Primary resection anastomosis versus Hartmann's procedure in Hinchey III and IV diverticulitis.

Introduction: Surgical management of Hinchey III and IV diverticulitis utilizes either Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. The aim of this meta-analysis is to determine which of the two procedures has a more favorable outcome. Methods: A systematic review of the existing literature was performed using the PRISMA guidelines. A meta-analysis was carried out using a Mantel-Haenszel, random effects model, and forest plots were generated. The Newcastle-Ottawa and Jadad scoring tools were used to assess the included studies. Results: A total of 25 studies involving 3546 patients were included in this study. The overall mortality in the HP group was 10.8% across the observational studies and 9.4% in the randomized controlled trials (RCTs). The mortality rate in the PRA group was lower than that in the HP group, at 8.2% in the observational studies and 4.3% in the RCTs. A comparison of PRA vs HP demonstrated a 40% lower mortality rate in the PRA group than in the HP (OR 0.60, 95% CI 0.38-0.95, p = 0.03) when analyzing the observational studies. However, meta-analysis of the three RCTs did not demonstrate any difference in mortality, (OR 0.44 (95% CI 0.14-1.34, p = 0.15). Wound infection rates between the two groups were comparable (OR 0.75, 95% CI 0.20-2.78, p = 0.67). Conclusion: Analysis of observational studies suggests that PRA may be associated with a lower overall mortality. There were no differences in wound infection rates. Based on the current evidence, both surgical strategies appear to be acceptable.

Effect of near-total thyroidectomy on thyroid orbitopathy due to toxic goiter.

BACKGROUND: The relative merit of surgery in the treatment of Graves' ophthalmopathy as well as the extent of surgical resection are still matters of debate. This study aimed at reporting an assessment of the impact of near-total thyroidectomy on the course of ophthalmopathy including exophthalmos. METHODS: A total of 20 patients with thyrotoxic goiters who were suffering from mild to moderate exophthalmos were enrolled in this prospective study. Preoperative evaluation of ophthalmopathy was accomplished through the NOSPECS classification, magnetic resonance imaging (MRI) for measuring the extraocular muscle diameters, and measurement of the exophthalmos using Hertel's exophthalmometer. Ophthalmopathy including exophthalmos was reevaluated 6 months after operation using the same parameters. RESULTS: Clinical activity evaluation, exophthalmometry, and extraocular muscles measurement by MRI revealed that most of the patients experienced improvement of their ophthalmopathy (65%). This improvement was statistically significant. In addition, no major postoperative complications were observed. However, the study, unlike a number of reported retrospective ones, failed to specify any statistically significant prognostic factors affecting the course of ophthalmopathy; this may have been due to the limited number of patients. In addition, all of the patients were of relatively young age and thyrotoxic, and most were female and nonsmoking. CONCLUSIONS: In addition to the fact that near-total thyroidectomy adds the advantages of total thyroidectomy (no recurrence) to those of subtotal thyroidectomy (low incidence of temporary and permanent hypoparathyroidism), it has a significant positive impact on thyroid-associated orbitopathy.