BACKGROUND: The optimal surgical management of acute diverticulitis is still a controversial and unresolved issue. While the Hartmann's procedure (`) is the most commonly performed operation, primary anastomosis (PA), with or without proximal diversion, has also been used with increasing frequency. METHODS: This is a National Surgical Quality Improvement Program database study including all patients requiring emergency surgery for acute diverticulitis. Three operative approaches were analyzed: HP, colectomy with PA, and colectomy with PA with proximal diversion (PAPD). Mortality and postoperative outcomes were compared between the three groups using a logistical regression model. RESULTS: There were 1,314 patients who required emergent operation for acute diverticulitis, 75.4% underwent HP, 21.7% underwent PA, and 2.9% underwent PAPD. Thirty-day mortality was 7.3%, 4.6%, and 1.6% for HP, PA, and PAPD respectively (p = 0.163), while surgical site infections occurred in 19.7%, 17.9%, and 13.2%, respectively (p = 0.59). After multivariable analysis adjusting for age, alcohol consumption, comorbidities, steroid use, preoperative laboratory values, hemorrhage at admission and laparoscopic surgery, the adjusted odds ratio for 30-day mortality comparing PA with HP was 0.77 (95% confidence interval [CI], 0.38-1.56; p = 0.465), 0.47 (95% CI, 0.06-3.74; p = 0.479) comparing PAPD with HP, and 1.62 (95% CI, 0.19-13.78; p = 0.658) comparing PA with PAPD. In addition, the three groups did not have significantly different adjusted odds ratio for the development of surgical infectious complications, acute kidney injury, cardiovascular incidents, or venous thromboembolism after surgery. CONCLUSION: Resection and PA in patients undergoing an emergency operation for acute diverticulitis is a safe alternative to the HP, with no significant difference in mortality or postoperative surgical site infections. LEVEL OF EVIDENCE: Therapeutic study, level IV.
BACKGROUND: The optimal surgical management of acute diverticulitis is still a controversial and unresolved issue. While the Hartmann's procedure (`) is the most commonly performed operation, primary anastomosis (PA), with or without proximal diversion, has also been used with increasing frequency. METHODS: This is a National Surgical Quality Improvement Program database study including all patients requiring emergency surgery for acute diverticulitis. Three operative approaches were analyzed: HP, colectomy with PA, and colectomy with PA with proximal diversion (PAPD). Mortality and postoperative outcomes were compared between the three groups using a logistical regression model. RESULTS: There were 1,314 patients who required emergent operation for acute diverticulitis, 75.4% underwent HP, 21.7% underwent PA, and 2.9% underwent PAPD. Thirty-day mortality was 7.3%, 4.6%, and 1.6% for HP, PA, and PAPD respectively (p = 0.163), while surgical site infections occurred in 19.7%, 17.9%, and 13.2%, respectively (p = 0.59). After multivariable analysis adjusting for age, alcohol consumption, comorbidities, steroid use, preoperative laboratory values, hemorrhage at admission and laparoscopic surgery, the adjusted odds ratio for 30-day mortality comparing PA with HP was 0.77 (95% confidence interval [CI], 0.38-1.56; p = 0.465), 0.47 (95% CI, 0.06-3.74; p = 0.479) comparing PAPD with HP, and 1.62 (95% CI, 0.19-13.78; p = 0.658) comparing PA with PAPD. In addition, the three groups did not have significantly different adjusted odds ratio for the development of surgical infectious complications, acute kidney injury, cardiovascular incidents, or venous thromboembolism after surgery. CONCLUSION: Resection and PA in patients undergoing an emergency operation for acute diverticulitis is a safe alternative to the HP, with no significant difference in mortality or postoperative surgical site infections. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors: R Cirocchi; S Di Saverio; D G Weber; R Taboła; I Abraha; J Randolph; A Arezzo; G A Binda Journal: Tech Coloproctol Date: 2017-02-15 Impact factor: 3.781
Authors: Anthony B Mozer; Konstantinos Spaniolas; Megan E Sippey; Adam Celio; Mark L Manwaring; Kevin R Kasten Journal: Int J Colorectal Dis Date: 2016-11-04 Impact factor: 2.571
Authors: Matthijs H van Gool; Georgios F Giannakopoulos; Leo M G Geeraedts; Elly S M de Lange-de Klerk; Wietse P Zuidema Journal: Langenbecks Arch Surg Date: 2014-12-23 Impact factor: 3.445
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