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[Hartmann's procedure for perforated diverticulitis and malignant left-sided colorectal obstruction and perforation].
Zentralbl Chir 2011; 136(1):25-33ZC

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.

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  • Publisher Full Text

    • Authors+Show Affiliations

    Meyer F
    Universitätsklinikum A. ö. R., Klinik für Allgemein-, Viszeral- u. Gefäβchirurgie, Magdeburg, Deutschland. Frameyer@t-online.de
    Grundmann RT
    No affiliation info available

    MeSH

    Anastomosis, SurgicalColonic DiseasesColorectal NeoplasmsColostomyDiverticulitis, ColonicEmergenciesHumansIntestinal ObstructionIntestinal PerforationLaparoscopyPeritoneal LavagePostoperative ComplicationsQuality of LifeReoperationStentsSurvival Rate

    Pub Type(s)

    English Abstract
    Journal Article
    Review

    Language

    ger

    PubMed ID

    21337290

    Citation

    Meyer, F, and R T. Grundmann. "[Hartmann's Procedure for Perforated Diverticulitis and Malignant Left-sided Colorectal Obstruction and Perforation]." Zentralblatt Fur Chirurgie, vol. 136, no. 1, 2011, pp. 25-33.
    Meyer F, Grundmann RT. [Hartmann's procedure for perforated diverticulitis and malignant left-sided colorectal obstruction and perforation]. Zentralbl Chir. 2011;136(1):25-33.
    Meyer, F., & Grundmann, R. T. (2011). [Hartmann's procedure for perforated diverticulitis and malignant left-sided colorectal obstruction and perforation]. Zentralblatt Fur Chirurgie, 136(1), pp. 25-33. doi:10.1055/s-0030-1262753.
    Meyer F, Grundmann RT. [Hartmann's Procedure for Perforated Diverticulitis and Malignant Left-sided Colorectal Obstruction and Perforation]. Zentralbl Chir. 2011;136(1):25-33. PubMed PMID: 21337290.
    * Article titles in AMA citation format should be in sentence-case
    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 -