Top

International Journal of Colorectal Disease

Published in:

01-11-2003 | Original Article

Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon

Authors: N. Regenet, P. Pessaux, S. Hennekinne, E. Lermite, J. J. Tuech, O. Brehant, J. P. Arnaud

Published in: International Journal of Colorectal Disease | Issue 6/2003

Abstract

Background and aims

For complicated diverticulitis Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease, but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. This study compared primary resection with intraoperative colonic lavage and Hartmann's procedure.

Patients and methods

Between January 1994 and November 2001, 60 patients underwent emergency laparotomy for diverticular peritonitis (Hinchey stages III and IV). Primary resection and anastomosis with intraoperative colonic lavage was performed in 27 patients and Hartmann's procedure in 33. All data were collected prospectively on a standardized form.

Results

Mortality with intraoperative colonic lavage was 11% and with Hartmann's procedure 12%. The incidence of postoperative complication was significantly higher after Hartmann's procedure. The mean hospital stay was significantly longer after Hartmann's procedure than after primary resection with intraoperative colic lavage.

Conclusion

Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to Hartmann's procedure in stercoral peritonitis.

Zeitoun G, Laurent A, Rouffet F, Hay JM, Fingerhut A, Pacquet JC, Peillon C and the French Associations for Surgical Research (2000) Multicenter, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis. Br J Surg 87:1366–1374CrossRefPubMed

Belmonte C, Klas JV, Javier Perez J, Wong WD, Rothenberger DA, Goldberg SM, Madoff RD (1996) The Hartmann's procedure: first choice or last resort in diverticular disease? Arch Surg 131:612–615

Wigmore SS, Duthie GS, Young IE, Spalding EM, Rainey JB (1995) Restoration of intestinal continuity following Hartmann's procedure. The Lahey's experience 87–92. Br J Surg 82:27–30PubMed

Forloni B, Reduzzi R, Paludetti A, Colpani L, Cavallari G, Frosali D (1998) Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum 41:23–27PubMed

Dudley H, Radcliffe AG, McGeehan D (1980) Intra-operative irrigation of the colon to permit primary anastomosis. Br J Surg 67:80–81PubMed

Kressner U, Antonsson J, Ejerblad S, Gerdin B, Pahlman L (1994) Intraoperative colonic lavage and primary anastomosis—an alternative to Hartmann's procedure in emergency surgery of the left colon. Eur J Surg 160:287–292PubMed

Lee ES, Murray JJ, Coller JA, Roberts P, Schoetz DJ (1997) Intraoperative colonic lavage in non-elective surgery for diverticular disease. Dis Colon Rectum 40:669–674PubMed

Biondo S, Jaurrieta E, Marti Ragué J, Ramos E, Deiros M, Moreno P, Farran L (2000) Role of resection and primary anastomosis of the left colon in the presence of peritonitis. Br J Surg 87:1580–1584CrossRefPubMed

Hinchey ET, School PJ, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109PubMed

10.

Wacha H, Linder MM, Wesch G, Gundlach E, Steifensand RA (1987) Manheim peritonitis index—prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theor Surg 1:169–177

11.

Arnaud JP, Casa C, Georgeac C, Ronceray J, Serra-Maudet V, Kanane S (1994) L'irrigation colique per-opératoire dans le traitement en urgences des lésions occlusives du colon gauche. J Chir (Paris) 131:538–540

12.

Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F et al. (1997) Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 84:222–225PubMed

13.

Koruth NM, Hunter DC, Krukowski ZH, Matheson NA (1985) Immediate resection in emergency large bowel surgery: a 7 years audit. Br J Surg 72:703–711PubMed

14.

Smith SRG, Connolly JC, Gilmore OJA (1983) The effect of faecal loading on colonic anastomotic healing. Br J Surg 70:49–50PubMed

15.

Ravo B, Metwally N, Castero P, Polanky PJ, Gei R (1988) The importance of intraluminal anastomotic faecal contact and peritonitis in colonic anastomosis leakage. Dis Colon Rectum 31:868–871PubMed

16.

Feres O, Monteiro dos Santos Jr JC, Andrade JI (2001) The role of mechanical bowel preparation for colonic resection and anastomosis: an experimental study. Int J Colorectal Dis 16:353–356

17.

Okada M, Bothin C, Kanzawa K, Midtvedt T (1999) Experimental study of the influence of intestinal flora on the healing of intestinal anastomoses. Br J Surg 86:961–965CrossRefPubMed

18.

Smith MB, Baliga P, Sartor WM, Goradia VK, Holmes JW, Nichols RL (1991) Intraoperative colonic lavage: failure to decrease mucosal microflora. South Med J 84:38–42PubMed

19.

Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2809 consecutive patients. Ann Surg 234:181–189CrossRefPubMed

20.

Isbister WH, Prasad J (1997) Emergency large bowel surgery: a 15 years audit. Int J Colorectal Dis 12:285–290CrossRefPubMed

21.

Illert B, Engemann R, Thiede A (2001) Success in treatment of complicated diverticular disease is stage related. Int J Colorectal Dis 16:276–279CrossRefPubMed

22.

Tornqvist A, Forsgren A, Faldt K, Jiborn H, Zederfeldt B (1991) Bacterial load and inflammatory reaction in the bowel wall after colonic obstruction. An experimental study in rats. Eur J Surg 157:539–542PubMed

23.

Kriwanek S, Armbruster C, Beckerhinn P, Dittrich K (1994) Prognostic factors for survival in colonic perforation. Int J Colorectal Dis 9:158–162PubMed

24.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed

25.

Grunau G, Heemken R, Hau T (1996) Predictors of outcomes in patients with postoperative intra abdominal infection. Eur J Surg 162:619–625PubMed

26.

Gooszen AW, Gooszen HG, Veerman W, Van Dongen VM, Hermans S, Klein Kranenbarg E, Tollenaar AEM (2001) Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection. Eur J Surg 167:35–39CrossRefPubMed

Title: Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon
Authors: N. Regenet
P. Pessaux
S. Hennekinne
E. Lermite
J. J. Tuech
O. Brehant
J. P. Arnaud
Publication date: 01-11-2003
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 6/2003
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-003-0512-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon

Abstract

Background and aims

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2003

Prognostic relevant factors within pT3 rectal carcinomas: depth of invasion or circumferrential resection margins?

Environmental factors affect colon carcinoma and rectal carcinoma in men and women differently

Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications

Evaluating toxicity in neoadjuvant radio-chemotherapy of rectal cancer

Sphincter saving rectum resection is the standard procedure for low rectal cancer

Resistance mechanisms of gastrointestinal cancers: why does conventional chemotherapy fail?