Pellegrin Alexandra, Alves Arnaud, Beyer-Berjot Laura, Zerbib Philippe, Bridoux Valérie, Manceau Gilles, Panis Yves, Buscail Etienne, Venara Aurélien, Khaoudy Iman, Gaillard Martin, Ortega-Deballon Pablo, Thobie Alexandre, Menahem Benjamin, Eveno Clarisse, Bonnel Catherine, Mabrut Jean-Yves, Badic Bogdan, Godet Camille, Eid Yassine, Duchalais Emilie, Lakkis Zaher, Cotte Eddy, Laforest Anaïs, Desfourneaux Véronique, Maggiori Léon, Rebibo Lionel, Niki Christou, Talal Ali, Mege Diane, Bonnamy Cécile, Germain Adeline, Mauvais François, Tresallet Christophe, Roudie Jean, Laurent Alexis, Trilling Bertrand, Martin Bertrand, Massalou Damien, Romain Benoit, Tranchart Hadrien, Giger Urs, Ouaissi Mehdi, Briant Anaïs R, Parienti J J, Sabbagh Charles
Department of Digestive Surgery Service, Amiens University Hospital, Rond point du Pr Cabrol, 80054, Amiens Cedex 01, France.
Department of Digestive Surgery, Digestive Cancer Registry of Calvados, "ANTICIPE" U1086 INSERM-UCN, Normandie University UNICAEN, Caen University Hospital, Caen, France.
Surg Endosc. 2025 Sep;39(9):5676-5688. doi: 10.1007/s00464-025-11906-y. Epub 2025 Jul 14.
Primary anastomosis with a diverting stoma (PA) has been evaluated relative to Hartmann's procedure (HP) for Hinchey III/IV peritonitis in four randomized trials, all of which lacked power. We aimed to evaluate the safety of PA for this indication in real-life settings.
Patients who underwent surgery for Hinchey III/IV diverticulitis at 43 French centers from 2010 to 2021 were included in this retrospective multicenter study. The primary endpoint was the rate of severe complications at 90 days (Clavien-Dindo III-V). Secondary endpoints included the overall complication rate and stoma-free survival at one year. Two groups of patients (PA vs. HP) were created by propensity score matching (PSM).
In total, 651 patients were included (112 with PA and 539 with HP). We matched 102 of the patients with PA with 102 patients who underwent HP. On day 90, there was no difference in the rate of severe complications (31% vs. 29%, p = 0.75) between these groups in subgroup analyses for Hinchey III (p = 0.99) or Hinchey IV (p = 0.35) diverticulitis. The percentages of patients with Hinchey III or IV diverticulitis did not differ significantly between the groups (SMD = 0.03). After inverse probability treatment weighting, mortality was significantly higher in the HP group than in the PA group (6% vs. 1%, p = 0.019). Stoma-free survival at one year was higher in the PA group (85% vs. 73%, p = 0.03). The reoperation rate at 90 days was higher in the PA group than in the HP group (unadjusted: 21% vs. 13%, p = 0.028; PSM: 21% vs. 7%, p = 0.007, respectively).
PA did not increase the overall rate of complications. Conversely, it decreased mortality and the rate of definitive stomas in a large cohort of patients with Hinchey III/IV sigmoid diverticulitis.
在四项随机试验中，已对原发性吻合术加转流造口术（PA）与哈特曼手术（HP）治疗欣奇 III/IV 级腹膜炎进行了评估，但所有这些试验的效能均不足。我们旨在评估在实际临床环境中 PA 用于该适应症的安全性。
纳入了 2010 年至 2021 年期间在法国 43 家中心因欣奇 III/IV 级憩室炎接受手术的患者，进行这项回顾性多中心研究。主要终点是 90 天时严重并发症的发生率（Clavien-Dindo III-V 级）。次要终点包括总体并发症发生率和一年时无造口生存率。通过倾向评分匹配（PSM）创建了两组患者（PA 组与 HP 组）。
总共纳入了 651 例患者（112 例接受 PA，539 例接受 HP）。我们将 102 例接受 PA 的患者与 102 例接受 HP 的患者进行了匹配。在 90 天时，对于欣奇 III 级（p = 0.99）或欣奇 IV 级（p = 0.35）憩室炎的亚组分析中，两组之间严重并发症发生率无差异（31% 对 29%，p = 0.75）。两组中欣奇 III 级或 IV 级憩室炎患者的百分比无显著差异（标准化均值差 = 0.03）。在逆概率处理加权后，HP 组的死亡率显著高于 PA 组（6% 对 1%，p = 0.019）。PA 组一年时的无造口生存率更高（85% 对 73%，p = 0.03）。PA 组 90 天时的再次手术率高于 HP 组（未调整：21% 对 13%，p = 0.028；PSM：21% 对 7%，p = 0.007）。
PA 并未增加总体并发症发生率。相反，在一大群欣奇 III/IV 级乙状结肠憩室炎患者中，它降低了死亡率和确定性造口的发生率。
