Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy?

2021 ◽  
Author(s):  
Nicolás H. Dreifuss ◽  
Camila Bras Harriott ◽  
Francisco Schlottmann ◽  
Maximiliano E. Bun ◽  
Nicolás A. Rotholtz
Keyword(s):  
Laparoscopic Resection ◽  
Primary Anastomosis ◽  
Loop Ileostomy ◽  
Perforated Diverticulitis

scholarly journals Jejunal Intussusception: A Rare Adult Presentation of Lymphoid Hyperplasia

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Linda Laham ◽  
Ratul Bhattacharyya ◽  
Manrique Guerrero ◽  
Jafar Haghshenas ◽  
Mark Ingram
Keyword(s):  
Small Bowel ◽  
African American Male ◽  
Laparoscopic Resection ◽  
Primary Anastomosis ◽  
Lymphoid Hyperplasia ◽  
Reactive Lymphoid Hyperplasia ◽  
Open Approach ◽  
Safe Navigation ◽  
Mesenteric Fat ◽  
Exploratory Laparoscopy

A 21-year-old African-American male presented to the emergency room with a sudden diffuse onset abdominal pain of one day duration. CT findings revealed mild telescoping of loops of small bowel and mesenteric fat in the left mid abdomen with no apparent masses. The patient underwent an exploratory laparoscopy revealing intussusception of the mid jejunum. As a fair amount of distention compromised safe navigation of the bowel, laparoscopic resection was not warranted at this time. Open approach allowed for segmental resection of the affected segment of the small bowel. This was followed by primary anastomosis. Pathological findings revealed focal reactive lymphoid hyperplasia with marked congestion in the lamina propria of the jejunum. The patient had an unremarkable postoperative period and recovered with no further complications.

scholarly journals EP.WE.205Impact of the Covid-19 Pandemic on Loop Ileostomy Formation

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
E Z Farrow ◽  
T A Cook
Keyword(s):  
Primary Anastomosis ◽  
Loop Ileostomy ◽  
Median Number ◽  
Subsequent Reduction ◽  
Emergency Case ◽  
Defunctioning Stoma ◽  
Stoma Formation ◽  
Colorectal Cancer Patients ◽  
The Impact ◽  
Early Phases

Abstract Aim Uncertainty during the early phases of the Covid-19 pandemic regarding availability of critical care beds and peri-operative impact of SARS-CoV-2 led to changing intercollegiate guidance in favour of increased stoma formation. This study assessed the impact the Covid-19 pandemic had on loop ileostomy formation. Methods Data were reviewed from a prospectively collected database on the number of loop ileostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters. Results 114 loop ileostomies were formed in the 20-month period. There was a 10.0% reduction in loop ileostomy formation in 2020 compared with 2019. The median number of loop ileostomies formed per month over the two 10-month periods was 6. This peaked at 11 in April 2020 coinciding with the first wave of Covid-19, falling in subsequent months. All 11 of these loop ileostomies were formed in colorectal cancer patients undergoing anterior resection, after appropriate counselling. Conclusions There was a reduction in the number of ileostomies formed in 2020 compared with 2019 reflecting the impact of the Covid-19 pandemic on both elective and emergency case load and presentations. These results show reactive change in surgical practice corresponding to guidance at a time of maximum uncertainty. Primary anastomosis still occurred but with an increased likelihood of a defunctioning stoma to minimise the consequences of an anastomotic leak. A subsequent reduction in stoma formation in the following months indicates that practice rapidly returned to normal.

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

2020 ◽  
Vol 33 (3) ◽  
Author(s):  
Rogério Perônico BEZERRA ◽  
Adriano Carneiro da COSTA ◽  
Fernando SANTA-CRUZ ◽  
Álvaro A. B. FERRAZ
Keyword(s):  
Primary Anastomosis ◽  
Meta Analysis ◽  
Emergency Operation ◽  
Treatment Method ◽  
Good Alternative ◽  
Perforated Diverticulitis ◽  
Hartmann Procedure ◽  
Mortality And Morbidity ◽  
Severe Morbidity ◽  
Surgery Rates

ABSTRACT Background: 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.

scholarly journals Diverticulitis

2008 ◽  
Vol 55 (3) ◽  
pp. 97-102 ◽  
Author(s):  
J. Pfeifer
Keyword(s):  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Treatment Modalities ◽  
Perforated Diverticulitis ◽  
Western World ◽  
Common Disease ◽  
Concomitant Treatment ◽  
Wide Range ◽  
Life Threatening

Diverticular disease produces a wide range of clinical presentations varying from minimal clinical discomfort to life-threatening complications. Often there is a considerable discrepancy between clinical, radiologic, endoscopic and pathologic findings. Diverticulosis is a quite common disease affecting about 2/3 of people in the Western world over the age 80. The exact incidence of acute diverticulitis is unclear. We distinguish between uncomplicated and complicated diverticular disease forms. The latter includes abscess formation, stricture, obstruction, and free perforation causing life-threatening peritonitis. Several classifications for perforated diverticulitis have been proposed. From the practical point of view the Hansen-Stock classification seems to be the most appropriate one as it includes all forms of diverticular disease; it can also be used preoperatively. Prophylactic resection to avoid complications is not justified in minimally symptomatic individuals. Timing of the operation depends on the clinical course and the grade of peritonitis and on concomitant treatment modalities. Emergency operations should be avoided if possible, to reduce morbidity and mortality. Elective operations should be performed best 6-8 weeks after a second diverticulitis attack. Resection plus primary anastomosis is preferred to a Hartmann?s procedure, if possible. Elective surgery should be done laparoscopically. In acute diverticulitis the goal is to treat uncomplicated forms conservatively, while complicated forms should undergo elective, laparoscopic colon resection.

scholarly journals Short- and long-term outcomes for primary anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis: a multivariate logistic regression analysis of risk factors

2020 ◽  
Author(s):  
Ivan Facile ◽  
Raffaele Galli ◽  
Pavlo Dinter ◽  
Robert Rosenberg ◽  
Markus Von Flüe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Postoperative Morbidity ◽  
Primary Anastomosis ◽  
Multivariate Logistic Regression Analysis ◽  
Morbidity And Mortality ◽  
Perforated Diverticulitis ◽  
Multivariate Logistic Regression

Abstract Purpose The management of perforated diverticulitis with generalized peritonitis is still controversial and no preferred standardized therapeutic approach has been determined. We compared surgical outcomes between Hartmann’s procedure (HP) and primary anastomosis (PA) in patients with Hinchey III and IV perforated diverticulitis. Methods Multicenter retrospective analysis of 131 consecutive patients with Hinchey III and IV diverticulitis operated either with HP or PA from 2015 to 2018. Postoperative morbidity was compared after adjustment for known risk factors in a multivariate logistic regression. Results Sixty-six patients underwent HP, while PA was carried out in 65 patients, 35.8% of those were defunctioned. HP was more performed in older patients (74.6 vs. 61.2 years, p < .001), with Hinchey IV diverticulitis (37% vs. 7%, p < .001) and in patients with worse prognostic scores (P-POSSUM Physiology Score, p < .001, Charlson Comorbidity Index p < .001). Major morbidity and mortality were higher in HP compared to PA (30.3% vs. 9.2%, p = .002 and 10.6% vs. 0%, p = .007, respectively) with lower stoma reversal rate (43.9% vs. 86.9%, p < .001). In a multivariate logistic regression, PA was independently associated with lower postoperative morbidity and mortality (OR 0.24, 95% CI 0.06–0.96, p = .044). Conclusions In comparison to PA, HP is associated with a higher morbidity, higher mortality, and a lower stoma reversal rate. Although a higher prevalence of risk factors in HP patients may explain these outcomes, a significant increase in morbidity and mortality persisted in a multivariate logistic regression analysis that was stratified for the identified risk factors.

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