Primary Anastomosis with Diverting Loop Ileostomy vs Hartmann’s Procedure for Acute Diverticulitis: What Happens after Discharge? Results of a Nationwide Analysis

Background: Sigmoid Volvulus (SV) is a common cause of acute bowel obstruction in Malawi. We aimed to describe the surgical management of SV and its outcomes at Kamuzu Central Hospital, Lilongwe, Malawi. Methods: We retrospectively reviewed records from January 2019 to December 2019 of all SV patients, aged 18 years and above. Data extracted included age, sex, admission date, surgery date, bowel viability at time of surgery, procedure done, suspected anastomotic leakage, length of hospital stay and mortality. The data was analyzed using STATA 14.0. Results: There were more males (n= 59, 81.9 %) than females. The median (IQR) age was 50.5 (38-60) years. A viable sigmoid colon was present in 61 (84.7%) patients. The commonest procedures done were sigmoid resection and primary anastomosis (RPA) (59.7%, n=43) and Hartmann’s procedure (HP) (36.1%, n=26). The median length of hospital stay was 5 days in HP, 7 days in RPA and longest in mesosigmoidopexy (10 days). Suspected anastomotic leakage occurred in 2(4.7%) patients. The overall mortality was 6.9% with all deaths occurring in RPA patients. Conclusion: Mortality is high in SV patients who undergo RPA. We recommend Hartmann’s procedure in cases where the bowel has significant oedema or is gangrenous.

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Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis—a comparison of stoma reversal rates

International Journal of Colorectal Disease ◽

10.1007/s00384-013-1753-2 ◽

2013 ◽

Vol 28 (12) ◽

pp. 1681-1688 ◽

Cited By ~ 17

Author(s):

P. H. Alizai ◽

M. Schulze-Hagen ◽

C. D. Klink ◽

F. Ulmer ◽

A. A. Roeth ◽

...

Keyword(s):

Primary Anastomosis ◽

Hartmann’S Procedure ◽

Perforated Diverticulitis ◽

Defunctioning Stoma ◽

Stoma Reversal ◽

Hartmann's Procedure

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Application of a Tertiary Referral Scoring System to Predict Nonreversal of Hartmann's Procedure for Diverticulitis in a Community Hospital

The American Surgeon ◽

10.1177/000313481107700712 ◽

2011 ◽

Vol 77 (7) ◽

pp. 814-819 ◽

Cited By ~ 5

Author(s):

Sachin Vaid ◽

Joshua Wallet ◽

Jeff Litt ◽

Ted Bell ◽

Rod Grim ◽

...

Keyword(s):

Logistic Regression ◽

Scoring System ◽

Community Hospital ◽

Acute Diverticulitis ◽

Cleveland Clinic ◽

Hospital Setting ◽

Hartmann’S Procedure ◽

Hartmann’S Reversal ◽

Hartmann's Procedure ◽

Hartmann's Reversal

Riansuwan et al. at Cleveland Clinic developed a scoring system to quantify the risk of Hartmann's nonreversal based on age, preoperative transfusion, pulmonary comorbidity, American Society of Anesthesiologists score, perforation, and anticoagulation. Our study validates the scoring system in a community hospital setting. Patients undergoing Hartmann's procedure for diverticulitis (2006 to June 2009) were identified from our hospital's database. Two groups were formed based on Hartmann's reversal within 1 year and those with nonreversal. An independent-sample t test and logistic regression using score and nine other variables as predictors of Hartmann's non-reversal were run. Sixty-three of 93 patients (67.7%) had a Hartmann's reversal. Higher scores and higher mean age were seen in the nonreversal group (15.5 ± 3.0 vs 12.1 ± 2.5 and 73 ± 15 vs 63 ± 14 years, respectively). Patients with scores 18 or above were not reversed; 43 of 49 patients (88%) with scores of 13 or less were reversed. Logistic regression confirmed that the only predictive variable for nonreversal is a higher score. The scoring system is predictive of nonreversibility of Hartmann's procedure for acute diverticulitis. This will be useful in allowing surgeons to strategize accurately and to counsel patients realistically. Higher scores may allow both the surgeon and patient to have a low threshold for exploring alternatives to Hartmann's procedure.

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