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Randomized Controlled Trial
. 2022 Feb:98:106221.
doi: 10.1016/j.ijsu.2021.106221. Epub 2022 Jan 10.

Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or fecal peritonitis: Three-year follow-up of a randomised controlled trial

Pim P Edomskis  1 , Vincent T Hoek, Pieter W Stark, Daniël P V Lambrichts, Werner A Draaisma, Esther C J Consten, Willem A Bemelman, Johan F Lange; LADIES trial collaborators
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Free article
Randomized Controlled Trial

Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or fecal peritonitis: Three-year follow-up of a randomised controlled trial

Pim P Edomskis et al. Int J Surg. 2022 Feb.
Free article

Abstract

Background: The aim of the present study is to present the three years follow-up a randomised controlled trial that compared Hartmann's Procedure (HP) with sigmoidectomy with primary anastomosis (with or without defunctioning ileostomy) (PA) in a randomised design to determine the optimal treatment strategy for perforated diverticulitis with purulent or fecal peritonitis.

Methods: Data were prospectively gathered for the first 12 months after randomization and retrospectively collected up to 36 months. The primary long-term endpoint was stoma free rate 36 months after the index procedure. Secondary outcomes were patients with a stoma at 36 months, percentage of stoma reversals, related reinterventions, parastomal/incisional hernia rates, total in hospital days including all readmissions regardless their relation to the intervention, overall morbidity and mortality.

Results: Three years follow-up was completed in 119 of the originally 130 included patients, with 57 (48%) in the PA-group and 62 (52%) patients in the HP-group. 36 months stoma free rate was significantly better for patients undergoing PA compared with HP (PA 92% vs HP 81%, hazard ratio 2.326 [95% CI 1.538-3.517]; log-rank p < 0·0001). Stoma reversal rates did not significantly differ (PA 31/40(78%) versus HP 45/61(74%), p = 0.814). Overall cumulative morbidity (PA 21/57(36%) versus HP 30/62(48%), p = 0.266) and mortality (PA 6/57(11%) versus HP 7/62 (11%), p = 1.000) did not differ between groups. However, more parastomal hernias occurred in the HP-group (HP 10/62(16%) vs PA 1/57(2%), p = 0.009) and the mean total in hospital days after three years follow-up was significantly lower in the PA-group compared to the HP-group (PA 14 days (IQR 9.5-22.5) versus HP 17 days (IQR 12.5-27.5)), p = 0.025).

Conclusion: Long-term results showed that in haemodynamically stable, immunocompetent patients primary anastomosis is superior to Hartmann's procedure as treatment for perforated diverticulitis with respect to long-term stoma free rate, overall hospitalization and parastomal hernias.

Keywords: Complicated diverticulitis; Hartmann's procedure; Primary anastomosis; Stoma free rate; Surgery; long-term;therapy.

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References

    1. Rustom LBO, Sharara AI. The natural history of colonic diverticulosis: much ado about nothing? Inflamm Intest Dis . 2018;3(2):69-74.
    1. Peery AF, Keku TO, Addamo C, McCoy AN, Martin CF, Galanko JA, et al. Colonic diverticula are not associated with mucosal inflammation or chronic gastrointestinal symptoms. Clin. Gastroenterol. Hepatol . 2018;16(6):884-891 e1.
    1. Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology 2019;156(1):254, 72 e11.
    1. Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N. Engl. J. Med . 1998;338(21):1521-1526.
    1. Shahedi K, Fuller G, Bolus R, Cohen E, Vu M, Shah R, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin. Gastroenterol. Hepatol . 2013;11(12):1609-1613.

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