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Table 7 Systematic review: primary resection with anastomosis vs Hartmann’s procedure

From: A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine

Authors Type of review Number of studies included Number of patients included Conclusion
Salem 2004 systematic review 98 1.051 “Reported mortality and morbidity in patients with diverticular peritonitis who underwent primary anastomosis were not higher than those in patients undergoing Hartmann’s procedure were. This suggests that primary anastomosis is a safe operative alternative in certain patients with peritonitis. Despite inclusion of only patients with peritonitis in this analysis, selection bias may have been a limitation and a prospective, randomized trial is recommended.”
Constantinides 2006 systematic review and metanalysis 15 963 “Patients selected for primary resection and anastomosis have a lower mortality than those treated by Hartmann’s procedure in the emergency setting and comparable mortality under conditions of generalized peritonitis (Hinchey > 2). The retrospective nature of the included studies allows for a considerable degree of selection bias that limits robust and clinically sound conclusions. This analysis highlights the need for high-quality randomized trials comparing the two techniques
Abbas 2007 systematic review 18 884 “This review suggests that surgical resection and primary anastomosis in acute diverticulitis with peritonitis compares favourably with Hartmann’s procedure in terms of peri-operative complications. The need for revision of Hartmann’s procedure could be subsequently avoided. Some articles showed that patients with severe peritonitis, who had a diverting stoma, in the setting of resection and primary anastomosis, had the lowest complication rate. However, the quality of these studies was poor with the presence of selection bias.”
Cirocchi 2013 systematic review and metanalysis 14 1041 “Despite numerous published articles on operative treatments for patients with generalized peritonitis from perforated diverticulitis, we found a marked heterogeneity between included studies limiting the possibility to summarize in a meta-analytical method the data provided and make difficult to synthesize data in a quantitative fashion. The advantages in the group of colon resection with primary anastomosis in terms of lower mortality rate and postoperative stay should be interpreted with caution because of several limitations. Future randomized controlled trials are needed to further evaluate different surgical treatments for patients with generalized peritonitis from perforated diverticulitis.”
Lorusso 2016 systematic review and metanalysis 24 4.062 Our meta-analysis shows that the PRA technique is better than HP for all considered outcomes. Due to the high variability of the included studies, further randomized controlled trials would be required to confirm these results”.