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Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates.
Int J Colorectal Dis 2013; 28(12):1681-8IJ

Abstract

PURPOSE

The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies.

METHODS

A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire.

RESULTS

A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4-118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien-Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014).

CONCLUSION

The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease.

Authors+Show Affiliations

Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany, palizai@ukaachen.de.No 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

Language

eng

PubMed ID

23913315

Citation

Alizai, P H., et al. "Primary Anastomosis With a Defunctioning Stoma Versus Hartmann's Procedure for Perforated Diverticulitis--a Comparison of Stoma Reversal Rates." International Journal of Colorectal Disease, vol. 28, no. 12, 2013, pp. 1681-8.
Alizai PH, Schulze-Hagen M, Klink CD, et al. Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates. Int J Colorectal Dis. 2013;28(12):1681-8.
Alizai, P. H., Schulze-Hagen, M., Klink, C. D., Ulmer, F., Roeth, A. A., Neumann, U. P., ... Rosch, R. (2013). Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates. International Journal of Colorectal Disease, 28(12), pp. 1681-8. doi:10.1007/s00384-013-1753-2.
Alizai PH, et al. Primary Anastomosis With a Defunctioning Stoma Versus Hartmann's Procedure for Perforated Diverticulitis--a Comparison of Stoma Reversal Rates. Int J Colorectal Dis. 2013;28(12):1681-8. PubMed PMID: 23913315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates. AU - Alizai,P H, AU - Schulze-Hagen,M, AU - Klink,C D, AU - Ulmer,F, AU - Roeth,A A, AU - Neumann,U P, AU - Jansen,M, AU - Rosch,R, Y1 - 2013/08/03/ PY - 2013/07/22/accepted PY - 2013/8/6/entrez PY - 2013/8/6/pubmed PY - 2014/6/19/medline SP - 1681 EP - 8 JF - International journal of colorectal disease JO - Int J Colorectal Dis VL - 28 IS - 12 N2 - PURPOSE: The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies. METHODS: A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire. RESULTS: A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4-118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien-Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014). CONCLUSION: The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease. SN - 1432-1262 UR - https://www.unboundmedicine.com/medline/citation/23913315/Primary_anastomosis_with_a_defunctioning_stoma_versus_Hartmann's_procedure_for_perforated_diverticulitis__a_comparison_of_stoma_reversal_rates_ L2 - https://dx.doi.org/10.1007/s00384-013-1753-2 DB - PRIME DP - Unbound Medicine ER -