Primary anastomosis <i>vs</i> nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial

Binda, G; Karas, Joshua R.; Serventi, A.; Sökmen, Selman; Amato, Antonio; Hydo, Lynn J.; Bergamaschi, Roberto

doi:10.1111/j.1463-1318.2012.03117.x

Cited by 148 publications

(167 citation statements)

References 25 publications

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“…Even if both techniques have shown similar results in terms of efficacy, when considering feculent peritonitis the number of accrued patients is still inadequate to challenge the established use of non-restorative surgery [163,164].…”

Section: What Are the Treatment Options For Feculent Peritonitis?mentioning

confidence: 99%

“…Two prematurely interrupted RCTs [163,164] and several studies with weaker methodology [165,166] have demonstrated similar mortality and morbidity after resection with primary anastomosis and non-restorative procedures: it seems highly unlikely that an exhaustive RCT will be performed [167].…”

Section: What Are the Treatment Options For Purulent Peritonitis?mentioning

confidence: 99%

“…A number of studies, including 2 RCTs, have compared the efficacy and safety of primary anastomosis with those of non-restorative surgery (Hartmann's procedure) in patients with diverticular perforation and diffuse peritonitis [163][164][165][166].…”

Section: What Are the Treatment Options For Feculent Peritonitis?mentioning

confidence: 99%

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Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

et al. 2015

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The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options.

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Section: What Are the Treatment Options For Feculent Peritonitis?mentioning

confidence: 99%

Section: What Are the Treatment Options For Purulent Peritonitis?mentioning

confidence: 99%

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Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

et al. 2015

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“…To reduce this bias, introduced by performing PA in more favorable subjects, prospective randomized studies were soon designed and conducted. As stated by the authors, from the prematurely terminated trial by Binda et al [75], no conclusions could be drawn on treatment preference, although they included a total of 90 patients (15% of calculated sample size) of which 15 patients (16.7%) had Hinchey IV. Furthermore, Oberkofler et al [76] published results favoring PA with diverting ileostomy over HP in a total of 62 patients (30 HP vs. 32 PA).…”

Section: Operative Treatmentmentioning

confidence: 95%

The Multidisciplinary Management of Acute Complicated Diverticulitis

et al. 2018

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Background: Acute complicated diverticulitis (ACD) is an important and increasing issue in Western countries that leads to a significant impact and burden for patients, but also for the society due to its effects on hospital costs. In recent years, essential progression has been made regarding the research and implementation of novel or improved treatment strategies for the various disease entities of ACD. Much debated topics in the multidisciplinary approach of patients with ACD, such as the choice for nonoperative treatment options, the role of percutaneous drainage for diverticular abscesses, the role of laparoscopic lavage for perforated diverticulitis with purulent peritonitis, and the role of sigmoidectomy with primary anastomosis for patients with perforated diverticulitis, require clinicians to attentively follow and participate in these discussions. Summary: The aim of this review article is to provide clinicians with a structured overview of the recent literature on the multidisciplinary management of complicated diverticulitis by a panel of experts on the topic. By performing an extensive literature search in the online medical databases MEDLINE (Ovid) and Embase, insights into nonoperative treatment, percutaneous drainage, minimally invasive and open surgical treatment of ACD are provided. Furthermore, a comprehensive algorithm for the treatment of ACD has been developed. Key Messages: Accurate patient evaluation and selection based on patient and disease characteristics is of paramount importance to determine the appropriate treatment strategy for patients with complicated diverticulitis. The presence of an experienced surgeon with advanced skills in laparoscopic emergency colorectal surgery is crucial for the treatment of patients with perforated diverticulitis in order to properly evaluate, select and treat patients suitable for nonoperative or operative treatment with an open or laparoscopic approach.

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“…A further 52 patients presenting during the study period were not assessed for eligibility for inclusion in the trial because the surgeons involved were not willing to enroll the patient, thus introducing the possibility of selection bias. An earlier attempt at a randomized trial also had to be stopped prematurely because of poor recruitment, highlighting the difficulties of performing a randomized trial on an emergency procedure for a potentially life-threatening condition [44].…”

Section: Primary Anastomosis Versus Hartmann's Proceduresmentioning

confidence: 99%

Management of Acute Diverticulitis and its Complications

Welbourn

Hartley

2014

Indian J Surg

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Colonic diverticular disease is a common condition, and around a quarter of people affected by it will experience acute symptoms at some time. The most common presentation is uncomplicated acute diverticulitis that can be managed conservatively with bowel rest and antibiotics. However, some patients will present with diverticular abscesses or purulent or faeculent peritonitis due to perforated diverticular disease. Whilst most mesocolic abscesses can be managed with percutaneous drainage alone, pelvic abscesses are associated with a higher rate of future complications and usually require percutaneous drainage followed by interval sigmoid resection. Patients who require emergency surgery for complicated acute diverticulitis most commonly undergo a Hartmann's procedure, although resection with primary anastomosis and laparoscopic peritoneal lavage have emerged as alternative treatment options for patients with purulent peritonitis in recent years. However, robust evidence from randomized trials is lacking for these alternative procedures, and the studies that have reported good outcomes from them have included carefully selected patient groups. There has been a move away from recommending elective prophylactic colectomy after two episodes of acute diverticulitis in the light of evidence that most patients will not experience a significant recurrence of their symptoms; elective surgery is indicated for those with ongoing symptoms, pelvic abscesses, complications-such as fistulating disease, strictures or recurrent diverticular bleeding-and those who are at high risk of perforation during future episodes, for example, due to immunosuppression, chronic renal failure or collagen-vascular diseases.

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Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial

Abstract: No conclusions may be drawn on preference of one treatment over another from this RCT because it was prematurely terminated following accrual of 15% of its sample size.

Cited by 148 publications

References 25 publications

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

The Multidisciplinary Management of Acute Complicated Diverticulitis

Management of Acute Diverticulitis and its Complications

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