Meta-analysis of Randomized Clinical Trials on Long-term Outcomes of Surgical Treatment of Perforated Diverticulitis.
Ann Surg
; 278(5): e966-e972, 2023 11 01.
Article
en En
| MEDLINE
| ID: mdl-37249187
ABSTRACT
OBJECTIVE:
To assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL).BACKGROUND:
Surgical treatment of perforated diverticulitis has changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surgical options. However, debate about the optimal surgical strategy lingers.METHODS:
PubMed, Scopus, and Web of Science were searched for randomized clinical trials (RCT) on surgical treatment of perforated diverticulitis from inception to October 2022. Long-term reports of RCT comparing surgical interventions for the treatment of perforated diverticulitis were selected. The main outcome measures were long-term ostomy, long-term complications, recurrence, and reintervention rates.RESULTS:
After screening 2431 studies, 5 long-term follow-up studies of RCT comprising 499 patients were included. Three studies, excluding patients with fecal peritonitis, compared LL and colonic resection, and 2 compared PRA and Hartmann procedures. LL had lower odds of long-term ostomy [odds ratio (OR) = 0.133, 95% CI 0.278-0.579; P < 0.001] and reoperation (OR = 0.585, 95% CI 0.365-0.937; P = 0.02) compared with colonic resection but higher odds of diverticular disease recurrence (OR = 5.8, 95% CI 2.33-14.42; P < 0.001). Colonic resection with PRA had lower odds of long-term ostomy (OR = 0.02, 95% CI 0.003-0.195; P < 0.001), long-term complications (OR = 0.195, 95% CI 0.113-0.335; P < 0.001), reoperation (OR = 0.2, 95% CI 0.108-0.384; P < 0.001), and incisional hernia (OR = 0.184, 95% CI 0.102-0.333; P < 0.001). There was no significant difference in odds of mortality among the procedures.CONCLUSIONS:
Long-term follow-up of patients who underwent emergency surgery for perforated diverticulitis showed that LL had lower odds of long-term ostomy and reoperation, but more risk for disease recurrence when compared with resection in purulent peritonitis. Colonic resection with PRA had better long-term outcomes than the Hartmann procedure for fecal peritonitis.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Peritonitis
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Laparoscopía
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Diverticulitis
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Diverticulitis del Colon
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Perforación Intestinal
Tipo de estudio:
Clinical_trials
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Ann Surg
Año:
2023
Tipo del documento:
Article