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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2023

16-12-2022 | Laparotomy | Review Article

Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review

Authors: Anders Peter Skovsen, Jakob Burcharth, Ismail Gögenur, Mai-Britt Tolstrup

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2023

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Abstract

Purpose

Anastomotic leakage after small bowel resection in emergency laparotomy is a severe complication. A consensus on the risk factors for anastomotic leakage has not been established, and it is still unclear if peritonitis is a risk factor. This systematic review aimed to evaluate if an entero-entero/entero-colonic anastomosis is safe in patients with peritonitis undergoing abdominal acute care surgery.

Methods

A systematic literature review based on PRISMA guidelines was performed, searching the databases Pubmed/MEDLINE, Cochrane Library, and Science Direct for studies of anastomosis in peritonitis. Patients with an anastomosis after non-planned small bowel resection (ischemia, perforation, or strangulation), including secondary peritonitis, were included. Elective laparotomies and colo-colonic anastomoses were excluded. Due to the etiology, traumatic perforation, in-vitro, and animal studies were excluded.

Results

This review identified 26 studies of small-bowel anastomosis in peritonitis with a total of 2807 patients. This population included a total of 889 small-bowel/right colonic resections with anastomoses, and 242 enterostomies. All studies, except two, were retrospective reviews or case series. The overall mortality rates were 0–20% and anastomotic leakage rates 0–36%. After performing a risk of bias evaluation there was no basis for conducting a meta-analysis. The quality of evidence was rated as low.

Conclusion

There was no evidence to refute performing a primary small-bowel anastomosis in acute laparotomy with peritonitis. There is currently insufficient evidence to label peritonitis as a risk factor for anastomotic leakage in acute care laparotomy with small-bowel resection.

Trial registration

The review was registered with the PROSPERO register of systematic reviews on 14/07/2020 with the ID: CRD42020168670.
Appendix
Available only for authorised users
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Metadata
Title
Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review
Authors
Anders Peter Skovsen
Jakob Burcharth
Ismail Gögenur
Mai-Britt Tolstrup
Publication date
16-12-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-02192-7

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