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Meta-Analysis
. 2021 Jan 15;33(3):e1546.
doi: 10.1590/0102-672020200003e1546. eCollection 2021.

HARTMANN PROCEDURE OR RESECTION WITH PRIMARY ANASTOMOSIS FOR TREATMENT OF PERFORATED DIVERTICULITIS? SYSTEMATIC REVIEW AND META-ANALYSIS

[Article in English, Portuguese]
Rogério Perônico Bezerra  1 , Adriano Carneiro da Costa  1 , Fernando Santa-Cruz  1 , Álvaro A B Ferraz  1
Affiliations
Meta-Analysis

HARTMANN PROCEDURE OR RESECTION WITH PRIMARY ANASTOMOSIS FOR TREATMENT OF PERFORATED DIVERTICULITIS? SYSTEMATIC REVIEW AND META-ANALYSIS

[Article in English, Portuguese]
Rogério Perônico Bezerra et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity.

Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment.

Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion.

Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion.

Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

Racional:: O procedimento a Hartmann permanece sendo o tratamento de escolha da maioria dos cirurgiões para o tratamento cirúrgico de urgência da diverticulite perfurada, entretanto está associado com altas taxas de não reversão da ostomia e de morbidade pós-operatória.

Objetivo:: Estudar os resultados após o procedimento de Hartmann vs. ressecção com anastomose primária, com ou sem ileostomia, para o tratamento da diverticulite perfurada com peritonite purulenta ou fecal (grau de Hinchey III ou IV), e comparar as vantagens entre as duas formas de tratamento.

Método:: Busca sistemática na literatura de artigos observacionais e randomizados comparando ressecção com anastomose primária vs. procedimento de Hartmann no tratamento de urgência da diverticulite perfurada. Analisar como desfechos primários a mortalidade após a operação de urgência e a morbidade geral após ela; como desfechos secundários, a morbidade severa após a operação de urgência, as taxas de não reversão da ostomia, a morbidade geral e severa após a reversão.

Resultados:: Não houve diferenças significativas entre os procedimentos cirúrgicos para mortalidade, morbidade geral e morbidade severa. Contudo, as diferenças foram significativas estatisticamente favorecendo anastomose primária na comparação com procedimento de Hartmann nos desfechos taxas de não reversão do estoma, morbidade geral e morbidade severa após reversão.

Conclusão:: A anastomose primária apresenta-se como boa alternativa ao procedimento de Hartmann, sem aumento de mortalidade e morbidade, e com melhores resultados na operação de reconstrução do trânsito intestinal.

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Conflict of interest statement

Conflict of interest: none

Figures

None
Mortality after emergency surgery in randomized controlled trials
None
Mortalidade após operação de urgência nos ensaios clínicos randomizados
FIGURE 1
FIGURE 1. Identification and selection of articles
FIGURE 2
FIGURE 2. Forest plot of mortality after emergency surgery in observational studies
FIGURE 3
FIGURE 3. Forest plot of mortality after emergency operation of observational studies with only Hinchey III and IV patients
FIGURE 4
FIGURE 4. General morbidity after emergency surgery in observational studies
FIGURE 5
FIGURE 5. Mortality after emergency surgery in randomized controlled trials
FIGURE 6
FIGURE 6. General morbidity after emergency surgery in randomized controlled trials
FIGURE 7
FIGURE 7. Severe morbidity after emergency surgery in randomized controlled trials
FIGURE 8
FIGURE 8. Rate of non-reversion of the ostomy
FIGURE 9
FIGURE 9. General morbidity after a reversal operation
FIGURE 10
FIGURE 10. Severe morbidity after reversal in randomized controlled trials
FIGURE 11
FIGURE 11. Summary of the risk of bias attributed to each randomized clinical trial according to the authors’ judgment
FIGURE 12
FIGURE 12. Graph with percentage representation of the risk of bias in each study according to the authors’ judgment
FIGURE 13
FIGURE 13. Funnel plot of mortality after emergency surgery in subgroup 1
See this image and copyright information in PMC

References

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