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

  • Review Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary material. Raw data that support the findings of this study are available from published peer reviewed articles referenced, and are available from the corresponding author, upon reasonable request. Copyrights may apply.

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Acknowledgements

The authors would like to thank Inger and Hakon Fabricius Foundation for supporting the research.

Funding

Partial funding received from the Inger and Hakon Fabricius Foundation.

Author information

Authors and Affiliations

  1. Surgical Department, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark

    Anders Peter Skovsen & Mai-Britt Tolstrup

  2. Surgical Department, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    Jakob Burcharth

  3. Surgical Department, Zealand University Hospital, University of Copenhagen, Køge, Denmark

    Ismail Gögenur

  4. Center for Surgical Science, Zealand University Hospital, Køge, Denmark

    Ismail Gögenur

Authors
  1. Anders Peter Skovsen
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  2. Jakob Burcharth
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  3. Ismail Gögenur
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  4. Mai-Britt Tolstrup
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Contributions

The conception and design of the study (APS, JB, MT, IG), acquisition of data (APS, MT), analysis and interpretation of data (APS, JB, MT), writing of manuscript (APS, JB, MT, IG).

Corresponding author

Correspondence to Anders Peter Skovsen.

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Competing interests

The authors declare that they have no competing interests associated with the study.

Ethics approval

In accordance with Danish law, there was no requirement for approval by The National Committee on Health Research Ethics.

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Skovsen, A.P., Burcharth, J., Gögenur, I. et al. Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review. Eur J Trauma Emerg Surg 49, 2047–2055 (2023). https://doi.org/10.1007/s00068-022-02192-7

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  • DOI: https://doi.org/10.1007/s00068-022-02192-7

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