Laura Beyer-Berjot1, Léon Maggiori2, Didier Loiseau3, Jean-Dominique De Korwin4, Jean-Pierre Bongiovanni5, Philippe Lesprit6, Nathalie Salles7, Pascal Rousset8, Thomas Lescot9, Aymeric Henriot10, Magalie Lefrançois11, Eddy Cotte12, Yann Parc13. 1. Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France. 2. Department of Colorectal Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France. 3. Cetad (Gastroenterology), Paris, France. 4. Department of Internal Medicine, Centre Hospitalier Régional Universitaire de Nancy - Hôpital de Brabois, Vandoeuvre-Lès-Nancy, France. 5. Department of Anesthesiology - Intensive Care, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France. 6. Department of Clinical Biology, Hôpital Foch, Suresnes, France. 7. Clinical Geriatrics, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France. 8. Department of Radiology, Hospices Civils de Lyon, Université de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France. 9. Department of Anesthesiology - Intensive Care, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Université Sorbonne, Paris, France. 10. Université Grenoble Alpes (General Practice), Domène, France. 11. Department of Gastrointestinal Surgery, Clinique du Parc, Castelnau Le Lez, France. 12. Department of Gastrointestinal Surgery, Hospices Civils de Lyon, Université de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France. 13. Department of Digestive Surgery, Hôpital Saint Antoine, Assistance Publique -Hôpitaux de Paris, Université Sorbonne, Paris, France.
Abstract
BACKGROUND: Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis. OBJECTIVE: The aim of this systematic review was to define the accurate surgical management of acute diverticulitis. DATA SOURCES: Medline, Embase, and the Cochrane Library were sources used. STUDY SELECTION: One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee. INTERVENTIONS: The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach. MAIN OUTCOME MEASURES: Morbidity, mortality, long-term stoma rates, and quality of life were measured. RESULTS: Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach. LIMITATIONS: Trials specifically assessing Hinchey IV diverticulitis have not yet been completed. CONCLUSIONS: High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
BACKGROUND:Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis. OBJECTIVE: The aim of this systematic review was to define the accurate surgical management of acute diverticulitis. DATA SOURCES: Medline, Embase, and the Cochrane Library were sources used. STUDY SELECTION: One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee. INTERVENTIONS: The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach. MAIN OUTCOME MEASURES: Morbidity, mortality, long-term stoma rates, and quality of life were measured. RESULTS: Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach. LIMITATIONS: Trials specifically assessing Hinchey IV diverticulitis have not yet been completed. CONCLUSIONS: High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Authors: Nicolás H Dreifuss; Francisco Schlottmann; Jose M Piatti; Maximiliano E Bun; Nicolás A Rotholtz Journal: Surg Endosc Date: 2019-06-17 Impact factor: 4.584