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Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis.
Dis Colon Rectum. 2001 May; 44(5):699-703; discussion 703-5.DC

Abstract

PURPOSE

Our hypothesis was that in patients with perforated sigmoid colon diverticulitis and peritonitis (Hinchey Stage III and IV) a one-stage sigmoid colon resection is safe and cost effective when performed by an experienced colorectal surgeon. We evaluated outcome and cost of one-stage vs. two-stage sigmoid colon resection after diverticulitis perforation and peritonitis.

METHODS

Patients undergoing emergency resection for perforated sigmoid colon diverticulitis and peritonitis (Hinchey Stage III and IV). Outcome, costs, and insurers reimbursement were compared between 13 patients undergoing sigmoid colon resection and primary anastomosis (Group A) and 42 patients undergoing sigmoid colon resection with Hartmann's procedure and secondary descendorectostomy (Group B).

RESULTS

Group A patients were comparable to Group B patients in age, gender, preoperative risk and severity of peritonitis (Mannheim Peritonitis Index and C-reactive protein). Operating room time for sigmoid colon resection with primary anastomosis (3.3 +/- 1.2 hours) was identical to the time for sigmoid colon resection with colostomy (3.3 +/- 1 hour), and morbidity and mortality, intensive care unit, and in-hospital stay were not significantly different between the two groups. In Group B patients' intestinal continuity was restored 169 +/- 74 days after the primary resection in 32 of 42 patients only (78 percent). The second procedure took on average 1.4 hours longer than the first procedure. Patients in Group B received more antibiotics (2.2 vs. 2) albeit for a shorter period of time (4.5 vs. 5.7 days, P = not significant). Overall expenses for restoration of intestinal continuity were between 74 and 229 percent higher for Group B patients than for Group A patients. Reimbursement was 18,191 +/- 16,761 SFr (Group A) and 41,321 +/- 26,983 SFr (Group B) respectively.

CONCLUSION

With meticulous surgical technique and extensive intraoperative lavage, perforated sigmoid colon diverticulitis with peritonitis can be treated by a one-stage sigmoid colon resection and anastomosis with a low mortality and morbidity. A one-stage procedure is considerably cheaper and patients are rehabilitated faster and to a higher percentage.

Authors+Show Affiliations

Department of Visceral and Transplantation Surgery, University of Bern, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

11357032

Citation

Schilling, M K., et al. "Primary Vs. Secondary Anastomosis After Sigmoid Colon Resection for Perforated Diverticulitis (Hinchey Stage III and IV): a Prospective Outcome and Cost Analysis." Diseases of the Colon and Rectum, vol. 44, no. 5, 2001, pp. 699-703; discussion 703-5.
Schilling MK, Maurer CA, Kollmar O, et al. Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum. 2001;44(5):699-703; discussion 703-5.
Schilling, M. K., Maurer, C. A., Kollmar, O., & Büchler, M. W. (2001). Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Diseases of the Colon and Rectum, 44(5), 699-703; discussion 703-5.
Schilling MK, et al. Primary Vs. Secondary Anastomosis After Sigmoid Colon Resection for Perforated Diverticulitis (Hinchey Stage III and IV): a Prospective Outcome and Cost Analysis. Dis Colon Rectum. 2001;44(5):699-703; discussion 703-5. PubMed PMID: 11357032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. AU - Schilling,M K, AU - Maurer,C A, AU - Kollmar,O, AU - Büchler,M W, PY - 2001/5/18/pubmed PY - 2001/6/8/medline PY - 2001/5/18/entrez SP - 699-703; discussion 703-5 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 44 IS - 5 N2 - PURPOSE: Our hypothesis was that in patients with perforated sigmoid colon diverticulitis and peritonitis (Hinchey Stage III and IV) a one-stage sigmoid colon resection is safe and cost effective when performed by an experienced colorectal surgeon. We evaluated outcome and cost of one-stage vs. two-stage sigmoid colon resection after diverticulitis perforation and peritonitis. METHODS: Patients undergoing emergency resection for perforated sigmoid colon diverticulitis and peritonitis (Hinchey Stage III and IV). Outcome, costs, and insurers reimbursement were compared between 13 patients undergoing sigmoid colon resection and primary anastomosis (Group A) and 42 patients undergoing sigmoid colon resection with Hartmann's procedure and secondary descendorectostomy (Group B). RESULTS: Group A patients were comparable to Group B patients in age, gender, preoperative risk and severity of peritonitis (Mannheim Peritonitis Index and C-reactive protein). Operating room time for sigmoid colon resection with primary anastomosis (3.3 +/- 1.2 hours) was identical to the time for sigmoid colon resection with colostomy (3.3 +/- 1 hour), and morbidity and mortality, intensive care unit, and in-hospital stay were not significantly different between the two groups. In Group B patients' intestinal continuity was restored 169 +/- 74 days after the primary resection in 32 of 42 patients only (78 percent). The second procedure took on average 1.4 hours longer than the first procedure. Patients in Group B received more antibiotics (2.2 vs. 2) albeit for a shorter period of time (4.5 vs. 5.7 days, P = not significant). Overall expenses for restoration of intestinal continuity were between 74 and 229 percent higher for Group B patients than for Group A patients. Reimbursement was 18,191 +/- 16,761 SFr (Group A) and 41,321 +/- 26,983 SFr (Group B) respectively. CONCLUSION: With meticulous surgical technique and extensive intraoperative lavage, perforated sigmoid colon diverticulitis with peritonitis can be treated by a one-stage sigmoid colon resection and anastomosis with a low mortality and morbidity. A one-stage procedure is considerably cheaper and patients are rehabilitated faster and to a higher percentage. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/11357032/Primary_vs__secondary_anastomosis_after_sigmoid_colon_resection_for_perforated_diverticulitis__Hinchey_Stage_III_and_IV_:_a_prospective_outcome_and_cost_analysis_ L2 - http://link.springer.com/article/10.1007/bf02234569 DB - PRIME DP - Unbound Medicine ER -