Abstract
Purpose
The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies.
Methods
A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire.
Results
A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4–118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien–Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014).
Conclusion
The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease.
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PH Alizai and M Schulze-Hagen contributed equally and are both first authors.
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Alizai, P.H., Schulze-Hagen, M., Klink, C.D. et al. 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 (2013). https://doi.org/10.1007/s00384-013-1753-2
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DOI: https://doi.org/10.1007/s00384-013-1753-2