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Primary Anastomosis or Hartmann’s Procedure for Patients With Diverticular Peritonitis? A Systematic Review

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Diseases of the Colon & Rectum

PURPOSE

This systematic literature review was designed to summarize and compare the reported outcomes of one-stage and two-stage operations for the treatment of perforated diverticulitis with peritonitis.

METHODS

This review identified 98 published studies (1957–2003) dealing with the surgical management of perforated diverticulitis with peritonitis, either with primary resection and anastomosis or with the Hartmann’s procedure. Aggregated results of adverse outcomes were calculated but statistical comparisons were not appropriate because of data and design heterogeneity.

RESULTS

Operative mortality data from patients with diverticular peritonitis undergoing Hartmann’s procedure (n = 1,051) were derived from 54 studies. Considering the Hartmann’s procedure and its reversal procedures together, the mortality rate was 19.6 percent (18.8 percent for the Hartmann’s procedure and 0.8 percent for its reversal), the wound infection rate was 29.1 percent (24.2 percent for the Hartmann’s procedure and 4.9 percent for its reversal), and stoma complications and anastomotic leaks (in the reversal operation) occurred in 10.3 and 4.3 percent, respectively. Of 569 reported cases of primary anastomosis from 50 studies, the aggregated mortality rate was 9.9 (range, 0–75) percent with an anastomotic leak rate of 13.9 (range, 0–60) percent and a wound infection rate of 9.6 (range, 0–26) percent.

CONCLUSIONS

Reported mortality and morbidity in patients with diverticular peritonitis who underwent primary anastomosis were not higher than those in patients undergoing Hartmann’s procedure were. This suggests that primary anastomosis is a safe operative alternative in certain patients with peritonitis. Despite inclusion of only patients with peritonitis in this analysis, selection bias may have been a limitation and a prospective, randomized trial is recommended.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, Seattle, Washington

    Leon Salem M.D. & David R. Flum M.D., M.P.H.

  2. Department of Health Services, University of Washington, Seattle, Washington

    David R. Flum M.D., M.P.H.

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  1. Leon Salem M.D.
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Correspondence to David R. Flum M.D., M.P.H..

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Salem, L., Flum, D. Primary Anastomosis or Hartmann’s Procedure for Patients With Diverticular Peritonitis? A Systematic Review. Dis Colon Rectum 47, 1953–1964 (2004). https://doi.org/10.1007/s10350-004-0701-1

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