BACKGROUND: The optimal treatment for acute complicated diverticulitis is still a matter of debate. We evaluated outcomes of primary anastomosis with proximal diversion (PAD) versus Hartman's procedure (HP) in acute diverticulitis. METHODS: Using the National Inpatient Sample database, we examined the clinical data of patients who underwent an urgent open colorectal resection (sigmoidectomy or anterior resection) for acute diverticulitis from 2002 to 2007 in the United States. We evaluated patient characteristics, patient comorbidities, perioperative complications, in-hospital mortality, length of hospital stay and total hospital charges between two groups. RESULTS: A total of 99,259 patients underwent urgent surgery for acute diverticulitis during these years (Primary anastomosis without diversion: 39.3%; HP: 57.3% and PAD: 3.4%). The overall complication rate was lower in the PAD group compared with the HP group (PAD: 39.06% vs. HP: 40.84%; p = 0.04). Patients in the HP group had a shorter mean length of stay (12.5 vs.14.4 days, p < 0.001) and lower mean hospital costs (USD 65,037 vs. USD 73,440, p < 0.01) compared with the PAD group. Mortality was higher in the HP group (4.82 vs. 3.99%, p = 0.03). CONCLUSION: PAD has improved outcomes compared with HP, and should be considered in patients who are deemed candidates for two-stage operations for acute diverticulitis.
BACKGROUND: The optimal treatment for acute complicated diverticulitis is still a matter of debate. We evaluated outcomes of primary anastomosis with proximal diversion (PAD) versus Hartman's procedure (HP) in acute diverticulitis. METHODS: Using the National Inpatient Sample database, we examined the clinical data of patients who underwent an urgent open colorectal resection (sigmoidectomy or anterior resection) for acute diverticulitis from 2002 to 2007 in the United States. We evaluated patient characteristics, patient comorbidities, perioperative complications, in-hospital mortality, length of hospital stay and total hospital charges between two groups. RESULTS: A total of 99,259 patients underwent urgent surgery for acute diverticulitis during these years (Primary anastomosis without diversion: 39.3%; HP: 57.3% and PAD: 3.4%). The overall complication rate was lower in the PAD group compared with the HP group (PAD: 39.06% vs. HP: 40.84%; p = 0.04). Patients in the HP group had a shorter mean length of stay (12.5 vs.14.4 days, p < 0.001) and lower mean hospital costs (USD 65,037 vs. USD 73,440, p < 0.01) compared with the PAD group. Mortality was higher in the HP group (4.82 vs. 3.99%, p = 0.03). CONCLUSION: PAD has improved outcomes compared with HP, and should be considered in patients who are deemed candidates for two-stage operations for acute diverticulitis.
Authors: Rosario Cuomo; Giovanni Barbara; Fabio Pace; Vito Annese; Gabrio Bassotti; Gian Andrea Binda; Tino Casetti; Antonio Colecchia; Davide Festi; Roberto Fiocca; Andrea Laghi; Giovanni Maconi; Riccardo Nascimbeni; Carmelo Scarpignato; Vincenzo Villanacci; Bruno Annibale Journal: United European Gastroenterol J Date: 2014-10 Impact factor: 4.623
Authors: Massimo Sartelli; Frederick A Moore; Luca Ansaloni; Salomone Di Saverio; Federico Coccolini; Ewen A Griffiths; Raul Coimbra; Ferdinando Agresta; Boris Sakakushev; Carlos A Ordoñez; Fikri M Abu-Zidan; Aleksandar Karamarkovic; Goran Augustin; David Costa Navarro; Jan Ulrych; Zaza Demetrashvili; Renato B Melo; Sanjay Marwah; Sanoop K Zachariah; Imtiaz Wani; Vishal G Shelat; Jae Il Kim; Michael McFarlane; Tadaja Pintar; Miran Rems; Miklosh Bala; Offir Ben-Ishay; Carlos Augusto Gomes; Mario Paulo Faro; Gerson Alves Pereira; Marco Catani; Gianluca Baiocchi; Roberto Bini; Gabriele Anania; Ionut Negoi; Zurabs Kecbaja; Abdelkarim H Omari; Yunfeng Cui; Jakub Kenig; Norio Sato; Andras Vereczkei; Matej Skrovina; Koray Das; Giovanni Bellanova; Isidoro Di Carlo; Helmut A Segovia Lohse; Victor Kong; Kenneth Y Kok; Damien Massalou; Dmitry Smirnov; Mahir Gachabayov; Georgios Gkiokas; Athanasios Marinis; Charalampos Spyropoulos; Ioannis Nikolopoulos; Konstantinos Bouliaris; Jaan Tepp; Varut Lohsiriwat; Elif Çolak; Arda Isik; Daniel Rios-Cruz; Rodolfo Soto; Ashraf Abbas; Cristian Tranà; Emanuele Caproli; Darija Soldatenkova; Francesco Corcione; Diego Piazza; Fausto Catena Journal: World J Emerg Surg Date: 2015-02-19 Impact factor: 5.469