Emergency left colon resection for acute perforation: primary anastomosis or Hartmann's procedure? A case-matched control study.

Details

Serval ID
serval:BIB_6FC143A29C3A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Emergency left colon resection for acute perforation: primary anastomosis or Hartmann's procedure? A case-matched control study.
Journal
World journal of surgery
Author(s)
Breitenstein S., Kraus A., Hahnloser D., Decurtins M., Clavien P.A., Demartines N.
ISSN
0364-2313
Publication state
Published
Issued date
2007
Peer-reviewed
Oui
Volume
31
Number
11
Pages
2117-2124
Language
english
Notes
Journal Article --- Old month value: Nov
Abstract
BACKGROUND: The optimal treatment remains controversial for acute left-sided colon perforation. Therefore, the effectiveness and safety of primary anastomosis versus Hartmann's operation (HP) was compared in a case-matched control study. METHODS: Thirty consecutive patients with primary anastomosis and protective ileostomy (PAS) were matched to 30 HP patients, controlling for age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and peritonitis severity (Hinchey). In a second analysis, PAS patients with purulent peritonitis (Hinchey 3) were matched to patients with primary anastomosis without ileostomy (PA). RESULTS: Hospital mortality was similar between HP (17%) and PAS (10%). Complication frequency and severity (requiring re-intervention or admission to the Intensive Care Unit [ICU]) were comparable for the first operation (60% versus 56% and 30% versus 32%). The stoma reversal rate was higher in PAS than in HP (96% versus 60%, p = 0.001), with significantly fewer complications (23% versus 66%, p = 0.02), and lower severity (7% versus 33%, p = 0.02). Additional analysis of PAS versus PA showed similar morbidity (52% versus 41%, p = 0.45) and complication severity (18% versus 24%, p = 0.51), whereas overall operation time and hospital stay were significantly shorter in PA (169 versus 320 min, p = 0.003, 17 versus 28 days, p < 0.001). CONCLUSIONS: Primary anastomosis and protective ileostomy is a superior treatment to HP in acute left-sided colon perforation. In the absence of feculent peritonitis an ileostomy appears unnecessary.
Keywords
Acute Disease, Aged, Anastomosis, Surgical, Case-Control Studies, Colectomy, Colonic Diseases, Colostomy, Female, Hospital Mortality, Humans, Ileostomy, Intestinal Perforation, Male, Middle Aged, Peritonitis
Pubmed
Web of science
Create date
28/01/2008 9:53
Last modification date
20/08/2019 15:28
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