98 - Freie Mitteilung
17. Mai 2019, 14:15 - 15:45, Kursaal Arena, 5. OG
Primary anastomosis vs Hartmann procedure for Hinchey III and IV complicated diverticulitis. A single-center experience reflecting current trends.
I. Facile, R. Rosenberg, R. Galli, Presenter: I. Facile (Liestal)
This study was designed to assess management of patients presenting with perforated diverticulitis (Hinchey stages III and IV) in a regional tertiary referral center comparing patients’ characteristics affecting choice of procedure (primary anastomosis “PA” or Hartmann procedure “HP”) and postoperative outcomes.
Retrospective review of all patients operated for a Hinchey III and IV diverticulitis in our institution between 2015 and 2018 was performed. 33 Patients underwent PA with or without defunctioning ileostomy and 33 patients had a HP. Basic patients’ demographics, comorbidities, P-Possum score, ASA classification, operating time and outcomes (mortality, complications according to Clavien-Dindo classification, stoma reversal, length of hospital stay and ICU stay) were analyzed.
Patients undergoing HP were older (75±11.9 vs 62±11.6 years, p<0.001), had a higher number of Hinchey IV diverticulitis (45% vs 9%, p=0.002), higher rate of preoperative renal failure (51% vs 3%, p<0.001), higher ASA classification ≥ 3 (82% vs 57%, p=0.032), higher estimated morbidity (83±13.6% vs 66±12.2%, p<0.001) and mortality (23.1±20.9% vs 6.36±5.5%, p<0.001) according to P-Possum Score, and longer hospital stay (19.7±17 vs 12.8±5.1 days, p=0.014) and ICU stay (6±8.3 vs 1.3±2 days, p=0.015). Operating time was shorter (161±61 vs 194±56 min, p=0.015). No significant differences were found for comorbidities such as immunosuppression (33% vs 15%, p=0.142), diabetes (24% vs 6%, p=0.082) or obesity (BMI 26.1 vs 26.1, p=0.472). Postoperative outcome didn’t differ significantly between PA and HP (severe complications >IIIa 33% vs 15%, p=0.085; mortality within 30 days 18% vs 3%, p=0.0502). Stoma reversal, when applicable, was more frequent after PA (92.3%) than after HP (37%).
This study confirms that HP is the preferred procedure for older patients and patients with severe comorbidities presenting with fecal peritonitis. As showed in the literature PA is a feasible and safe option in terms of morbidity and mortality rates, although a careful pre-operative selection and definition of high risk patients is warranted.