Does primary anastomosis with diversion have any advantages over Hartmann's procedure in acute diverticulitis?.

Abstract:

BACKGROUND:The optimal treatment for acute complicated diverticulitis is still a matter of debate. We evaluated outcomes of primary anastomosis with proximal diversion (PAD) versus Hartman's procedure (HP) in acute diverticulitis. METHODS:Using the National Inpatient Sample database, we examined the clinical data of patients who underwent an urgent open colorectal resection (sigmoidectomy or anterior resection) for acute diverticulitis from 2002 to 2007 in the United States. We evaluated patient characteristics, patient comorbidities, perioperative complications, in-hospital mortality, length of hospital stay and total hospital charges between two groups. RESULTS:A total of 99,259 patients underwent urgent surgery for acute diverticulitis during these years (Primary anastomosis without diversion: 39.3%; HP: 57.3% and PAD: 3.4%). The overall complication rate was lower in the PAD group compared with the HP group (PAD: 39.06% vs. HP: 40.84%; p = 0.04). Patients in the HP group had a shorter mean length of stay (12.5 vs.14.4 days, p < 0.001) and lower mean hospital costs (USD 65,037 vs. USD 73,440, p < 0.01) compared with the PAD group. Mortality was higher in the HP group (4.82 vs. 3.99%, p = 0.03). CONCLUSION:PAD has improved outcomes compared with HP, and should be considered in patients who are deemed candidates for two-stage operations for acute diverticulitis.

journal_name

Dig Surg

journal_title

Digestive surgery

authors

Masoomi H,Stamos MJ,Carmichael JC,Nguyen B,Buchberg B,Mills S

doi

10.1159/000342549

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

315-20

issue

4

eissn

0253-4886

issn

1421-9883

pii

000342549

journal_volume

29

pub_type

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