Hand-Sewn Versus Stapled Small Bowel Anastomoses in Patients With Secondary Mesenteric Ischemia.

INTRODUCTION: Although stapled anastomoses have been widely evaluated in the context of the elective surgery, few reports compared manual with stapled anastomoses in patients undergoing emergency surgery. The aim of this study is to compare the outcome of hand-sewn end-to-end anastomoses with stapled side-to-side and stapled end-to-side anastomoses in patients undergoing small bowel resection for acute mesenteric ischemia secondary to intestinal obstruction. METHODS: From January 2015 to June 2021 all the hemodynamically stable patients undergoing emergency surgery with small bowel resection for intestinal obstruction were enrolled in this study. According to surgical technique in performing anastomosis, the patients were divided into three groups: group 1: hand-sewn end-to-end anastomosis, group 2: stapled end-to-side anastomosis, and group 3: stapled side-to-side anastomosis. RESULTS: Although the anastomosis failure rate was higher in group 3, it was not significantly different between the three groups (P = 0.78: chi-square test). Likewise, no significant differences in the median hospital stay were found between the patients' groups (P = 0.87: Kruskal-Wallis test). The median operating time was similar in patients undergoing stapled anastomoses and was significantly higher in patients undergoing hand-sewn anastomoses (P = 0.0009: Kruskal-Wallis test). CONCLUSIONS: In patients undergoing emergency small bowel resection for complicated intestinal obstruction, a similar outcome in terms of dehiscence rate and hospital stay can be achieved performing stapled or hand-sewn anastomoses, even if restoring the intestinal continuity with stapled technique is associated with lower operating time.

Treatment of acute diverticulitis with open abdomen technique.

AIM: The aim of this study is to highlight our experience about the use of open Abdomen's technique as strategy for the management of complicated colon diverticulitis with a delayed anastomosis or colostomy. MATERIALS AND METHODS: Thirty patients, with III and IV Hinchey stage, have been undertaken to a surgical procedure with Open Abdomen technique and application of Ab-thera device. A second surgical look was made after 48-72 hours in order to evaluate the possibility to do an anastomosis or colostomy. RESULTS: No deaths in patients with anastomosis were reported, but one case of leakage at the 8th day and one case of micro pulmonary embolism had been displayed. Elderly patients were discharged between the 15TH /18th day. One patient affected by lymphoma was sent in haematology department for other treatment. DISCUSSION: Today trend is to treat the diverticular disease with colic and paracolic abscess by a medical therapy and percutaneous drainage under CT scan or ultrasound view. With III and IV of Hinchey scale we perform the resection with anastomosis or colostomy. The open abdomen technique allows the surgeons to make the decision of colostomy or anastomosis in the second surgical look at 48-72 hours after the first treatment with irrigation and aspiration during AB-Thera. CONCLUSION: The Open Abdomen technique is a valid therapeutic alternative approach for patients with acute diverticulitis disease in III and IV Hinchey grade. This therapeutic approach gives important advantages in patients with delayed colostomy. KEY WORDS: Diverticulitis, Damage Control Surgery, Open Abdomen.

Advantages of Damage Control Strategy With Abdominal Negative Pressure and Instillation in Patients With Diffuse Peritonitis From Perforated Diverticular Disease.

Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients' conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann's procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann's procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.