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International Journal of Colorectal Disease

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01-04-2013 | Review

Treatment of Hinchey stage III–IV diverticulitis: a systematic review and meta-analysis

Authors: Roberto Cirocchi, Stefano Trastulli, Jacopo Desiderio, Chiara Listorti, Carlo Boselli, Amilcare Parisi, Giuseppe Noya, Liu Liu

Published in: International Journal of Colorectal Disease | Issue 4/2013

Abstract

Background

This manuscript is a review of different surgical techniques to manage perforated colon diverticulitis.

Objective

This study was conducted to compare the benefits and disadvantages of different surgical treatments for Hinchey III or IV type of colon diverticulitis.

Methods

A systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, and the Science Citation Index (1990 and 2011). A total of 1,809 publications were identified and 14 studies with 1,041 patients were included in the study. Any surgical treatment was considered in this review. Mortality was considered the primary outcome, whereas hospital stay and reoperation rate were considered secondary outcomes.

Results

Primary resection with anastomosis has a significant advantage in terms of lower mortality rate with respect to Hartmann’s procedure (P = 0.02). The postoperative length of hospitalization was significantly shorter in the resection with anastomosis group (P < 0.001). Different findings have emerged from studies of patients with the primary resection with anastomosis vs laparoscopic peritoneal lavage and subsequent resection: overall surgical morbidity and hospital stay were lower in the laparoscopic peritoneal lavage group compared to the primary resection and anastomosis group (P < 0.001).

Conclusions

Despite numerous published articles on operative treatments for patients with generalized peritonitis from perforated diverticulitis, we found a marked heterogeneity between included studies limiting the possibility to summarize in a metanalytical method the data provided and make difficult to synthesize data in a quantitative fashion. The advantages in the group of colon resection with primary anastomosis in terms of lower mortality rate and postoperative stay should be interpreted with caution because of several limitations. Future randomized controlled trials are needed to further evaluate different surgical treatments for patients with generalized peritonitis from perforated diverticulitis.

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Title: Treatment of Hinchey stage III–IV diverticulitis: a systematic review and meta-analysis
Authors: Roberto Cirocchi
Stefano Trastulli
Jacopo Desiderio
Chiara Listorti
Carlo Boselli
Amilcare Parisi
Giuseppe Noya
Liu Liu
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 4/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1622-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of Hinchey stage III–IV diverticulitis: a systematic review and meta-analysis

Abstract

Background

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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