Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon

Régenet, Nicolas; Pessaux, Patrick; Hennekinne, S; Lermite, Émilie; Tuech, Jean‐Jacques; Bréhant, Olivier; Arnaud, J. P.

doi:10.1007/s00384-003-0512-1

Cited by 107 publications

(114 citation statements)

References 19 publications

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“…Technically, PAD is more difficult (and probably less successful) in abdominal septic conditions, such as complicated diverticulitis or pancreatitis. However, PAD has its limitations, and it is significant that advanced age seems to be associated with a higher risk for PAD failure in our series and others as well [17].…”

Section: Discussionmentioning

confidence: 91%

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Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

et al. 2006

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Background: Percutaneous abscess drainage guided by computed tomography scan is considered the initial step in the management of patients presenting with Hinchey II diverticulitis. The rationale behind this approach is to manage the septic complication conservatively and to follow this later using elective sigmoidectomy with primary anastomosis. Methods: The clinical outcomes for Hinchey II patients who underwent percutaneous abscess drainage in our institution were reviewed. Drainage was considered a failure when signs of continuing sepsis developed, abscess or fistula recurred within 4 weeks of drainage, and emergency surgical resection with or without a colostomy had to be performed. Results: A total of 34 patients (17 men and 17 women; median age, 71 years; range, 34-90 years) were considered for analysis. The median abscess size was 6 cm (range, 3-18 cm), and the median duration of drainage was 8 days (range, 1-18 days). Drainage was considered successful for 23 patients (67%). The causes of failure for the remaining 11 patients included continuing sepsis (n = 5), abscess recurrence (n = 5), and fistula formation (n = 1). Ten patients who failed percutaneous abscess drainage underwent an emergency Hartmann procedure, with a median delay of 14 days (range, 1-65 days) between drainage and surgery. Three patients in this group (33%) died in the immediate postoperative period. Among the 23 patients successfully drained, 12 underwent elective sigmoid resection with a primary anastomosis. The median delay between drainage and surgery was 101 days (range, 40-420 days). In this group, there were no anastomotic leaks and no mortality. Conclusion: Drainage of Hinchey II diverticulitis guided by computed scan was successful in two-thirds of the cases, and 35% of the patients eventually underwent a safe elective sigmoid resection with primary anastomosis. By contrast, failure of percutaneous abscess drainage to control sepsis is associated with a high mortality rate when an emergency resection is performed. The current results demonstrate that percutaneous abscess drainage is an effective initial therapeutic approach for patients with Hinchey II diverticulitis, and that emergency surgery should be avoided whenever possible.

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Section: Discussionmentioning

confidence: 91%

“…However, some surgeons have reported good results for selected series of patients who underwent semi-urgent sigmoidectomy with a colorectal anastomosis [16][17][18]. Thus, the question is to determine whether PAD for Hinchey stage II diverticulitis actually is delaying definitive treatment rather than downstaging the initial disease.…”

mentioning

confidence: 99%

Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

et al. 2006

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“…Three patients with complicated (Hinchey II) disease underwent diversion with a loop ileostomy due to fistula formation and significant pelvic abscess. While not routinely employed for Hinchey stage I or II disease, diversion has been reported as a safe and beneficial option in the presence of significant inflammatory reaction [57][58][59][60][61][62]. Ileostomy takedown was performed successfully without complication 3 months after their initial procedures.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature

Ragupathi¹,

Ramos-Valadez²,

Patel³

et al. 2010

Surg Endosc

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“…Neither bursting pressure nor the amount of adhesions were studied at earlier time points than 1 week in the CLP model because of the high mortality during the first days 22 . The operative management of the colon in coexisting peritonitis has recently changed with an increasing percentage of resections performed with primary anastomosis 23 . Doubts has also risen whereas to use antiadhesive agents at all during peritonitis since this could potentially diminish the abdominal host defense capacity of restraining infection and e.g.…”

Section: Discussionmentioning

confidence: 99%

Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat

Tingstedt

Nehéz

Axelsson

et al. 2005

Int J Colorectal Dis

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Methods: An ileocolic anastomosis was performed under both "clean" and "septic"conditions in the rat. The treatment group received intraperitoneal poly-L-lysine and poly-Lglutamate while controls received sodium chloride. Abdominal adhesions, anastomosis leakage and burst pressure were analyzed after 1, 3, 5 and 7 days in the "clean" anastomosis model and after 7 days in the "septic" model.Results: A significant decrease (p<0.01) in the amount of adhesions was seen in animals treated with polypeptides after 1, 3, and 5 days, while no difference was seen after 7 days.The anastomosis demonstrated a significantly higher burst pressure as evaluated day 1 and 3 (p<0.05 and p<0.01, respectively) in the polypeptide treated animals while no difference was seen between the groups at days 5 or 7.Conclusion: The use of differently charged polypeptides administered intraperitoneal after surgery resulted in a significant decrease in the extent of postoperative adhesions.Furthermore, an increase in intestinal anastomosis safety, based on improved burst pressure during the first 3 days, i.e. the critical period during the healing process, was noted. No adverse effects were seen in surgery during "septic" conditions.

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Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon

Abstract: Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to Hartmann's procedure in stercoral peritonitis.

Cited by 107 publications

References 19 publications

Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan

Robotic-assisted laparoscopic surgery for recurrent diverticulitis: experience in consecutive cases and a review of the literature

Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat

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