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Outcome after emergency surgery for acute perforated diverticulitis in 200 cases.
Dig Surg 2007; 24(5):361-6DS

Abstract

BACKGROUND

Mortality and morbidity rates of acute perforated diverticulitis remain high. The ideal treatment is still controversial. The object of this study was to compare patients with perforated diverticulitis treated either by resection with primary anastomosis (PA) or Hartmann's procedure (HP).

METHODS

A multicenter study was carried out on 200 consecutive patients with acute perforated diverticulitis who were presented in the surgical units of four affiliated teaching hospitals in Rotterdam, The Netherlands, between 1995 and 2005. Mortality and morbidity were compared in relation to type of surgery, ASA classification, age, gender, Mannheim Peritonitis Index (MPI), Hinchey score, surgeon's experience, and the time of operation.

RESULTS

There was a tendency for more severely affected patients (Hinchey, MPI, ASA and age) to undergo HP. Multivariate logistic regression analysis showed no significant difference in mortality between HP and PA. After HP, more patients needed one or more reinterventions to treat postoperative complications compared to PA. Besides, HP resulted in a longer total hospital and intensive care unit stay. Specialist colorectal surgeons performed significantly more frequently a PA instead of a HP and had fewer postoperative complications than general surgeons. The time of operation did not influence the choice of surgical procedure.

CONCLUSION

Selected patients with perforated diverticulitis can be managed well by PA, as it does not seem to be inferior to HP in terms of severe postoperative complications that need surgical or radiological reintervention and mortality. This decision should be made while taking into account the patient's concomitant diseases, response on preoperative resuscitation and the availability of a surgeon experienced in colorectal surgery.

Authors+Show Affiliations

Department of Surgery, MCRZ St. Clara Hospital and Zuider Hospital, Rotterdam, The Netherlands. VermeulenJ@MCRZ.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

17785981

Citation

Vermeulen, Jefrey, et al. "Outcome After Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases." Digestive Surgery, vol. 24, no. 5, 2007, pp. 361-6.
Vermeulen J, Akkersdijk GP, Gosselink MP, et al. Outcome after emergency surgery for acute perforated diverticulitis in 200 cases. Dig Surg. 2007;24(5):361-6.
Vermeulen, J., Akkersdijk, G. P., Gosselink, M. P., Hop, W. C., Mannaerts, G. H., van der Harst, E., ... Lange, J. F. (2007). Outcome after emergency surgery for acute perforated diverticulitis in 200 cases. Digestive Surgery, 24(5), pp. 361-6.
Vermeulen J, et al. Outcome After Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases. Dig Surg. 2007;24(5):361-6. PubMed PMID: 17785981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome after emergency surgery for acute perforated diverticulitis in 200 cases. AU - Vermeulen,Jefrey, AU - Akkersdijk,George P, AU - Gosselink,Martijn P, AU - Hop,Wim C J, AU - Mannaerts,Guido H, AU - van der Harst,Erwin, AU - Coene,Peter-Paul L O, AU - Weidema,Wibo F, AU - Lange,Johan F, Y1 - 2007/08/30/ PY - 2006/11/29/received PY - 2007/06/15/accepted PY - 2007/9/6/pubmed PY - 2008/1/26/medline PY - 2007/9/6/entrez SP - 361 EP - 6 JF - Digestive surgery JO - Dig Surg VL - 24 IS - 5 N2 - BACKGROUND: Mortality and morbidity rates of acute perforated diverticulitis remain high. The ideal treatment is still controversial. The object of this study was to compare patients with perforated diverticulitis treated either by resection with primary anastomosis (PA) or Hartmann's procedure (HP). METHODS: A multicenter study was carried out on 200 consecutive patients with acute perforated diverticulitis who were presented in the surgical units of four affiliated teaching hospitals in Rotterdam, The Netherlands, between 1995 and 2005. Mortality and morbidity were compared in relation to type of surgery, ASA classification, age, gender, Mannheim Peritonitis Index (MPI), Hinchey score, surgeon's experience, and the time of operation. RESULTS: There was a tendency for more severely affected patients (Hinchey, MPI, ASA and age) to undergo HP. Multivariate logistic regression analysis showed no significant difference in mortality between HP and PA. After HP, more patients needed one or more reinterventions to treat postoperative complications compared to PA. Besides, HP resulted in a longer total hospital and intensive care unit stay. Specialist colorectal surgeons performed significantly more frequently a PA instead of a HP and had fewer postoperative complications than general surgeons. The time of operation did not influence the choice of surgical procedure. CONCLUSION: Selected patients with perforated diverticulitis can be managed well by PA, as it does not seem to be inferior to HP in terms of severe postoperative complications that need surgical or radiological reintervention and mortality. This decision should be made while taking into account the patient's concomitant diseases, response on preoperative resuscitation and the availability of a surgeon experienced in colorectal surgery. SN - 0253-4886 UR - https://www.unboundmedicine.com/medline/citation/17785981/Outcome_after_emergency_surgery_for_acute_perforated_diverticulitis_in_200_cases_ L2 - https://www.karger.com?DOI=10.1159/000107719 DB - PRIME DP - Unbound Medicine ER -