Type of publication:
Conference abstract
Author(s):
*Rajalingam V.; *Chang J.; *Dowdeswell M.; *McCloud J.; *Cheetham M.
Citation:
Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Edinburgh United Kingdom. 24(Supplement 2) (pp 77), 2022. Date of Publication: September 2022.
Abstract:
Purpose: For decades there has been very little change in practice in the surgical management of perforated diverticulitis. Reluctance to risk anastomotic leak persists despite increasing recognition that primary anastomosis (PA) should be considered in selected patients as an alternative to Hartmanns Procedure (HP). We retrospectively studied our outcomes for patients undergoing resectional surgery for diverticulitis. Method(s): All patients undergoing emergency resectional surgery for perforated diverticulitis between March 2015 and Jan 2021 were identified from the Hospital Episode Statistics (HES) data. Demographics were collected and the patient groups were case matched for age and Charleson Comorbidity Index (CCI), Computed Tomography (CT) appearance and intraoperative contamination data. Result(s): 105 patients were included. 15 patients had PA (without diversion) and 90 HP. In the PA cohort were 10 males, median age 52 (range 27-76). There were no anastomotic leaks. 30-day morbidities were superficial wound dehiscence (1) and early incisional hernia (1). Median post-operative stay was 9 days (range 5-25). HP control group (age below 76, CCI 10 and below, Hinchey 1-3). 58 patients, 26 males, median age 60.5 (range 30-76). Median post-operative stay was 10.5 days (range 5-227). 2 patients required re-operation. 5 patients developed wound infections. At the time of the study 18 patients have undergone reversal, 6 are on waiting-list. There was a single 30-day mortality (post-discharge). Conclusion(s): PA in selected patients is not only safe, but has lower morbidity than HP. We should be challenging the status quo and offering our patients appropriate surgery on an individualised basis.
Link to full-text [p. 56, NHS OpenAthens account required]