Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil.
Arq Bras Cir Dig. 2021 Jan 15;33(3):e1546. doi: 10.1590/0102-672020200003e1546. eCollection 2021.
Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity.
To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment.
Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion.
There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion.
Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.
随机对照试验中急诊手术后的死亡率。对于大多数外科医生来说，在紧急情况下治疗穿孔性憩室炎时，哈氏手术仍然是首选治疗方法；然而，它与高造口非逆转率和术后发病率相关。
研究哈氏手术与一期吻合术（伴或不伴回肠造口术）治疗伴有脓性或粪便性腹膜炎（Hinchey 分级 III 或 IV 级）的穿孔性憩室炎的结果，并比较两种治疗方法的优势。
对比较一期吻合术与哈氏手术治疗穿孔性憩室炎的观察性和随机文章进行系统文献检索。将急诊手术后的死亡率和手术后一般发病率作为主要结局进行分析。次要结局为急诊手术后的严重发病率、造口非逆转率、再手术后的一般发病率和严重发病率。
两种手术方法在死亡率、一般发病率和严重发病率方面无显著差异。然而，与哈氏手术相比，一期吻合术在造口非逆转率、再手术后一般发病率和严重发病率方面的结果具有统计学意义的优势。
一期吻合术是哈氏手术的一个很好的替代方法，死亡率和发病率没有增加，并且在肠转运重建手术中具有更好的结果。
