Tags

Type your tag names separated by a space and hit enter

Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis.
Colorectal Dis. 2018 09; 20(9):753-770.CD

Abstract

AIM

It is still controversial whether the optimal operation for perforated diverticulitis with peritonitis is primary anastomosis (PRA) or nonrestorative resection (NRR). The aim of this systematic review and meta-analysis was to evaluate mortality and morbidity rates following emergency resection for perforated diverticulitis with peritonitis and ostomy reversal, as well as ostomy nonreversal rates.

METHOD

The Pubmed, EMBASE, Cochrane Library, MEDLINE via Ovid, CINAHL and Web of Science databases were systematically searched. Mortality was the primary end-point. A subgroup meta-analysis of randomized controlled trials was performed in addition to a meta-analysis of all eligible studies. Odds ratios (ORs) and mean difference (MD) were calculated for dichotomous and continuous outcomes, respectively.

RESULTS

Seventeen studies, including three randomized controlled trials (RCTs), involving 1016 patients (392 PRA vs 624 NRR) were included. Overall, mortality was significantly lower in patients with PRA compared with patients with NRR [OR (95% CI) = 0.38 (0.24, 0.60), P < 0.0001]. Organ/space surgical site infection (SSI) [OR (95% CI) = 0.25 (0.10, 0.63), P = 0.003], reoperation [OR (95% CI) = 0.48 (0.25, 0.91), P = 0.02] and ostomy nonreversal rates [OR (95% CI) = 0.27 (0.09, 0.84), P = 0.02] were significantly decreased in PRA. In the RCTs, the mortality rate did not differ [OR (95% CI) = 0.46 (0.15, 1.38), P = 0.17]. The mean operating time for PRA was significantly longer than for NRR [MD (95% CI) = 19.96 (7.40, 32.52), P = 0.002]. Organ/space SSI [OR (95% CI) = 0.28 (0.09, 0.82), P = 0.02] was lower after PRA. Ostomy nonreversal rates were lower after PRA. The difference was not statistically significant [OR (95% CI) = 0.26 (0.06, 1.11), P = 0.07]. However, it was clinically significant [number needed to treat/harm (95% CI) = 5 (3.1, 8.9)].

CONCLUSION

This meta-analysis found that organ/space SSI rates as well as ostomy nonreversal rates were decreased in PRA at the cost of prolonging the operating time.

Authors+Show Affiliations

Division of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.Department of Surgery, University Hospital Zurich, Zurich, Switzerland.Department of Digestive Surgery, Rouen University Hospital, Rouen, France.Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.Division of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

29694694

Citation

Gachabayov, M, et al. "Resection With Primary Anastomosis Vs Nonrestorative Resection for Perforated Diverticulitis With Peritonitis: a Systematic Review and Meta-analysis." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 20, no. 9, 2018, pp. 753-770.
Gachabayov M, Oberkofler CE, Tuech JJ, et al. Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Colorectal Dis. 2018;20(9):753-770.
Gachabayov, M., Oberkofler, C. E., Tuech, J. J., Hahnloser, D., & Bergamaschi, R. (2018). Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 20(9), 753-770. https://doi.org/10.1111/codi.14237
Gachabayov M, et al. Resection With Primary Anastomosis Vs Nonrestorative Resection for Perforated Diverticulitis With Peritonitis: a Systematic Review and Meta-analysis. Colorectal Dis. 2018;20(9):753-770. PubMed PMID: 29694694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. AU - Gachabayov,M, AU - Oberkofler,C E, AU - Tuech,J J, AU - Hahnloser,D, AU - Bergamaschi,R, Y1 - 2018/05/15/ PY - 2018/02/06/received PY - 2018/04/09/accepted PY - 2018/4/26/pubmed PY - 2019/10/19/medline PY - 2018/4/26/entrez KW - Hartmann's procedure KW - Perforated diverticulitis KW - meta-analysis KW - peritonitis KW - primary anastomosis SP - 753 EP - 770 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 20 IS - 9 N2 - AIM: It is still controversial whether the optimal operation for perforated diverticulitis with peritonitis is primary anastomosis (PRA) or nonrestorative resection (NRR). The aim of this systematic review and meta-analysis was to evaluate mortality and morbidity rates following emergency resection for perforated diverticulitis with peritonitis and ostomy reversal, as well as ostomy nonreversal rates. METHOD: The Pubmed, EMBASE, Cochrane Library, MEDLINE via Ovid, CINAHL and Web of Science databases were systematically searched. Mortality was the primary end-point. A subgroup meta-analysis of randomized controlled trials was performed in addition to a meta-analysis of all eligible studies. Odds ratios (ORs) and mean difference (MD) were calculated for dichotomous and continuous outcomes, respectively. RESULTS: Seventeen studies, including three randomized controlled trials (RCTs), involving 1016 patients (392 PRA vs 624 NRR) were included. Overall, mortality was significantly lower in patients with PRA compared with patients with NRR [OR (95% CI) = 0.38 (0.24, 0.60), P < 0.0001]. Organ/space surgical site infection (SSI) [OR (95% CI) = 0.25 (0.10, 0.63), P = 0.003], reoperation [OR (95% CI) = 0.48 (0.25, 0.91), P = 0.02] and ostomy nonreversal rates [OR (95% CI) = 0.27 (0.09, 0.84), P = 0.02] were significantly decreased in PRA. In the RCTs, the mortality rate did not differ [OR (95% CI) = 0.46 (0.15, 1.38), P = 0.17]. The mean operating time for PRA was significantly longer than for NRR [MD (95% CI) = 19.96 (7.40, 32.52), P = 0.002]. Organ/space SSI [OR (95% CI) = 0.28 (0.09, 0.82), P = 0.02] was lower after PRA. Ostomy nonreversal rates were lower after PRA. The difference was not statistically significant [OR (95% CI) = 0.26 (0.06, 1.11), P = 0.07]. However, it was clinically significant [number needed to treat/harm (95% CI) = 5 (3.1, 8.9)]. CONCLUSION: This meta-analysis found that organ/space SSI rates as well as ostomy nonreversal rates were decreased in PRA at the cost of prolonging the operating time. SN - 1463-1318 UR - https://www.unboundmedicine.com/medline/citation/29694694/Resection_with_primary_anastomosis_vs_nonrestorative_resection_for_perforated_diverticulitis_with_peritonitis:_a_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/codi.14237 DB - PRIME DP - Unbound Medicine ER -