cases of acute diverticulitis requiring operative treatment.
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Affiliation(s)
- Arturo J Rios Diaz
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa A Bevilacqua
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Alicja Zalewski
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Metcalfe
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caitlyn Costanzo
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charles J Yeo
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Agresta F, Montori G, Podda M, Ortenzi M, Giordano A, Bergamini C, Mazzarolo G, Licitra E, Gobbi T, Procida G, Borgo AD, Botteri E, Ansaloni L, Fugazzola P, Savino G, Guerrieri M, Campanile FC, Sartori A, Petz W, Silecchia G, di Saverio S, Catena F, Agrusa A, Salemi M, Morales-Conde S, Arezzo A. Diverticulitis, surgery, evidence-based medicine, and the Steve Jobs' dots: a narrative review. Eur J Trauma Emerg Surg 2024; 50:81-91. [PMID: 37747500 DOI: 10.1007/s00068-023-02362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Emergency treatment of acute diverticulitis remains a hazy field. Despite a number of clinical studies, randomized controlled trials (RCTs), guidelines and surgical societies recommendations, the most critical hot topics have yet to be addressed. METHODS Literature research from 1963 until today was performed. Data regarding the principal RCTs and observational studies were summarized in descriptive tables. In particular we aimed to focus on the following topics: the role of laparoscopy, the acute care setting, the RCTs, guidelines, observational studies and classifications proposed by literature, the problem in case of a pandemic, and the importance of adapting treatment /place/surgeon conditions. RESULTS In the evaluation of these points we did not try to find any prospective evolution of the concepts achievements. On the contrary we simply report the individuals strands of research from a retrospective point of view, similarly to what Steve Jobes said: "you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future". We have finally obtained what can be defined "a narrative review of the literature on diverticulitis". CONCLUSIONS Not only evidence-based medicine but also the contextualization, as also the role of 'competent' surgeons, should guide to novel approach in acute diverticulitis management.
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Affiliation(s)
- Ferdinando Agresta
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy.
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Monica Ortenzi
- Clinica di Chirurgia Generale e d'Urgenza, Università Politecnica delle Marche, Ancona, Italy
| | - Alessio Giordano
- Surgery Department, Emergency Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Bergamini
- Surgery Department, Emergency Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Giorgio Mazzarolo
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Edelweiss Licitra
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Tobia Gobbi
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Giuseppa Procida
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Andrea Dal Borgo
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | | | - Luca Ansaloni
- Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Grazia Savino
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Mario Guerrieri
- Clinica di Chirurgia Generale e d'Urgenza, Università Politecnica delle Marche, Ancona, Italy
| | | | - Alberto Sartori
- Department of General Surgery, Ospedale di Montebelluna, Montebelluna, Italy
| | - Wanda Petz
- Division of Digestive Surgery, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy
| | - Salomone di Saverio
- Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, Cesena, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Michelangelo Salemi
- Medical Director of ULSS 2Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto, TV, Italy
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
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Kim DH, Lee KH. Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study. Front Surg 2023; 10:1243125. [PMID: 37829597 PMCID: PMC10566360 DOI: 10.3389/fsurg.2023.1243125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Most patients undergoing the Hartmann procedure for complicated colorectal cancer require chemotherapy because of their advanced status. Stoma created during the procedure is typically closed after the completion of postoperative chemotherapy. However, stomas can induce medical or surgical complications and disturb quality of life. This study aimed to evaluate the safety of Hartmann's reversal during postoperative chemotherapy. Methods We conducted a retrospective review of electronic medical records. Between 2017 and 2021, 96 patients underwent Hartmann reversal for after colorectal cancer surgery. Among them, the number of patients who underwent Hartmann procedure with radical resection of complicated colorectal cancer and Hartmann reversal during adjuvant chemotherapy was 13. The clinical, surgical, and pathological characteristics of the patients were evaluated. Results Eight and five patients had obstructions and perforations, respectively. Two patients with synchronous liver metastases underwent simultaneous liver resection and reversal simultaneously. Five and eight patients received adjuvant chemotherapy with capecitabine and FOLFOX, respectively. The median interval between the Hartmann procedure and reversal was 3.31 months (2.69-5.59). The median operative time for Hartmann's reversal was 190 min (100-335). The median hospital stay was 10 days (7-21). Four patients (30.8%) developed postoperative complications, and the rate of 3 or higher grade according to the Clavien-Dindo classification within 90 days postoperatively was 0%. Except for 1 patient who refused continuation of chemotherapy, 12 patients completed the planned chemotherapy. Median total duration of adjuvant chemotherapy was 6.78 months (5.98-8.48). There was no mortality. Conclusion Early Hartmann reversal during adjuvant chemotherapy is tolerable and safe in carefully selected patients. In particular, it can be used as a therapeutic option for patients with complicated colorectal cancer with synchronous resectable metastases.
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Affiliation(s)
| | - Kyung-Ha Lee
- Department of Colorectal Surgery, Chungnam National University College of Medicine and Hospital, Daejeon, Republic of Korea
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Fernoux P, Delorme E, Foote A, Faucheron JL. The suspended ileal loop for difficult Hartmann's reversal. Tech Coloproctol 2023; 27:243-6. [PMID: 36316535 DOI: 10.1007/s10151-022-02715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hartmann's reversal can be complicated by the presence of dense adhesions in the upper part of the abdominal cavity, difficulties in freeing the splenic flexure with the risk of splenic tears, a lack of sufficient colonic length, the risk of ureteral lesion, or the risk of lesions of the vascular arcade. METHODS We propose a technique which consists of interposing an adapted segment of ileal loop between the end of the proximal colon and the rectum to restore intestinal continuity. RESULTS Two patients had Hartmann procedure, the first for a Hinchey stage 4 perforated diverticulitis and the second for a colorectal fistula due to ischemia of the proximal colonic segment. Hartmann's reversal was expected to be difficult, so a suspended ileal loop was used. The outcomes were uneventful, and functional results were satisfactory. CONCLUSIONS A suspended ileal loop could be used as a salvage procedure in some cases of potentially difficult Hartmann's reversal.
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Borejsza-Wysocki M, Bobkiewicz A, Ledwosiński W, Szmyt K, Banasiewicz T, Krokowicz Ł. Challenges in restoring bowel continuity: An analysis of 91 patients undergoing a reversal procedure. Pol Przegl Chir 2023; 95:39-45. [PMID: 36808063 DOI: 10.5604/01.3001.0016.2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Introduction: The restoration of bowel continuity is associated with significant postoperative morbidity. Aim: The aim of the study was to report the outcomes of restoring intestinal continuity in a large patient cohort. Material and methods: A retrospective analysis was conducted on 91 patients with terminal stoma who were qualified for restoration of GI tract continuity between January 2015 and March 2020. The following demographic and clinical characteristics were analyzed: age, gender, BMI, comorbidities, indication for stoma creation, operative time, the need for blood replacement, the site and type of the anastomosis, and complication and mortality rates. Results: The study group was comprised of 40 women (44%) and 51 men (56%). The mean BMI was 26.8 ±4.9 kg/m2. Only 29.7% of the patients (n = 27) were at normal weight (BMI: 18.5–24.9) and only 11% (n = 10) did not suffer from any comorbidities. The most common indications for index surgery were complicated diverticulitis (37.4%) and colorectal cancer (21.9%). The stapled technique was used in the majority of patients (n = 79, 87%). The mean operative time was 191.7 ±71.4 min. Nine patients (9.9%) required blood replacement peri- or postoperatively, whereas 3 patients (3.3%) required intensive care unit admission. The overall surgical complication rate was 36.2% (n = 33) and the mortality rate was 1.1% (n = 1). Discussion: Restoration of bowel continuity is quite a demanding and complex procedure and thus should be performed by an experienced surgical team. In the majority of patients, the complication rate represents only minor complications. The morbidity and mortality rates are acceptable and comparable to other publications.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu
| | - Adam Bobkiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu
| | - Witold Ledwosiński
- Department of General, Endocrinological Surgery and Gastroenterological Oncology Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrinological Surgery and Gastrointestinal Oncology, Poznań University of Medical Sciences
| | - Tomasz Banasiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Krokowicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu
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Stefanou AJ, Kalu RU, Tang A, Reickert CA. Bowel Preparation for Elective Hartmann Operation: Analysis of the National Surgical Quality Improvement Program Database. Surg Infect (Larchmt) 2022; 23:436-443. [PMID: 35451876 DOI: 10.1089/sur.2022.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Use of pre-operative bowel preparation in colorectal resection has not been examined solely in patients who have had colorectal resection with primary colostomy (Hartmann procedure). We aimed to evaluate the association of bowel preparations with short-term outcomes after non-emergent Hartmann procedure. Patients and Methods: The National Surgical Quality Improvement Program Participant Use File colectomy database was queried for patients who had elective open or laparoscopic Hartmann operation. Patients were grouped by pre-operative bowel preparation: no bowel preparation, oral antibiotic agents, mechanical preparation, or both mechanical and oral antibiotic agent preparation (combined). Propensity analysis was performed, and outcomes were compared by type of pre-operative bowel preparation. The primary outcome was rate of any surgical site infection (SSI). Secondary outcomes included overall complication, re-operation, re-admission, Clostridioides difficile colitis, and length of stay. Results: Of the 4,331 records analyzed, 2,040 (47.1%) patients received no preparation, 251 (4.4%) received oral antibiotic preparation, 1,035 (23.9%) received mechanical bowel preparation, and 1,005 (23.2%) received combined oral antibiotic and mechanical bowel preparation. After propensity adjustment, rates of any SSI, overall complication, and length of hospital stay varied significantly between pre-operative bowel regimens (p < 0.005). The use of combined bowel preparation was associated with decreased rate of SSI, overall complication, and length of stay. No difference in rate of re-operation or post-operative Clostridioides difficile infection was observed based on bowel preparation. Conclusions: Compared with no pre-operative bowel preparation, any bowel preparation was associated with reduced rate of SSI, but not rate of re-operation or post-operative Clostridioides difficile infection.
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Affiliation(s)
- Amalia J Stefanou
- Division of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Richard U Kalu
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Craig A Reickert
- Division of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Ahmadinejad M, Ahmadinejad I, Soltanian A, Mardasi KG, Taherzade N. Using new technicque in sigmoid volvulus surgery in patients affected by COVID19. Ann Med Surg (Lond) 2021; 70:102789. [PMID: 34512969 PMCID: PMC8416359 DOI: 10.1016/j.amsu.2021.102789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Coronavirus pandemic-initiated Wuhan city, Hubei Province, China. It mainly involves respiratory system and cause fever, cough. However, it has other manifestations such as GI system, CNS and skin involvement. It is transmitted mostly through respiratory system, but some researchers claim that in can potentially spread by oral, fecal or intestinal gas. During colorectal surgeries such as volvulus sigmoid, surgeons are at risk of exposure to intestinal gas. CASE PRESENTATION A 57-year-old mentally retarded man came to our emergency department with complain of abdominal pain, constipation, obstipation, nausea, vomiting and abdominal distention. His vital sign was stable and his laboratory data revealed no abnormality. His abdominal x-ray showed intestinal obstruction with suspicious of sigmoid volvulus. His PCR for COVID 19 was positive and his chest CT scan has manifestations of lung involvement. He was proceeded for surgery. CONCLUSION Owing to odds of spread of coronavirus through intestinal gas, in this case, sigmoid colon was removed without evacuation of intestinal gas.
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Affiliation(s)
- Mojtaba Ahmadinejad
- Department of Surgery, School of Medicine, Shahid Madani Hostpital, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Ali Soltanian
- Department of Surgery, School of Medicine, Shahid Madani Hostpital, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Noshin Taherzade
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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Altin O, Kaya S, Sari R, Altuntas YE, Baris B, Kucuk HF. Surgical results of Hartmann procedure in emergency cases with left-sided colorectal cancer. CIR CIR 2021; 89:150-155. [PMID: 33784281 DOI: 10.24875/ciru.20000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to define indication of Hartmann procedure (HP) under emergency conditions, analyze, and present in which cases this procedure should be used. METHODS The patients who underwent emergency surgery for colorectal cancer were analyzed. Rates of mortality, overall, and disease-free survival of the patients were evaluated. The colostomy closure rate, operative mortality, and surgical complications of the secondary operation performed after the HP were also assessed. RESULTS Fifty-seven patients who underwent HP were included in the study. The indications were obstruction (n = 37) or perforation (n = 20). The post-operative mortality and morbidity rates were 21.1% and 63.2%, respectively. The 1-, 3-, and 5-year survival rates for all patients were 54%, 49%, and 45%. CONCLUSION HP can be a life-saving procedure in cases of high risk, emergency colorectal disease. Surgeons create a temporary stoma as a part of this procedure that is generally closed with a second operation. However, it is not possible to close the stoma in some cases, and the potential physical and emotional issues related to the stoma should be a part of the surgeon's considerations.
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Affiliation(s)
- Onder Altin
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Kaya
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Sari
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Yunus E Altuntas
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Baver Baris
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Hasan F Kucuk
- Department of General Surgery, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Yamamoto D, Sakimura Y, Kitamura H, Tsuji T, Kadoya S, Bando H. Standardization of laparoscopic reversal of the Hartmann procedure: A single-center report. Asian J Endosc Surg 2021; 14:653-657. [PMID: 33258292 DOI: 10.1111/ases.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reestablishing continuity after the Hartmann procedure, the Hartmann reversal has been recognized as a complex procedure with a high morbidity rate. Laparoscopic reversal of the Hartmann procedure (LHR) is technically challenging, although good short-term results have been reported. We formulated this technique in 2013 and have been gradually devising and standardizing it. MATERIAL AND SURGICAL TECHNIQUE Ten patients who had undergone the Hartmann procedure from January 2013 to December 2019 and subsequently LHR were retrospectively examined. During the procedure, a circular incision was made at the original site of the colostomy to safely reach the abdominal cavity, and pneumoperitoneum was performed using the glove technique. Next, pelvic adhesions and the descending colon were dissected. If the rectal stump was difficult to identify, an intraoperative endoscope was used. Finally, either a Gambee or stapled anastomosis without tension was performed. The median surgical time was 265 minutes (range, 160-435 minutes), and the median blood loss was 100 mL (range, 10-700 mL). The median postoperative hospital stay was 11 days (range, 8-14 days). In one case, laparotomy was performed because of severe intra-abdominal adhesion. DISCUSSION No major complication was observed during or after surgery. Therefore, LHR can be performed safely. Standardizing this procedure could render it minimally invasive, although a high level of evidence is needed.
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Affiliation(s)
- Daisuke Yamamoto
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Nguyen DA, Mai-Phan TA, Thai TT, Nguyen HV. Laparoscopic Hartmann Reversal: Experiences From a Developing Country. Ann Coloproctol 2021; 38:297-300. [PMID: 34162175 PMCID: PMC9441538 DOI: 10.3393/ac.2020.00577.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose Laparoscopic surgery is considered a promising approach for Hartmann reversal but is also a complicated major surgical procedure. We conducted a retrospective analysis at a city hospital in Vietnam to evaluate the treatment technique and outcomes of laparoscopic Hartmann reversal (LHR). Methods A colorectal surgery database in 5 years between 2015 and 2019 (1,175 cases in total) was retrieved to collect 35 consecutive patients undergoing LHR. Results The patients had a median age of 61 years old. The median operative time was 185 minutes. All the procedures were first attempted laparoscopically with a conversion rate of 20.0% (7 of 35 cases). There was no intraoperative complication. Postoperative mortality and morbidity were 0 and 11.4% (2 medical, 1 deep surgical site infection, and 1 anastomotic leak required reoperation) respectively. The median time to first bowel activity was 2.8 days and median length of hospital stay was 8 days. Conclusion When performed by skilled surgeons, LHR is a feasible and safe operation with acceptable morbidity rate.
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Affiliation(s)
- Dung Anh Nguyen
- Department of General Surgery, Nhan dan Gia Dinh Hospital, Ho Chi Minh, Viet Nam
| | - Tuong-Anh Mai-Phan
- Department of General Surgery, Nhan dan Gia Dinh Hospital, Ho Chi Minh, Viet Nam
| | - Truc Thanh Thai
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Viet Nam
| | - Hai Van Nguyen
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Viet Nam
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12
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Brac B, Sabbagh C, Regimbeau JM. Strategy and technique for colostomy reversal by laparoscopy after left colectomy with end colostomy ( Hartmann procedure). J Visc Surg 2021; 158:506-512. [PMID: 34059482 DOI: 10.1016/j.jviscsurg.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B Brac
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, Picardie, Amiens, France
| | - C Sabbagh
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, Picardie, Amiens, France; Unité de Recherche UPJV 7518 SSPC "Simplification des Soins des Patients Complexes", Université de Picardie-Jules-Verne, Amiens, France
| | - J M Regimbeau
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, Picardie, Amiens, France; Unité de Recherche UPJV 7518 SSPC "Simplification des Soins des Patients Complexes", Université de Picardie-Jules-Verne, Amiens, France.
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Sohn M, Agha A, Iesalnieks I, Gundling F, Presl J, Hochrein A, Tartaglia D, Brillantino A, Perathoner A, Pratschke J, Aigner F, Ritschl P. Damage control strategy in perforated diverticulitis with generalized peritonitis. BMC Surg 2021; 21:135. [PMID: 33726727 PMCID: PMC7968247 DOI: 10.1186/s12893-021-01130-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann’s procedure (HP), laparoscopic lavage (LL) and damage control surgery (DCS). This review intends to systematically analyze the current literature on DCS. Methods DCS consists of two stages. Emergency surgery: limited resection of the diseased colon, oral and aboral closure, lavage, vacuum-assisted abdominal closure. Second look surgery after 24–48 h: definite reconstruction with colorectal anastomosis (−/ + DI) or HP after adequate resuscitation. The review was conducted in accordance to the PRISMA-P Statement. PubMed/MEDLINE, Cochrane central register of controlled trials (CENTRAL) and EMBASE were searched using the following term: (Damage control surgery) AND (Diverticulitis OR Diverticulum OR Peritonitis). Results Eight retrospective studies including 256 patients met the inclusion criteria. No randomized trial was available. 67% of the included patients had purulent, 30% feculent peritonitis. In 3% Hinchey stage II diverticulitis was found. In 49% the Mannheim peritonitis index (MPI) was greater than 26. Colorectal anastomosis was constructed during the course of the second surgery in 73%. In 15% of the latter DI was applied. The remaining 27% received HP. Postoperative mortality was 9%, morbidity 31% respectively. The anastomotic leak rate was 13%. 55% of patients were discharged without a stoma. Conclusion DCS is a safe technique for the treatment of acute perforated diverticulitis with generalized peritonitis, allowing a high rate of colorectal anastomosis and stoma-free hospital discharge in more than half of the patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01130-5.
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Affiliation(s)
- Maximilian Sohn
- Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Ayman Agha
- Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Igors Iesalnieks
- Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Felix Gundling
- Department of Gastroenterology, Medizinische Klinik II, Sozialstiftung Bamberg, Bamberg Bamberg, Germany
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | - Dario Tartaglia
- Emergency Surgery Unit, Cisanello Hospital, University of Pisa, Pisa, Italy
| | | | - Alexander Perathoner
- Department of Abdominal, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, 10178, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Paul Ritschl
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, 10178, Berlin, Germany.
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14
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Gachabayov M, Tuech JJ, Tulina I, Coget J, Bridoux V, Bergamaschi R. Primary anastomosis and nonrestorative resection for perforated diverticulitis with peritonitis: meta-analysis of randomized trials. Colorectal Dis 2020; 22:1245-1257. [PMID: 32060982 DOI: 10.1111/codi.15016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of this meta-analysis was to comparatively evaluate the outcomes of primary anastomosis (PRA) and nonrestorative resection (NRR) as emergency surgery and ostomy reversal in patients with perforated diverticulitis and peritonitis. METHODS PubMed, MEDLINE via Ovid, Embase, CINAHL, Cochrane Library and Web of Science databases were systematically searched. Postoperative morbidity following emergency resection was the primary end-point. Quality assessment of the included studies was performed using the Cochrane Quality Assessment Tool including recruitment bias and crossover with intention-to-treat analysis. The Haenszel-Mantel method with odds ratios (OR, 95% CI) and the inverse variance method with mean difference (MD, 95% CI) as effect measures were utilized for dichotomous and continuous outcomes, respectively. RESULTS Four randomized controlled trials totaling 382 patients (180 PRA vs 204 NRR) were included. Morbidity rates following emergency resection did not differ (OR = 0.99, 95% CI 0.65, 1.51; P = 0.95; number needed to treat/harm (NNT) 96). Organ/space surgical site infection rates were 3.3% in PRA vs 11.3% in NRR (OR = 0.29, 95% CI 0.12, 0.74; P = 0.009; NNT = 13). Postoperative morbidity rates following ostomy reversal were significantly lower in PRA (OR = 0.31, 95% CI 0.15, 0.64; P = 0.001; NNT = 7). Pooled ostomy non-reversal rates were 16% in PRA vs 35.5% in NRR (OR = 0.37, 95% CI 0.22, 0.62; P = 0.0001; NNT = 6) with high heterogeneity (I2 = 63%; τ2 = 8.17). Meta-regression analysis revealed significant negative correlation between the PRA-to-NRR crossover rate and the ostomy non-reversal rate (P = 0.029). CONCLUSION This meta-analysis found that PRA was associated with better short- and long-term outcomes at the cost of significantly longer operating time at emergency surgery.
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Affiliation(s)
- M Gachabayov
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - J J Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex, France
| | - I Tulina
- Department of Surgery, Sechenov Moscow Medical University, Moscow, Russia
| | - J Coget
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex, France
| | - R Bergamaschi
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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15
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Curran T, Kwaan MR. Controversies in the Management of Diverticulitis. Adv Surg 2020; 54:1-16. [PMID: 32713424 DOI: 10.1016/j.yasu.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Curran
- Medical University of South Carolina, 30 Courtenay Drive, Suite 249, MSC 295, Charleston, SC 29425, USA.
| | - Mary R Kwaan
- David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Avenue, 72-215 CHS, Los Angeles, CA 90095-3075, USA
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Kühn F, Zimmermann J, Beger N, Wirth U, Hasenhütl SM, Drefs M, Chen C, Burian M, Karcz WK, Rentsch M, Werner J, Schiergens TS. Endoscopic vacuum therapy for treatment of rectal stump leakage. Surg Endosc 2020; 35:1749-1754. [PMID: 32314078 DOI: 10.1007/s00464-020-07569-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Symptomatic rectal stump leakage (RSL) is a serious complication after discontinuity resection and requires immediate surgical, interventional, or endoscopic therapy. Re-operations are associated with high morbidity and mortality in these mostly very ill patients. Endoscopic vacuum therapy (EVT) has been established for management of anastomotic leakage; however, its effectiveness for RSL treatment has not been analyzed in detail yet. METHODS A retrospective analysis of patients treated with EVT for RSL between 2001 and 2018 analyzing factors predicting therapy success and duration was carried out. RESULTS Fifty-six patients with RSL at a median age of 66 years were included. Of these, 18 patients (32%) had been referred for EVT from external departments or institutions. RSL was associated with a relevant clinical deterioration in all patients, and 55 patients (98%) had been classified as ASA 3 and 4, preoperatively. In 9 patients (16%), additional surgical revision was necessary with initiation of EVT. In 47 patients (84%), EVT was successful and local control of the inflammatory focus was achieved. The median duration of therapy was 20 days. Two patients (4%) suffered from minor EVT-associated bleeding that was endoscopically controlled. Preoperative radiation of the pelvis was significantly associated with EVT failure (P = 0.035), whereas patient age represented a predictive factor for therapy length (P = 0.039). In 12 patients (21%), restoration of intestinal continuity was achieved in the further course. CONCLUSIONS We present the first specific series on EVT for RSL. EVT for RSL was shown to be an effective and safe minimal-invasive treatment option, avoiding surgical revision in the majority of patients.
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Affiliation(s)
- Florian Kühn
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julia Zimmermann
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nicola Beger
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrich Wirth
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sandro M Hasenhütl
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Moritz Drefs
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Chen Chen
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maria Burian
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - W Konrad Karcz
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Rentsch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias S Schiergens
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
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Faucheron JL, Abba J, Trilling B. If you must operate on a patient presenting with purulent peritonitis secondary to sigmoid diverticular perforation…do not throw the baby out with the bathwater, not yet…. J Visc Surg 2018; 156:81-83. [PMID: 30241908 DOI: 10.1016/j.jviscsurg.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France.
| | - J Abba
- Department of Surgery, Emergency Unit, Michallon University Hospital, 38000 Grenoble, France
| | - B Trilling
- Department of Surgery, Colorectal Unit, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France
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18
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Desai GS, Narkhede R, Pande P, Bhole B, Varty P, Mehta H. An outcome analysis of laparoscopic management of diverticulitis. Indian J Gastroenterol 2018; 37:430-438. [PMID: 30367396 DOI: 10.1007/s12664-018-0907-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND All operative procedures for simple or complicated diverticulitis, including primary resection and anastomosis (PRA) with or without a diverting stoma, Hartmann procedure (HP), or stoma reversal, whether done in an elective setting or as an emergency, can be performed laparoscopically. However, owing to low incidence of the disease and complexity of the procedure, there are very few studies on outcomes of laparoscopic surgery for sigmoid diverticulitis from India. AIM The present study was undertaken to evaluate outcomes of laparoscopically treated patients of sigmoid diverticulitis. METHODS Prospective observational study enrolled 37 patients with sigmoid diverticulitis managed laparoscopically from March 2015 to March 2017. Demographic, clinical, operative, postoperative, and complication data were entered into a patient proforma and analyzed. RESULTS Eleven simple and 26 complicated diverticulitis patients were operated laparoscopically, 22 in emergency setting and 15 in elective setting. Only three patients required conversion to open surgery-two due to dense adhesions and one due to chronic obstructive pulmonary disease (COPD). No patients had ureteric or bowel injury. Eighteen patients underwent laparoscopic PRA without stoma, 11 patients had PRA with stoma, 6 had HP, and 2 had laparoscopic lavage. Results showed lesser blood loss, shorter hospital stay, and fewer complications in the elective group and simple diverticulitis patients. None of the patients had anastomosis-related complications. Two patients had stoma-related complications. CONCLUSION Laparoscopic management of diverticulitis is feasible, safe, provides the benefits of less wound-related complications, and shorter hospital stay and should be the surgical procedure of choice in elective or emergency setting for simple/complicated diverticulitis.
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Affiliation(s)
- Gunjan S Desai
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, A-791, Bandra Reclamation Road, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, 400 050, India.
| | - Rajvilas Narkhede
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, A-791, Bandra Reclamation Road, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, 400 050, India
| | - Prasad Pande
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, A-791, Bandra Reclamation Road, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, 400 050, India
| | - Bhushan Bhole
- Department of Gastrointestinal Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400 012, India
| | - Paresh Varty
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, A-791, Bandra Reclamation Road, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, 400 050, India
| | - Hitesh Mehta
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Center, A-791, Bandra Reclamation Road, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, 400 050, India
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Schmidt S, Ismail T, Puhan MA, Soll C, Breitenstein S. Meta-analysis of surgical strategies in perforated left colonic diverticulitis with generalized peritonitis. Langenbecks Arch Surg 2018; 403:425-433. [PMID: 29931505 DOI: 10.1007/s00423-018-1686-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/31/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Surgical strategies for perforated diverticulitis (Hinchey stages III and IV) remain controversial. This systematic review aimed to compare the outcome of primary anastomosis, Hartmann procedure and laparoscopic lavage. METHODS A systematic literature search was conducted through Medline, Embase, Cochrane Central Register and Health Technology Assessment Database to identify randomized and non-randomized controlled trials involving patients with perforated left-sided colonic diverticulitis comparing different surgical strategies. The methodological quality of the included studies was assessed systematically (Grading of Recommendations, Assessment, Development and Evaluation) and a meta-analysis was performed. RESULTS After screening 4090 titles and abstracts published between 1958 and January 2018, 148 were selected for full text assessment. Sixteen trials (7 RCTs, 9 non-RCTs) with 1223 patients were included. Mortality rates were not significantly different between Hartmann procedure and primary anastomosis for Hinchey III and IV, neither in the meta-analysis of three RCTs (RR 2.03 (95% CI 0.79 to 5.25); p = 0.14, moderate quality of evidence) nor in the meta-analysis of six observational studies (RR 1.53 (95% CI 0.89 to 2.65); p = 0.13, very low quality of evidence). However, stoma reversal rates were significantly higher in the primary anastomosis group (RR 0.73 (95% CI 0.58 to 0.98); p = 0.008, moderate quality of evidence). Meta-analysis of four RCTs showed no significant difference between laparoscopic lavage for Hinchey III compared to sigmoid resection neither for mortality (RR 1.07 (95% CI 0.65 to 1.76); p = 0.79, moderate quality of evidence) nor for major complications (RR 0.86 (95% CI 0.69 to 1.08); p = 0.20, moderate quality of evidence). CONCLUSIONS This systematic review suggests similar rates of complications but higher rates of colonic restoration after primary anastomosis compared to Hartmann procedure in perforated diverticulitis with generalized peritonitis (Hinchey III and IV). Results in laparoscopic lavage for Hinchey III are not superior to primary resection. However, further studies with a careful interpretation of the meaning of re-interventions are required.
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Affiliation(s)
- Sina Schmidt
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
| | - Tarek Ismail
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christopher Soll
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Clinic of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
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Galbraith N, Carter JV, Netz U, Yang D, Fry DE, McCafferty M, Galandiuk S. Laparoscopic Lavage in the Management of Perforated Diverticulitis: a Contemporary Meta-analysis. J Gastrointest Surg 2017; 21:1491-9. [PMID: 28608041 DOI: 10.1007/s11605-017-3462-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/19/2017] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Perforated diverticulitis carries the risk of significant comorbidity and mortality. Although colon resection provides adequate source control, the procedure itself carries morbidity, as well as later stoma reversal procedures. The effectiveness of laparoscopic lavage to treat perforated diverticulitis remains unclear. OBJECTIVE We aimed to conduct a meta-analysis to evaluate current studies comparing laparoscopic lavage with colon resection in cases of perforated diverticulitis for the effectiveness in source control, without the need for subsequent interventions, stoma formation, and death. DATA SOURCES Electronic database searches were conducted using EMBASE, Pubmed, CINAHL, Cochrane databases, and clinicaltrials.gov following PRISMA guidelines. STUDY SELECTION Randomized controlled trials (RCTs) were included that compared laparoscopic lavage against colon resection for perforated diverticulitis. DATA EXTRACTION AND SYNTHESIS Risk of bias in RCT's was assessed the Cochrane Assessment of Bias risk tool and Jadad scale. A meta-analysis was performed using random-effects risk ratios (RR) and 95% confidence intervals (CI). MAIN OUTCOME Outcome measures included the total rate of reoperation, rate of reoperation for infection, need for subsequent percutaneous drainage, stoma formation, and mortality rate within 90 days. RESULTS Three eligible randomized controlled studies were identified, with a combined total of 372 patients. Laparoscopic lavage carried an increased rate of total reoperations (RR 2.07; CI 1.12-3.84; p = 0.021) and an increased rate of reoperation for infection (RR 5.56; CI 1.97-15.69; p = 0.001) compared with colon resection. In addition, laparoscopic lavage increased the rate of subsequent percutaneous drainage (RR 6.54; CI 1.77-24.16; p = 0.005) compared with colon resection, but a lesser risk of stoma formation within 90 days (RR 0.18; CI 0.12-0.27; p < 0.001). No difference in mortality rate was observed between treatments (RR 1.03; CI 0.45-2.34; p = 0.950). CONCLUSION Despite decreased rates of stoma formation and equivalent mortality rates as compared with colon resection, laparoscopic lavage for Hinchey III diverticulitis fails to completely control the source of infection. Our data show that laparoscopic lavage is associated with increased rates of total reoperations, increased rates of reoperation for infections, and need for subsequent percutaneous drainage.
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Rosado-Cobián R, Blasco-Segura T, Ferrer-Márquez M, Marín-Ortega H, Pérez-Domínguez L, Biondo S, Roig-Vila JV. Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons. Cir Esp 2017; 95:369-377. [PMID: 28416357 DOI: 10.1016/j.ciresp.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/15/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022]
Abstract
The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed.
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Affiliation(s)
- Rafael Rosado-Cobián
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Torrecárdenas, Almería, España
| | - Teresa Blasco-Segura
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España
| | - Manuel Ferrer-Márquez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Torrecárdenas, Almería, España.
| | - Héctor Marín-Ortega
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces , Barakaldo (Vizcaya), España
| | - Lucinda Pérez-Domínguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Álvaro Cunqueiro Complejo Hospitalario Universitario de Vigo, Vigo, España
| | - Sebastiano Biondo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de Bellvitge, Barcelona, España
| | - José Vicente Roig-Vila
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Nisa 9 de Octubre, Valencia, España
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Haas JM, Singh M, Vakil N. Mortality and complications following surgery for diverticulitis: Systematic review and meta-analysis. United European Gastroenterol J 2016; 4:706-713. [PMID: 27733913 PMCID: PMC5042306 DOI: 10.1177/2050640615617357] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/21/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The surgical treatment of diverticulitis is in a state of evolution. Clinicians across many disciplines need to counsel patients regarding surgical choices. OBJECTIVES A systematic review and meta-analysis was conducted to determine the mortality and complication rates following surgery for diverticulitis in both the emergent and elective setting. METHODS We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published from 1980 to 2012. The primary outcome of interest was the point estimate of mortality, following surgery for diverticulitis. RESULTS Of the 289 citations reviewed, we included 59 studies. Overall, the point estimate for mortality was 3.05%, with a 95% confidence intereval (CI) of 1.73-5.32 and p < 0.001. Mortality following emergent surgery was 10.64% (95% CI 7.95-14.11; p < 0.001), versus 0.50% (95% CI 0.46-0.54; p < 0.001) following elective operations. A laparoscopic approach had an estimated mortality of 0.75% (95% CI 0.35-1.58; p < 0.001), compared to an open surgical approach, which had a mortality of 4.69% (95% CI 2.29-9.36, p < 0.001). The mortality following a resection with primary anastomosis was 1.96% (95% CI 1.22-3.13; p < 0.001) and for the Hartmann's procedure was 14.18% (95% CI 9.83-20.03; p < 0.001). A comparative analysis found that the risk of post-operative mortality was significantly higher following emergent surgery, compared to elective surgery (odds ratio (OR): 6.12 with 95% CI 1.62-23.10; p = 0.008; Q = 2.56, p = 0.46 and I2 = 0); the open approach, compared to a laparoscopic approach (OR: 36.43 with 95% CI 9.94-133.6; p = 0.13; and Q = 2.79, p = 0.25 and I2 = 28.26); and for Hartmann's procedure, compared to primary anastomosis without diversion (OR: 25.45 with 95% CI 15.13-42.81, p < 0.001; and Q = 23.34, p = 0.14 and I2 = 27.16). The overall reported post-operative complication rate was 32.64% (95% CI 27.43-38.32; p < 0.00). The overall surgical and medical complication rates were 18.96% and 13.93%, respectively. CONCLUSIONS Urgent surgical treatment of diverticulitis has a significant complication rate. Even elective surgery has a significant complication rate that needs to be considered when doing the clinical decision-making for recurrent diverticulitis.
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Affiliation(s)
- Jason M Haas
- Department of Gastroenterology, Aurora Health Care, Milwaukee, WI, USA
| | - Maharaj Singh
- Aurora Research Institute, Aurora Sinai Medical Center, Milwaukee, WI, USA
| | - Nimish Vakil
- Division of Gastroenterology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Hino H, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Numata M, Furutani A, Suzuki T, Torii K. Relationship between stoma creation route for end colostomy and parastomal hernia development after laparoscopic surgery. Surg Endosc 2016; 31:1966-1973. [PMID: 27553802 DOI: 10.1007/s00464-016-5198-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The therapeutic benefits of extraperitoneal colostomy with laparoscopic surgery remain unclear. The aim of this study was to investigate the relationship between the route for stoma creation with laparoscopic surgery and stoma-related complications, especially parastomal hernia (PSH). METHODS From January 2007 to March 2015, a total of 59 patients who underwent laparoscopic abdominoperineal resection or Hartmann procedure were investigated. Patient demographic and treatment characteristics, including stoma-related complications, were analyzed retrospectively. RESULTS Transperitoneal and extraperitoneal colostomy were performed in 29 and 30 patients, respectively. Median follow-up duration was 21 months (range: 2-95). Patient demographic and treatment characteristics were comparable between the transperitoneal group (TPG) and the extraperitoneal group (EPG). PSH developed in 12 (41 %) patients in TPG, and 4 (13 %) patients in EPG (p = 0.020). The incidence of other stoma-related complications and non-stoma-related complications did not differ significantly between TPG and EPG. No patient characteristics except for transperitoneal route for stoma creation were associated with PSH development. CONCLUSIONS The extraperitoneal route for stoma creation is associated with a significantly lower incidence of PSH development after laparoscopic surgery. Whenever possible, extraperitoneal colostomy should be recommended, even with laparoscopic surgery.
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Affiliation(s)
- Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yushi Yamakawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masakatsu Numata
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Akinobu Furutani
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Takuya Suzuki
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kakeru Torii
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Mahmoudi A, Maâtouk M, Noomen F, Nasr M, Zouari K, Hamdi A. [Stercoral the perforation of the colon: report of a case and review of literature]. Pan Afr Med J 2015; 22:249. [PMID: 26958112 PMCID: PMC4764317 DOI: 10.11604/pamj.2015.22.249.8114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/26/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ammar Mahmoudi
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Mezri Maâtouk
- Service d'imagerie Médicale, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Faouzi Noomen
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Mohamed Nasr
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Khadija Zouari
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Abdelaziz Hamdi
- Service de Chirurgie Générale et Digestive, CHU Fattouma Bourguiba de Monastir, Tunisie
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Affiliation(s)
- Anthony A Meyer
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, Chapel Hill, NC 27599-7050, USA
| | - Timothy S Sadiq
- Division of GI Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4035 Burnett-Womack, CB 7081, Chapel Hill, NC 27599-7081, USA.
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Choi BJ, Jeong WJ, Kim SJ, Lee SC. Single-port laparoscopic surgery for sigmoid volvulus. World J Gastroenterol 2015; 21:2381-2386. [PMID: 25741145 PMCID: PMC4342914 DOI: 10.3748/wjg.v21.i8.2381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/11/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To report our experience with single-port laparoscopic surgery (SPLS) for sigmoid volvulus (SV).
METHODS: Between October 2009 and April 2013, 10 patients underwent SPLS for SV. SPLS was performed transumbilically or through a predetermined stoma site. Conventional straight and rigid-type laparoscopic instruments were used. After intracorporeal, segmental resection of the affected sigmoid colon, the specimen was extracted through the single-incision site. Patient demographics and perioperative data were analyzed.
RESULTS: SPLS for SV was successful in all 10 patients (4, resection and primary anastomosis; 6, Hartmann’s procedure). The median operative time and postoperative hospitalization period were 168 (range, 85-315) min and 6.5 (range, 4-29) d, respectively. No intraoperative complications were noted; there were 2 postoperative complications, including 1 anastomotic leak.
CONCLUSION: SPLS was a safe and feasible therapeutic approach for SV, when performed by a surgeon experienced in conventional laparoscopic surgery.
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Chéreau N, Lefevre JH, Lefrancois M, Chafai N, Parc Y, Tiret E. Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option? Colorectal Dis 2013; 15:e646-53. [PMID: 23819886 DOI: 10.1111/codi.12335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/21/2013] [Indexed: 02/08/2023]
Abstract
AIM The surgical management of obstructed left colorectal cancer (OLCC) is still a matter of debate, and current guidelines recommend Hartmann's procedure (HP). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy (IC) followed by elective resection. METHOD All patients operated on for OLCC were reviewed. Clinical, surgical, histological, morbidity and long-term results were noted. RESULTS From 2000-11, 83 patients (48 men) with a mean age of 70.3 ± 15.1 years underwent surgery for OLCC. Eleven (13.3%) had a subtotal colectomy owing to a laceration of the caecal wall. Eleven had a HP for tumour perforation (n = 6) or as palliation in a severely ill patient (n = 5). The remaining 61 (73.5%) patients had an IC, with the intention of performing an elective resection shortly after recovery. Postoperative complications occurred in six (9.8%) and there were two (3.3%) deaths. Fifty-nine operation survivors had a colonoscopy shortly afterwards which showed a synchronous cancer in two (3.4%). Twelve of the 59 patients had synchronous metastases. The subsequent elective resection including the colostomy site could be performed in 45 (74%) patients during the same admission at a median interval of 11 (7-17) days. The overall median length of hospital stay was 20 days and the 30-day mortality was 3/61 (5%). CONCLUSION IC followed by surgical resection is a technically simple strategy, allowing initial abdominal exploration with a short period of having a colostomy, and permitting elective surgery with a low morbidity and full oncological lymphadenectomy.
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Affiliation(s)
- N Chéreau
- Department of Digestive Surgery, Hôpital Saint Antoine, University Pierre & Marie Curie, Paris VI, France
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Abstract
Background: The Hartmann procedure is a standard life-saving operation for acute left colonic complications. It is usually performed as a temporary procedure with the intent to reverse it later on. This reversal is associated with considerable morbidity and mortality by open method. The laparoscopic reestablishment of intestinal continuity after Hartmann procedure has shown better results in terms of decrease in morbidity and mortality. Materials and Methods: The laparoscopic technique was used consecutively in 12 patients for the reversal of Hartmann procedure in the last 3 years. The adhesiolysis and mobilization of the colon was done under laparoscopic guidance. The colostomy was mobilized and returned to abdominal cavity after tying the anvil in the proximal end. An end-to-end intracorporeal anastomosis was performed between the proximal colon and the rectum using the circular stapler. Results: Mean age of the patients was 40 years and the mean time of restoration of intestinal continuity was 130 days. Two patients were converted to open. The mean time of operation was 90 min. There were no postoperative complications and mortality. The mean hospital stay was 5 days. Conclusion: Laparoscopic reversal of Hartmann is technically safe and feasible.
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Affiliation(s)
- Vishwanath Golash
- Department of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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