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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 8/2020

Open Access 01-08-2020 | Enterostomy | Review

Sigmoid resection with primary anastomosis versus the Hartmann’s procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis

Authors: Daniël PV Lambrichts, Pim P Edomskis, Ruben D van der Bogt, Gert-Jan Kleinrensink, Willem A Bemelman, Johan F Lange

Published in: International Journal of Colorectal Disease | Issue 8/2020

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Abstract

Purpose

The optimal surgical approach for perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV) remains debated. In recent years, accumulating evidence comparing sigmoid resection with primary anastomosis (PA) with the Hartmann’s procedure (HP) was presented. Therefore, the aim was to provide an updated and extensive synthesis of the available evidence.

Methods

A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies comparing PA to HP for adult patients with Hinchey III or IV diverticulitis were included. Data on mortality, morbidity, stoma reversal, and patient-reported and cost-related outcomes were extracted. Random effects models were used to pool data and estimate odds ratios (ORs).

Results

From a total of 1560 articles, four randomized controlled trials and ten observational studies were identified, reporting on 1066 Hinchey III/IV patients. Based on trial outcomes, PA was found to be favorable over HP in terms of stoma reversal rates (OR 2.62, 95% CI 1.29, 5.31) and reversal-related morbidity (OR 0.33, 95% CI 0.16, 0.69). No differences in mortality (OR 0.83, 95% CI 0.32, 2.19), morbidity (OR 0.99, 95% CI 0.65, 1.51), and reintervention rates (OR 0.90, 95% CI 0.39, 2.11) after the index procedure were demonstrated. Data on patient-reported and cost-related outcomes were scarce, as well as outcomes in PA patients with or without ileostomy construction and Hinchey IV patients.

Conclusion

Although between-study heterogeneity needs to be taken into account, the present results indicate that primary anastomosis seems to be the preferred option over Hartmann’s procedure in selected patients with Hinchey III or IV diverticulitis.
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Metadata
Title
Sigmoid resection with primary anastomosis versus the Hartmann’s procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis
Authors
Daniël PV Lambrichts
Pim P Edomskis
Ruben D van der Bogt
Gert-Jan Kleinrensink
Willem A Bemelman
Johan F Lange
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 8/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-020-03617-8

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