Abstract
BACKGROUND
This review comments on the question whether laparoscopic techniques and interventional strategies have in the last ten years changed the emergency management of perforated diverticulitis and malignant colorectal obstruction or perforation with regard to the broad spectrum of indications for Hartmann's procedure (HP).
PERFORATED DIVERTICULITIS
Colon resection with primary anastomosis and defunctioning stoma is the optimal strategy for patients with perforated diverticulitis. HP should be considered for older patients with multiple comorbidities, realising that restoration of bowel continuity is no longer an issue. Laparoscopic peritoneal lavage is an alter-native to HP in Hinchey-III diverticulitis with promising results in experienced centers which should be further evaluated. OBSTRUCTIVE / PERFORATED LEFT-SIDED COLORECTAL CANCER: In perforated left-sided colorectal cancer HP may be generously indicated. In malignant obstruction, however, a temporary colostomy or -colonic stenting in case of appropriate expertise has been suggested as preoperative treatment -before elective surgery, allowing higher rates of RPA.
CONCLUSION
HP remains relevant, especially in high-risk patients and after hours and during the weekend, when the most experienced surgeon is not always available. However, subspecialised colorectal surgeons obtain with single-stage resection in this situation at least comparable results with respect to morbidity and mortality, but better patient quality of life.
TY - JOUR
T1 - [Hartmann's procedure for perforated diverticulitis and malignant left-sided colorectal obstruction and perforation].
AU - Meyer,F,
AU - Grundmann,R T,
Y1 - 2011/02/18/
PY - 2011/2/22/entrez
PY - 2011/2/22/pubmed
PY - 2011/7/1/medline
SP - 25
EP - 33
JF - Zentralblatt fur Chirurgie
JO - Zentralbl Chir
VL - 136
IS - 1
N2 - BACKGROUND: This review comments on the question whether laparoscopic techniques and interventional strategies have in the last ten years changed the emergency management of perforated diverticulitis and malignant colorectal obstruction or perforation with regard to the broad spectrum of indications for Hartmann's procedure (HP). PERFORATED DIVERTICULITIS: Colon resection with primary anastomosis and defunctioning stoma is the optimal strategy for patients with perforated diverticulitis. HP should be considered for older patients with multiple comorbidities, realising that restoration of bowel continuity is no longer an issue. Laparoscopic peritoneal lavage is an alter-native to HP in Hinchey-III diverticulitis with promising results in experienced centers which should be further evaluated. OBSTRUCTIVE / PERFORATED LEFT-SIDED COLORECTAL CANCER: In perforated left-sided colorectal cancer HP may be generously indicated. In malignant obstruction, however, a temporary colostomy or -colonic stenting in case of appropriate expertise has been suggested as preoperative treatment -before elective surgery, allowing higher rates of RPA. CONCLUSION: HP remains relevant, especially in high-risk patients and after hours and during the weekend, when the most experienced surgeon is not always available. However, subspecialised colorectal surgeons obtain with single-stage resection in this situation at least comparable results with respect to morbidity and mortality, but better patient quality of life.
SN - 1438-9592
UR - https://www.unboundmedicine.com/medline/citation/21337290/[Hartmann's_procedure_for_perforated_diverticulitis_and_malignant_left_sided_colorectal_obstruction_and_perforation]_
L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0030-1262753
DB - PRIME
DP - Unbound Medicine
ER -
