Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial

Lambrichts, D. P. V.; Vennix, Sandra; Musters, Gijsbert D.; Mulder, Irene M.; Swank, Hilko A; Hoofwijk, A G M; Belgers, E.; Stockmann, H. B. A. C.; Eijsbouts, Q. A. J.; Gerhards, Michael F.; Wagensveld, Bart A. van; Geloven, A. A. W. van; Crolla, Rogier M. P. H.; Nienhuijs, Simon W.; Govaert, Marc J. P. M.; Saverio, Salomone Di; D’Hoore, André; Consten, Esther C. J.; Grevenstein, Wilhelmina M U van; Pierik, Robert; Kruyt, Philip M.; Hoeven, Joost A. B. van der; Steup, W. H.; Catena, Fausto; Konsten, J.; Vermeulen, Jefrey; Dieren, Susan van; Bemelman, Willem A.; Lange, Johan F.; Hop, W C; Opmeer, BC; Reitsma, Johannes B.; Scholte, R A; Waltmann, E W H; Legemate, D A; Bartelsman, J F; Meijer, D.W.; Ünlü, Çağdaş; Kluit, A B; El-Massoudi, Youssef; Vuylsteke, R J C L M; Tanis, P.J.; Matthijsen, R; Polle, SW; Lagarde, SM; Gisbertz, Suzanne S.; Wijers, Oda B.; Bilt, J. van der; Boermeester, Marja A.; Blom, Rachel L. G. M.; Gooszen, JAH; Schreinemacher, MHF; Zande, T van der; Leeuwenburgh, M M N; Bartels, SAL; Hesp, W. L. E. M.; Koet, L; Schelling, GP van der; Dessel, Els Van; Zeeland, M van; Lensvelt, MMA; Nijhof, Hugo W.; Verest, S; Buijs, Mara; Jh, Wijsman; Stassen, L P S; Klinkert, Mo‐Quen; Maat, M de; Sellenraad, G; Jeekel, J; Kleinrensink, G.J.; Tha-In, Thanyalak; Nijboer, W N; Boom, M J; Verbeek, PCM; Sietses, C.; Stommel, M.; Huijstee, PJ van; Merkus, J W S; Eefting, D.; Mieog, J. Sven D.; Geldere, D. van; Patijn, G A; Vries, Max de; Boskamp, M; Bentohami, Abdelali; Bijlsma, T S; Korte, Niels de; Nio, D.; Luttikhold, Joanna; Gool, MH van; Fekkes, JF; Akkersdijk, GJM; Heuff, Gijsbert; Kortmann, B. A.; Werkman, JM; Laméris, Wytze; Rietbergen, L; Frankenmolen, P; Draaisma, W. A.; Stam, M. A. W.; Verweij, M S; Rijna, Herman; Nes, LC de; Fortuin, S; Castro, SM de; Doeksen, A.; Simons, M. P.; Koffeman, Geert I.; Steller, E. Philip; Tuynman, Jurriaan B.; Hensbroek, Pieter Boele van; Mok, MY; Diepen, SR van; Hulsewé, K W E; Melenhorst, J.; Stoot, J H M B; Fransen, S; Sosef, M N; Bastelaar, James van; Vissers, YLJ; Douchy, TPD; Christiaansen, CE; Smeenk, R.M.; Pijnenburg, A. C. M.; Tanaydin, Volkan; Veger, HTC; Clermonts, SHEM; Al-Taher, Mahdi; Graaf, EJR de; Ag, Menon; Vermaas, Maarten; Cense, H A; Jutte, E; Karsten, T M; Wiezer, M J; Smits, A B; Westerterp, Marinke; Marsman, HA; Hendriks, E R; Ruler, Oddeke van; Vriens, E J C; Vogten, J M; Rossem, CC van; Ohanis, David; Tanis, E.; Grinsven, Janneke van; Maring, JK; Heisterkamp, Joos; Besselink, M G H; Rinkes, Ihm Borel; Molenaar, I. Quintus; Joosten, J J A; Jongkind, Vincent; Diepenhorst, GMP; Boute, MC; Smeenge, Martijn; Nielsen, Kim; Harlaar, Joris Jan; Luyer, M D P; Montfort, G; Smulders, J F; Daams, Freek; Haren, E van; Gap, Nieuwenhuijzen; Lauret, GJ; Pereboom, ITA; Stokmans, RA; Birindelli, Arianna; Bianchi, E; Pellegrini, Sara; Terrasson, I; Wolthuis, Albert; Overstraeten, Anthony de Buck van; Nijs, Stefaan

doi:10.1016/s2468-1253(19)30174-8

Cited by 140 publications

(131 citation statements)

References 33 publications

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“…Several studies have addressed the intestinal continuity during surgical treatment for acute diverticulitis. There are three cohort studies and four randomized trials [116][117][118][119][140][141][142]. The randomized clinical trials all include a diverting loop ileostomy in the primary anastomosis arm.…”

Section: What Is the Role Of Restoration Of Intestinal Continuity Witmentioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

184

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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Section: What Is the Role Of Restoration Of Intestinal Continuity Witmentioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

184

177

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“…The LADIES trial assessed outcomes after Hartmann's procedure versus sigmoidectomy and primary anastomosis with or without protective ileostomy in 133 patients with severe sigmoid diverticulitis (Hinchey III or IV disease) aged <85 years. Twelve‐month stoma‐free survival was significantly better in patients with primary anastomosis, and no significant differences were observed in short‐term morbidity and mortality between the two procedures …”

Section: Diverticulitismentioning

confidence: 99%

Essential updates 2018/2019: Colorectal (benign)

Ogino

Mizushima

Matsuda

et al. 2019

Annals of Gastroent Surgery

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This review outlines current topics on the surgical treatment of benign colorectal diseases, with a focus on inflammatory bowel disease (IBD) and diverticulitis. Treatment options for IBD and diverticulitis have evolved in the last few years as a result of medical advances in technology and new clinical trials. Therefore, treatment options and strategies need to be updated to provide optimal care for patients. The purpose of this review is to elucidate recent global trends and update the surgical treatment strategy for IBD and diverticulitis based on literature published in the past 2 years. Prevalence of IBD, including ulcerative colitis and Crohn's disease, has increased over the last few decades. During this period, many new medical therapies were introduced for the treatment of IBD, including biological therapy, immunomodulators, and leukocyte apheresis therapy. As a result, new surgical strategies for IBD are required. In order to improve surgical outcomes in IBD patients, the influence of preoperative treatment on postoperative complications needs to be considered. The incidence of diverticulitis is also increasing with lifestyle changes and increasing numbers of older people. For diverticulitis with perforation and generalized peritonitis, surgery is the gold standard. Elective surgery after conservative treatment of diverticulitis is also an option because of high recurrence rates. With an increase in diverticulitis, systematic strategies are essential for an appropriate approach to diverticulitis, taking into account various factors, including the patient's background.

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“…Another study was published by Lambrichts et al (2019) [69] to evaluate HP versus primary anastomosis with or without defunctioning ileostomy in 133 patients (aged 18-85 years) with perforated diverticulitis with purulent or faecal peritonitis. This was a multicentre, parallel-group, randomised, open-label, superiority trial carried out in 34 teaching hospitals in Belgium, the Netherlands and Italy in the years 2010-2016.…”

Section: Hartmann's Procedures Vs Primary Resection and Anastomosismentioning

confidence: 99%

Hartmann’s Procedure for Complicated Diverticulitis: A Critical Reappraisal

Costantini¹

2019

TOATJ

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Background: Complicated diverticulitis in advanced stages (Hinchey III, IV) is an important surgical emergency for which Hartmann’s Procedure (HP) has traditionally represented the gold standard treatment. HP, however, has high mortality and morbidity and a low percentage of reanastomosis rate. Increasing efforts have therefore been made in recent years to propose alternatives. Objective: To critically review studies on the outcome of HP vs. alternative procedures for complicated diverticulitis Resection-Anastomosis without [RA] or with [RAS] protective stomia, Laparoscopic Lavage [LL]. Methods: Literature search in PubMed for original and review papers in the past 20 years (up to July 2019) with keywords: Hartmann’s procedure, complicated diverticulitis. Results: Comparative studies on HP vs. RA/RAS overall reveal better outcomes of RA/RAS, i.e., reduced mortality, morbidity and healthcare costs. However, most studies have limitations due to lack of randomization, limited number of patients and significant impact of surgeons’ specialization and hospital setting/organization in the decision of the type of surgery to perform. These factors might induce preferential allocation of the most critical patients (advanced age, hemodynamic instability, numerous comorbidities) to HP rather than RA/RAS. LL shows promising results but has been tested in a too small number of trials vs. HP to draw definite conclusions. Conclusion: Though valid alternatives to HP are being increasingly employed, consensus on the best approach to complicated diverticulitis has not yet been reached. HP is still far from representing an obsolete intervention, rather it appears to be the preferred choice in the most critical patients.

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Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial

Cited by 140 publications

References 33 publications

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Essential updates 2018/2019: Colorectal (benign)

Hartmann’s Procedure for Complicated Diverticulitis: A Critical Reappraisal

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