Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina.
Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina.
Surgery. 2023 Aug;174(2):180-188. doi: 10.1016/j.surg.2023.04.035. Epub 2023 May 29.
The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of this study was to compare the clinical outcomes of sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with a proximal diversion in perforated diverticulitis with diffuse peritonitis.
A systematic literature search on sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with proximal diversion for diverticulitis with diffuse peritonitis was conducted in the Medline and EMBASE databases. Randomized clinical trials and observational studies reporting the primary outcome of interest (30-day mortality) were included. Secondary outcomes were major morbidity, anastomotic leak, reoperation, stoma nonreversal rates, and length of hospital stay. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes.
A total of 17 studies involving 544 patients (sigmoid resection and primary anastomosis: 287 versus sigmoid resection and primary anastomosis with proximal diversion: 257) were included. Thirty-day mortality (odds ratio 1.12, 95% confidence interval 0.53-2.40, P = .76), major morbidity (odds ratio 1.40, 95% confidence interval 0.80-2.44, P = .24), anastomotic leak (odds ratio 0.34, 95% confidence interval 0.099-1.20, P = .10), reoperation (odds ratio 0.49, 95% confidence interval 0.17-1.46, P = .20), and length of stay (sigmoid resection and primary anastomosis: 12.1 vs resection and primary anastomosis with diverting ileostomy: 15 days, P = .44) were similar between groups. The risk of definitive stoma was significantly lower after sigmoid resection and primary anastomosis (odds ratio 0.05, 95% confidence interval 0.006-0.35, P = .003).
Sigmoid resection and primary anastomosis with or without proximal diversion have similar postoperative outcomes in selected patients with diverticulitis and diffuse peritonitis. However, further randomized controlled trials are needed to confirm these results.
在患有弥漫性腹膜炎的憩室炎患者中，施行乙状结肠切除术和一期吻合术以及施行乙状结肠切除术和一期吻合术加近端转流术的作用尚不清楚。本研究旨在比较穿孔性憩室炎伴弥漫性腹膜炎中行乙状结肠切除术和一期吻合术以及乙状结肠切除术和一期吻合术加近端转流术的临床结果。
在 Medline 和 EMBASE 数据库中对乙状结肠切除术和一期吻合术以及乙状结肠切除术和一期吻合术加近端转流术治疗弥漫性腹膜炎的研究进行了系统的文献检索。纳入了报告主要研究结局（30 天死亡率）的随机临床试验和观察性研究。次要结局包括主要发病率、吻合口漏、再次手术、造口非反转率和住院时间。采用比例的荟萃分析和线性回归模型来评估每种手术对不同结局的影响。
共纳入了 17 项研究，涉及 544 例患者（乙状结肠切除术和一期吻合术：287 例，乙状结肠切除术和一期吻合术加近端转流术：257 例）。30 天死亡率（比值比 1.12，95%置信区间 0.53-2.40，P=0.76）、主要发病率（比值比 1.40，95%置信区间 0.80-2.44，P=0.24）、吻合口漏（比值比 0.34，95%置信区间 0.099-1.20，P=0.10）、再次手术（比值比 0.49，95%置信区间 0.17-1.46，P=0.20）和住院时间（乙状结肠切除术和一期吻合术：12.1 天 vs 乙状结肠切除术和一期吻合术加转流性回肠造口术：15 天，P=0.44）在两组之间相似。乙状结肠切除术和一期吻合术组的确定性造口术风险明显低于乙状结肠切除术和一期吻合术加近端转流术组（比值比 0.05，95%置信区间 0.006-0.35，P=0.003）。
在选择的患有憩室炎和弥漫性腹膜炎的患者中，施行乙状结肠切除术和一期吻合术加或不加近端转流术的术后结局相似。然而，需要进一步的随机对照试验来证实这些结果。
