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Primary anastomosis vs Hartmann's procedure in patients undergoing emergency left colectomy for perforated diverticulitis.
Colorectal Dis. 2010 Jan; 12(1):54-60.CD

Abstract

OBJECTIVE

Comparison of primary anastomosis (PA) and Hartmann's procedure (HP) in perforated diverticulitis is biased as the patient groups are different in age, comorbidity and severity of disease. Still, PA has been advocated as the procedure of choice. The aim of this study was to compare the two surgical procedures after eliminating this selection bias using a propensity score model.

METHOD

Sixty-five HP and 46 PA patients who underwent emergency laparotomy for perforated diverticulitis were analysed. Multivariate logistic regression using the Mannheim peritonitis index, Colorectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity, Charlson comorbidity index and Hinchey score was performed to determine the propensity score.

RESULTS

Patients with HP had significantly higher scores, median age and were more often on immunosuppressive medication. Unadjusted logistic regression for outcome showed a significant risk of HP vs PA for nonsurgical morbidity (odds ratio 3.25, 95% CI: 1.26-8.43; P = 0.015), but not for mortality and surgical morbidity. After adjusting for the propensity score, outcome was not significantly different. Patients with PA had a clinical leak rate of 28% and none of the patients with leakage had a protective ileostomy. Patients with PA and leak had higher Charlson scores whereas all other scores were similar to nonleak patients.

CONCLUSION

The theory that PA is generally superior to HP cannot be supported. HP remains a safe technique for emergency colectomy in perforated diverticulitis, especially in elderly patients with multiple comorbidities. If PA is performed, a protective ileostomy must be considered.

Authors+Show Affiliations

Department of Surgery, Triemli Hospital, Zurich, Switzerland. uzingg@uhbs.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19175638

Citation

Zingg, U, et al. "Primary Anastomosis Vs Hartmann's Procedure in Patients Undergoing Emergency Left Colectomy for Perforated Diverticulitis." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 12, no. 1, 2010, pp. 54-60.
Zingg U, Pasternak I, Dietrich M, et al. Primary anastomosis vs Hartmann's procedure in patients undergoing emergency left colectomy for perforated diverticulitis. Colorectal Dis. 2010;12(1):54-60.
Zingg, U., Pasternak, I., Dietrich, M., Seifert, B., Oertli, D., & Metzger, U. (2010). Primary anastomosis vs Hartmann's procedure in patients undergoing emergency left colectomy for perforated diverticulitis. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 12(1), 54-60. https://doi.org/10.1111/j.1463-1318.2008.01694.x
Zingg U, et al. Primary Anastomosis Vs Hartmann's Procedure in Patients Undergoing Emergency Left Colectomy for Perforated Diverticulitis. Colorectal Dis. 2010;12(1):54-60. PubMed PMID: 19175638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary anastomosis vs Hartmann's procedure in patients undergoing emergency left colectomy for perforated diverticulitis. AU - Zingg,U, AU - Pasternak,I, AU - Dietrich,M, AU - Seifert,B, AU - Oertli,D, AU - Metzger,U, PY - 2009/1/30/entrez PY - 2009/1/30/pubmed PY - 2010/4/7/medline SP - 54 EP - 60 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 12 IS - 1 N2 - OBJECTIVE: Comparison of primary anastomosis (PA) and Hartmann's procedure (HP) in perforated diverticulitis is biased as the patient groups are different in age, comorbidity and severity of disease. Still, PA has been advocated as the procedure of choice. The aim of this study was to compare the two surgical procedures after eliminating this selection bias using a propensity score model. METHOD: Sixty-five HP and 46 PA patients who underwent emergency laparotomy for perforated diverticulitis were analysed. Multivariate logistic regression using the Mannheim peritonitis index, Colorectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity, Charlson comorbidity index and Hinchey score was performed to determine the propensity score. RESULTS: Patients with HP had significantly higher scores, median age and were more often on immunosuppressive medication. Unadjusted logistic regression for outcome showed a significant risk of HP vs PA for nonsurgical morbidity (odds ratio 3.25, 95% CI: 1.26-8.43; P = 0.015), but not for mortality and surgical morbidity. After adjusting for the propensity score, outcome was not significantly different. Patients with PA had a clinical leak rate of 28% and none of the patients with leakage had a protective ileostomy. Patients with PA and leak had higher Charlson scores whereas all other scores were similar to nonleak patients. CONCLUSION: The theory that PA is generally superior to HP cannot be supported. HP remains a safe technique for emergency colectomy in perforated diverticulitis, especially in elderly patients with multiple comorbidities. If PA is performed, a protective ileostomy must be considered. SN - 1463-1318 UR - https://www.unboundmedicine.com/medline/citation/19175638/Primary_anastomosis_vs_Hartmann's_procedure_in_patients_undergoing_emergency_left_colectomy_for_perforated_diverticulitis_ L2 - https://doi.org/10.1111/j.1463-1318.2008.01694.x DB - PRIME DP - Unbound Medicine ER -