Non-Elective Surgery for Acute Complicated Diverticulitis. Primary
Resection-Anastomosis or HartmannÃ¢ÂÂs Procedure? A Systematic Review
Dionigi Lorusso1*, Aurore Giliberti2, Margherita Bianco2 and Gioacchino3
1Department of Surgery, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Bari, Italy
2Trial Center, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Bari, Italy
3Department of Gastroenterology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Bari, Italy
- *Corresponding Author:
- Lorusso D
Department of Surgery, Scientific Institute for Digestive Disease
"Saverio de Bellis" Hospital Via Turi, 27-70013 – Castellana Grotte, Italy
E-mail: [email protected]
Received Date: June 19, 2016; Accepted Date: June 21, 2016; Published Date: June 27, 2016
Citation: Lorusso D, Giliberti A, Bianco M, Gioacchino. Non-Elective Surgery for Acute Complicated Diverticulitis. Primary Resection-Anastomosis or Hartmann’s Procedure? A Systematic Review and Meta-Analysis. Journal of Surgery [Jurnalul de chirurgie]. 2016; 12(2): 43-49 DOI:10.7438/1584-9341-12-2-1
Copyright: © 2016 Lorusso D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: The use of Primary Resection-Anastomosis with or without protective ileostomy (PRA) or Hartmann’s Procedure (HP) in the surgery of complicated acute diverticulitis is still an open question. The latest published meta-analyses were limited to the most severe stages (Hinchey III and IV). Our systematic review aimed to compare PRA with the HP in all non-elective surgical patients with complicated acute diverticulitis (perforation or obstruction). Methods: A computerized literature search was performed on Medline databases until July 2014. The studies included in the meta-analysis were 24 with a total of 4,062 patients. Study outcomes included postoperative surgical complications, reintervention, 30-day mortality, overall mortality as well as the length of stay as secondary outcome. The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Results were expressed as odds ratio (OR) and 95% confidence interval (CI) for dichotomous outcomes and as mean difference (MD) with 95% CI for continuous outcomes. Subgroup analyses by study type were performed. Results: The PRA group had a lower rate of postoperative surgical complications (OR=0.525, 95% CI 0.387-0.713), reintervention (OR=0.688, 95% CI 0.525-0.902), 30-day mortality (OR=0.389, 95% CI 0.259-0.586), overall mortality (OR=0.467, 95% CI 0.272-0.803) and length of stay (MD=9.129, 95% CI 2.391-15.867) compared to the HP group. Conclusion: Our meta-analysis shows that the PRA technique is better than HP for all considered outcomes. Due to the high variability of the included studies, further randomized controlled trials would be required to confirm these results.