scholarly journals Colonic invagination anastomosis in surgery of complicated forms of diverticular disease

2021 ◽  
Vol 20 (4) ◽  
pp. 42-48
Author(s):  
Yu. S. Pankratova ◽  
O. Yu. Karpukhin ◽  
M. I. Ziganshin ◽  
A. F. Shakurov
Keyword(s):  
Colorectal Cancer ◽  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Colorectal Anastomosis ◽  
Hartmann’S Procedure ◽  
Control Group ◽  
Stoma Closure ◽  
Double Row ◽  
Hartmann's Procedure ◽  
Anastomosis Leakage

AIM: to evaluate the prospects of using a colorectal invaginated anastomosis in patients with complicated diverticular disease (CDD).PATIENTS AND METHODS: during the period from 2014 to 2020, colorectal invaginated anastomosis, was used in 42 patients: 18 patients with CDD and 20 patients with colorectal cancer for stoma closure after Hartmann’s procedure. The comparison group consisted of 24 patients with CDD and 20 patients with colorectal cancer for stoma closure after Hartmann’s procedure: colorectal anastomosis was created here using traditional double-row handsewn technique. All patients underwent surgery with open access, while the primary anastomosis was performed in 20 (47.6%) patients, and in 22 (52.4%) patients of the group underwent stoma takedown.RESULTS: no anastomosis leakage developed in the main group. Moreover, the presence of single small diverticula with a diameter of 2–3 mm near the area of the anastomosis was not an indication to extend the resection borders. In the control group, in 13 (54.2%) patients, small diverticula were detected in the anastomosis are as well and required to expand the proximal border of resection. In this group, anastomosis leakage occurred in 2 (6.8%) patients with diverticular disease and required Hartmann’s procedure.CONCLUSION: the colorectal invaginated anastomosis is justified for patients with CDD during stoma takedown because it minimizes the risk of anastomosis leakage.

scholarly journals Operative Management and Outcomes of Patients with Sigmoid Volvulus at a Tertiary Public Hospital in Malawi

2021 ◽  
Vol 18 (3) ◽  
pp. 176-179
Author(s):  
Ephraim Bitilinyu-Bangoh ◽  
Fatsani Mwale ◽  
Loveness Ulunji Chawinga ◽  
Gift Mulima
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Primary Anastomosis ◽  
Length Of Hospital Stay ◽  
Operative Management ◽  
Sigmoid Resection ◽  
Sigmoid Volvulus ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Kamuzu Central Hospital

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.

scholarly journals State-of-the-art surgery for sigmoid diverticulitis

2021 ◽  
Author(s):  
Roberto Cirocchi ◽  
Paolo Sapienza ◽  
Gabriele Anania ◽  
Gian Andrea Binda ◽  
Stefano Avenia ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Fluid Resuscitation ◽  
State Of The Art ◽  
Colonic Resection ◽  
Hartmann’S Procedure ◽  
Sigmoid Diverticulitis ◽  
Definitive Treatment ◽  
Complication Rates ◽  
Bridge To Surgery ◽  
Hartmann's Procedure

Summary Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.

scholarly journals Emergency Left Colon Resection for Acute Perforation. Primary Anastomosis or Hartmann’s Procedure? A Case-matched Control Study

2007 ◽  
Vol 31 (11) ◽  
pp. 2117-2124 ◽  
Author(s):  
Stefan Breitenstein ◽  
Armin Kraus ◽  
Dieter Hahnloser ◽  
Marco Decurtins ◽  
Pierre-Alain Clavien ◽  
...  
Keyword(s):  
Matched Control ◽  
Primary Anastomosis ◽  
Colon Resection ◽  
Left Colon ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Acute Perforation ◽  
Control Study

Primary anastomosis with transverse colostomy as an alternative to Hartmann's procedure

1995 ◽  
Vol 82 (2) ◽  
pp. 170-171 ◽  
Author(s):  
G. J. Maddern ◽  
Y. Nejjari ◽  
A. Dennison ◽  
F. Siriser ◽  
E. Bardoxaglou ◽  
...  
Keyword(s):  
Primary Anastomosis ◽  
Transverse Colostomy ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure

scholarly journals Laparoscopic-assisted reversal of Hartmann's procedure

2010 ◽  
Vol 57 (3) ◽  
pp. 59-65 ◽  
Author(s):  
S. Achkasov ◽  
G. Vorobiev ◽  
A. Zhuchenko ◽  
M. Rinchinov
Keyword(s):  
Wound Infection ◽  
Operation Time ◽  
Main Group ◽  
Hartmann’S Procedure ◽  
Control Group ◽  
Open Approach ◽  
Hartmann's Procedure ◽  
Comparable Control ◽  
Hospital Stays ◽  
Laparoscopic Assisted

BACKGROUND: Postoperative morbidity after reversal of Hartmann's procedure remains high. AIM: to evaluate efficacy of laparoscopic-assisted approach. PATIENTS AND METHODS: 36 patients (19 men, aged 55.71+1.5 years) underwent laparoscopic-assisted reversal procedures in May 2008 - June 2010. The comparable control group consisted of 35 patients (16 men, aged 51.5+13.9 years). RESULTS: operation time was 179.5+65.1 min, 266.9+71.8 min in controls. Blood loss was 64.7+33.7 ml, 181.8+120.4 ml in controls. No conversions occurred in the main group. In three patients of the main group preventive ileostomy was performed. There were 11 diverting stomas in the control group. Postoperative hospital stays were 9.1+2.7 days (12.9+3.4 days in controls). There were 2 (5.9%) postoperative complications in the main group: one wound infection and one parastomal fistula. No mortality occurred. In the control group 3 (9.1%) complications (wound infection and haematoma) were detected. CONCLUSION: laparoscopic-assisted reversal of Hartmann's procedure promotes faster rehabilitation, its results are not worse than after open approach.

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