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The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis

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Abstract

To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44–1.33); p = 0.33]; [RR 0.66 (0.33–1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.

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References

  1. Strate LL, Morris AM (2019) Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology 156:1282–1298. https://doi.org/10.1053/j.gastro.2018.12.033

    Article  PubMed  Google Scholar 

  2. Abraha I, Binda GA, Montedori A et al (2017) Laparoscopic versus open resection for sigmoid diverticulitis. Cochrane Database Syst Rev 2017:CD009277. https://doi.org/10.1002/14651858.CD009277.pub2

    Article  PubMed Central  Google Scholar 

  3. Desai M, Fathallah J, Nutalapati V, Saligram S (2019) Antibiotics versus no antibiotics for acute uncomplicated diverticulitis: a systematic review and meta-analysis. Dis Colon Rectum 62:1005–1012. https://doi.org/10.1097/DCR.0000000000001324

    Article  PubMed  Google Scholar 

  4. Reyes-Espejel L, Ruiz-Campos M, Correa-Rovelo JM, García-Osogobio S (2015) Sigmoidectomía con anastomosis primaria para diverticulitis complicada. Rev Gastroenterol México 80:255–259. https://doi.org/10.1016/j.rgmx.2015.07.005

    Article  CAS  Google Scholar 

  5. van Dijk ST, Bos K, de Boer MGJ et al (2018) A systematic review and meta-analysis of outpatient treatment for acute diverticulitis. Int J Colorectal Dis 33:505–512. https://doi.org/10.1007/s00384-018-3015-9

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bezerra RP, da Costa AC, Santa-Cruz F, Ferraz ÁAB (2020) Hartmann procedure or resection with primary anastomosis for treatment of perforated diverticulitis? Systematic review and meta-analysis. Arq Bras Cir Dig São Paulo 33:e1546. https://doi.org/10.1590/0102-672020200003e1546

    Article  Google Scholar 

  7. Lambrichts DP, Edomskis PP, van der Bogt RD et al (2020) Sigmoid resection with primary anastomosis versus the Hartmann’s procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis. Int J Colorectal Dis 35:1371–1386. https://doi.org/10.1007/s00384-020-03617-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ryan OK, Ryan ÉJ, Creavin B et al (2020) Systematic review and meta-analysis comparing primary resection and anastomosis versus Hartmann’s procedure for the management of acute perforated diverticulitis with generalised peritonitis. Tech Coloproctol 24:527–543. https://doi.org/10.1007/s10151-020-02172-2

    Article  CAS  PubMed  Google Scholar 

  9. Gachabayov M, Tuech JJ, Tulina I et al (2020) Primary anastomosis and nonrestorative resection for perforated diverticulitis with peritonitis: meta-analysis of randomized trials. Colorectal Dis 22:1245–1257. https://doi.org/10.1111/codi.15016

    Article  CAS  PubMed  Google Scholar 

  10. Sartelli M, Weber DG, Kluger Y et al (2020) 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 15:1–18. https://doi.org/10.1186/s13017-020-00313-4

    Article  Google Scholar 

  11. Raña-Garibay R, Salgado-Nesme N, Carmona-Sánchez R et al (2019) Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon. Rev Gastroenterol México 84:220–240. https://doi.org/10.1016/j.rgmx.2019.01.002

    Article  Google Scholar 

  12. Barletta DH (2020) Diverticulitis aguda del colon izquierdo, nivel de consenso y de aplicación de las guías de práctica clínica entre miembros de la SACP. Rev Argent Coloproctol 31:89–96. https://doi.org/10.46768/racp.v31i3.65

    Article  Google Scholar 

  13. Bridoux V, Regimbeau JM, Ouaissi M et al (2017) Hartmann’s procedure or primary anastomosis for generalized peritonitis due to perforated diverticulitis: a prospective multicenter randomized trial (DIVERTI). J Am Coll Surg 225:798–805. https://doi.org/10.1016/j.jamcollsurg.2017.09.004

    Article  PubMed  Google Scholar 

  14. Binda GA, Karas JR, Serventi A et al (2012) Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial: perforated diverticulitis with peritonitis. Colorectal Dis 14:1403–1410. https://doi.org/10.1111/j.1463-1318.2012.03117.x

    Article  CAS  PubMed  Google Scholar 

  15. Lambrichts DPV, Vennix S, Musters GD et al (2019) Hartmann’s procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial. Lancet Gastroenterol Hepatol 4:599–610. https://doi.org/10.1016/S2468-1253(19)30174-8

    Article  PubMed  Google Scholar 

  16. Oberkofler CE, Rickenbacher A, Raptis DA et al (2012) A multicenter randomized clinical trial of primary anastomosis or hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 256:819–826. https://doi.org/10.1097/SLA.0b013e31827324ba

    Article  PubMed  Google Scholar 

  17. Lee JM, Chang JB, Hechi ME et al (2019) Hartmann’s procedure vs primary anastomosis with diverting loop ileostomy for acute diverticulitis: nationwide analysis of 2729 emergency surgery patients. J Am Coll Surg 229:48–55. https://doi.org/10.1016/j.jamcollsurg.2019.03.007

    Article  PubMed  Google Scholar 

  18. Alizai PH, Schulze-Hagen M, Klink CD et al (2013) Primary anastomosis with a defunctioning stoma versus Hartmann’s procedure for perforated diverticulitis—a comparison of stoma reversal rates. Int J Colorectal Dis 28:1681–1688. https://doi.org/10.1007/s00384-013-1753-2

    Article  CAS  PubMed  Google Scholar 

  19. Cauley CE, Patel R, Bordeianou L (2018) Use of primary anastomosis with diverting ileostomy in patients with acute diverticulitis requiring urgent operative intervention. Dis Colon Rectum 61:586–592. https://doi.org/10.1097/DCR.0000000000001080

    Article  PubMed  Google Scholar 

  20. Gawlick U, Nirula R (2012) Resection and primary anastomosis with proximal diversion instead of Hartmann’s: evolving the management of diverticulitis using NSQIP data. J Trauma Acute Care Surg 72:807–814. https://doi.org/10.1097/TA.0b013e31824ef90b

    Article  PubMed  Google Scholar 

  21. Masoomi H, Stamos MJ, Carmichael JC et al (2012) Does primary anastomosis with diversion have any advantages over Hartmann’s procedure in acute diverticulitis? Dig Surg 29:315–320. https://doi.org/10.1159/000342549

    Article  PubMed  Google Scholar 

  22. Herzog T, Janot M, Belyaev O et al (2011) Complicated sigmoid diverticulitis–Hartmann’s procedure or primary anastomosis? Acta Chir Belg 111:378–383. https://doi.org/10.1080/00015458.2011.11680777

    Article  CAS  PubMed  Google Scholar 

  23. Trenti L, Biondo S, Golda T et al (2011) Generalized peritonitis due to perforated diverticulitis: Hartmann’s procedure or primary anastomosis? Int J Colorectal Dis 26:377–384. https://doi.org/10.1007/s00384-010-1071-x

    Article  PubMed  Google Scholar 

  24. Di Saverio S, Vennix S, Birindelli A et al (2016) Pushing the envelope: laparoscopy and primary anastomosis are technically feasible in stable patients with Hinchey IV perforated acute diverticulitis and gross faeculent peritonitis. Surg Endosc 30:5656–5664. https://doi.org/10.1007/s00464-016-4869-y

    Article  PubMed  Google Scholar 

  25. Vennix S, Lips DJ, Di Saverio S et al (2016) Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort. Surg Endosc 30:3889–3896. https://doi.org/10.1007/s00464-015-4694-8

    Article  PubMed  Google Scholar 

  26. Vergara-Fernández O, Velasco L, Zarate X et al (2006) Tratamiento quirúrgico para la enfermedad diverticular de colon: Experiencia en el INCMNSZ. Rev Investig Clínica 58:272–278

    Google Scholar 

  27. Barberousse C, Ramírez L, Dardanelli S, Fernández L (2021) Vigencia de la operación de Hartmann en el tratamiento de la diverticulosis colónica complicada: estudio realizado en pacientes tratados durante el periodo 2009–2018, en Hospital de Clínicas de Montevideo. Rev Cir Urug 5:1–17. https://doi.org/10.31837/cir.urug.5.2.3

    Article  Google Scholar 

  28. Uzcátegui E, Canelón D, González C, Arvelo H, Mavare M, Hernández N (2013) Anastomosis Colonica Primaria en Pacientes con Peritonitis Aguda. Informe Médico 15:3. http://saber.ucv.ve/ojs/index.php/rev_im/article/view/6053

  29. Pérez-Morales AG, Roesch-Dietlen F, Martínez-Fernández S et al (2011) Enfermedad diverticular complicada: Manejo quirúrgico en el Hospital Español de Veracruz. Cir Gen 33:243–247

    Google Scholar 

  30. Edomskis PP, Hoek VT, Stark PW et al (2022) Hartmann’s procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or fecal peritonitis: three-year follow-up of a randomised controlled trial. Int J Surg 98:106221. https://doi.org/10.1016/j.ijsu.2021.106221

    Article  PubMed  Google Scholar 

  31. Loire M, Bridoux V, Mege D et al (2021) Long-term outcomes of Hartmann’s procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI). Int J Colorectal Dis 36:2159–2164. https://doi.org/10.1007/s00384-021-03962-2

    Article  CAS  PubMed  Google Scholar 

  32. Dreifuss NH, Bras Harriott C, Schlottmann F et al (2021) Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy? Updat Surg 73:555–560. https://doi.org/10.1007/s13304-020-00952-x

    Article  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, University of Azuay, Cuenca, Ecuador

    Doris Sarmiento-Altamirano, Daniela Neira-Quezada & Emilia Willches-Encalada

  2. San Juan de Dios Hospital, Cuenca, Ecuador

    Catherine Cabrera-Ordoñez

  3. José Carrasco Arteaga Hospital, Cuenca, Ecuador

    Rafael Valdivieso-Espinoza

  4. University of California San Francisco, San Francisco, USA

    Amber Himmler

  5. Department of General Surgery, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy

    Salomone Di Saverio

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  1. Doris Sarmiento-Altamirano
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Correspondence to Doris Sarmiento-Altamirano.

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Sarmiento-Altamirano, D., Neira-Quezada, D., Willches-Encalada, E. et al. The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis. Updates Surg 76, 397–409 (2024). https://doi.org/10.1007/s13304-023-01738-7

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