Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients
Purpose This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA). Methods From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL o...
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| Veröffentlicht in: | International journal of colorectal disease 2016-10, Vol.31 (10), p.1693-1699 |
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| container_title | International journal of colorectal disease |
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| creator | Catry, Jonathan Brouquet, Antoine Peschaud, Frédérique Vychnevskaia, Karina Abdalla, Solafah Malafosse, Robert Lambert, Benoit Costaglioli, Bruno Benoist, Stéphane Penna, Christophe |
| description | Purpose
This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA).
Methods
From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL or RPA. Patients with Hinchey II or IV peritonitis and patients who underwent an upfront Hartmann procedure were excluded. Primary endpoint was overall 30-day or in-hospital postoperative morbidity after surgical treatment of peritonitis.
Results
Twenty-five patients underwent RPA and 15 LPL. Overall postoperative morbidity and mortality rates were not significantly different after RPA and LPL (40 vs 67 %,
p
= 0.19; 4 vs 6.7 %,
p
= 1, respectively). Intra-abdominal morbidity and reoperation rates were significantly higher after LPL compared to RPA (53 vs 12 %,
p
|
| doi_str_mv | 10.1007/s00384-016-2642-2 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1827913363</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714489421</galeid><sourcerecordid>A714489421</sourcerecordid><originalsourceid>FETCH-LOGICAL-c472t-6f3450288080176a3350133dbf2823a092e06fb524441826688f874b719285003</originalsourceid><addsrcrecordid>eNqNUsuO1DAQtBCIXRY-gAuyxIVLFr-SONxWK17SShyAs-VJ2rNeJXGwnVnNV_JLtHeGp0BCOTjtrqqudIqQp5ydc8bal4kxqVXFeFOJRolK3COnXElRcdGI--SU8bareFfrE_IopRuGddOqh-REtI3kyDglXz_67RT8QCMk6LMPM731-Zou0U827qmdbcphCsknfB-oHyGUiz3dQUxroqNdbAypD4vvsdjZLVA_02WN6whzpgtEn8PsMwq4GKZy4UK0GQY6eBTJvl_H0n5Fw5r7MEEZOu7LRBSyaCWkpXjbAe3DdYiZBkcVw2JGz-tdY7HZ47j0mDxwdkzw5Hiekc9vXn-6fFddfXj7_vLiqupVK3LVOKlqJrRmuizFSlkzLuWwcUILaVkngDVuUwulFNeiabR2ulWblndC17j2M_LioIvuvqyQspl86mEc7QxhTQZJbYeKjfwfqGRoRyuEPv8DehPWiNu4QwmmatWxn6itHcH42YUcbV9EzUXLldKdEhxR539B4TPA5HF14PBf_k7gB0KPC08RnDmGwHBmSt7MIW8G82ZK3oxAzrOj4XUzwfCD8T1gCBAHQMLWvIX4yxf9U_UbY4LiGw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1822045490</pqid></control><display><type>article</type><title>Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Catry, Jonathan ; Brouquet, Antoine ; Peschaud, Frédérique ; Vychnevskaia, Karina ; Abdalla, Solafah ; Malafosse, Robert ; Lambert, Benoit ; Costaglioli, Bruno ; Benoist, Stéphane ; Penna, Christophe</creator><creatorcontrib>Catry, Jonathan ; Brouquet, Antoine ; Peschaud, Frédérique ; Vychnevskaia, Karina ; Abdalla, Solafah ; Malafosse, Robert ; Lambert, Benoit ; Costaglioli, Bruno ; Benoist, Stéphane ; Penna, Christophe</creatorcontrib><description>Purpose
This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA).
Methods
From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL or RPA. Patients with Hinchey II or IV peritonitis and patients who underwent an upfront Hartmann procedure were excluded. Primary endpoint was overall 30-day or in-hospital postoperative morbidity after surgical treatment of peritonitis.
Results
Twenty-five patients underwent RPA and 15 LPL. Overall postoperative morbidity and mortality rates were not significantly different after RPA and LPL (40 vs 67 %,
p
= 0.19; 4 vs 6.7 %,
p
= 1, respectively). Intra-abdominal morbidity and reoperation rates were significantly higher after LPL compared to RPA (53 vs 12 %,
p
< 0.01; 40 vs 4 %,
p
= 0.02, respectively). Multivariate analysis showed that LPL (
p
= 0.028, HR = 18.936, CI 95 % = 1.369–261.886) was associated with an increased risk of postoperative intra-abdominal septic morbidity. Among 6 patients who underwent reoperation after LPL, 4 had a Hartmann procedure. All surviving patients who had a procedure requiring stoma creation underwent stoma reversal after a median delay of 92 days after LPL and 72 days after RPA (
p
= 0.07).
Conclusion
LPL for perforated diverticulitis is associated with a high risk of inadequate intra-abdominal sepsis control requiring a Hartmann procedure in up to 25 % of patients. RPA appears to be safer and more effective. It may represent the best option in this context.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-016-2642-2</identifier><identifier>PMID: 27631642</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis ; Anastomosis, Surgical ; Care and treatment ; Colon, Sigmoid - surgery ; Diverticulitis ; Diverticulitis - complications ; Diverticulitis - surgery ; Female ; Gastroenterology ; Hepatology ; Humans ; Ileostomy - methods ; Internal Medicine ; Intestinal Perforation - complications ; Intestinal Perforation - surgery ; Laparoscopic surgery ; Laparoscopy ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Multivariate Analysis ; Original Article ; Patient outcomes ; Peritoneal Lavage ; Peritonitis ; Peritonitis - complications ; Peritonitis - surgery ; Postoperative Care ; Preoperative Care ; Proctology ; Prospective Studies ; Risk Factors ; Surgery ; Treatment Outcome</subject><ispartof>International journal of colorectal disease, 2016-10, Vol.31 (10), p.1693-1699</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><rights>COPYRIGHT 2016 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-6f3450288080176a3350133dbf2823a092e06fb524441826688f874b719285003</citedby><cites>FETCH-LOGICAL-c472t-6f3450288080176a3350133dbf2823a092e06fb524441826688f874b719285003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-016-2642-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-016-2642-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27631642$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Catry, Jonathan</creatorcontrib><creatorcontrib>Brouquet, Antoine</creatorcontrib><creatorcontrib>Peschaud, Frédérique</creatorcontrib><creatorcontrib>Vychnevskaia, Karina</creatorcontrib><creatorcontrib>Abdalla, Solafah</creatorcontrib><creatorcontrib>Malafosse, Robert</creatorcontrib><creatorcontrib>Lambert, Benoit</creatorcontrib><creatorcontrib>Costaglioli, Bruno</creatorcontrib><creatorcontrib>Benoist, Stéphane</creatorcontrib><creatorcontrib>Penna, Christophe</creatorcontrib><title>Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Purpose
This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA).
Methods
From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL or RPA. Patients with Hinchey II or IV peritonitis and patients who underwent an upfront Hartmann procedure were excluded. Primary endpoint was overall 30-day or in-hospital postoperative morbidity after surgical treatment of peritonitis.
Results
Twenty-five patients underwent RPA and 15 LPL. Overall postoperative morbidity and mortality rates were not significantly different after RPA and LPL (40 vs 67 %,
p
= 0.19; 4 vs 6.7 %,
p
= 1, respectively). Intra-abdominal morbidity and reoperation rates were significantly higher after LPL compared to RPA (53 vs 12 %,
p
< 0.01; 40 vs 4 %,
p
= 0.02, respectively). Multivariate analysis showed that LPL (
p
= 0.028, HR = 18.936, CI 95 % = 1.369–261.886) was associated with an increased risk of postoperative intra-abdominal septic morbidity. Among 6 patients who underwent reoperation after LPL, 4 had a Hartmann procedure. All surviving patients who had a procedure requiring stoma creation underwent stoma reversal after a median delay of 92 days after LPL and 72 days after RPA (
p
= 0.07).
Conclusion
LPL for perforated diverticulitis is associated with a high risk of inadequate intra-abdominal sepsis control requiring a Hartmann procedure in up to 25 % of patients. RPA appears to be safer and more effective. It may represent the best option in this context.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Anastomosis, Surgical</subject><subject>Care and treatment</subject><subject>Colon, Sigmoid - surgery</subject><subject>Diverticulitis</subject><subject>Diverticulitis - complications</subject><subject>Diverticulitis - surgery</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Ileostomy - methods</subject><subject>Internal Medicine</subject><subject>Intestinal Perforation - complications</subject><subject>Intestinal Perforation - surgery</subject><subject>Laparoscopic surgery</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Original Article</subject><subject>Patient outcomes</subject><subject>Peritoneal Lavage</subject><subject>Peritonitis</subject><subject>Peritonitis - complications</subject><subject>Peritonitis - surgery</subject><subject>Postoperative Care</subject><subject>Preoperative Care</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNUsuO1DAQtBCIXRY-gAuyxIVLFr-SONxWK17SShyAs-VJ2rNeJXGwnVnNV_JLtHeGp0BCOTjtrqqudIqQp5ydc8bal4kxqVXFeFOJRolK3COnXElRcdGI--SU8bareFfrE_IopRuGddOqh-REtI3kyDglXz_67RT8QCMk6LMPM731-Zou0U827qmdbcphCsknfB-oHyGUiz3dQUxroqNdbAypD4vvsdjZLVA_02WN6whzpgtEn8PsMwq4GKZy4UK0GQY6eBTJvl_H0n5Fw5r7MEEZOu7LRBSyaCWkpXjbAe3DdYiZBkcVw2JGz-tdY7HZ47j0mDxwdkzw5Hiekc9vXn-6fFddfXj7_vLiqupVK3LVOKlqJrRmuizFSlkzLuWwcUILaVkngDVuUwulFNeiabR2ulWblndC17j2M_LioIvuvqyQspl86mEc7QxhTQZJbYeKjfwfqGRoRyuEPv8DehPWiNu4QwmmatWxn6itHcH42YUcbV9EzUXLldKdEhxR539B4TPA5HF14PBf_k7gB0KPC08RnDmGwHBmSt7MIW8G82ZK3oxAzrOj4XUzwfCD8T1gCBAHQMLWvIX4yxf9U_UbY4LiGw</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Catry, Jonathan</creator><creator>Brouquet, Antoine</creator><creator>Peschaud, Frédérique</creator><creator>Vychnevskaia, Karina</creator><creator>Abdalla, Solafah</creator><creator>Malafosse, Robert</creator><creator>Lambert, Benoit</creator><creator>Costaglioli, Bruno</creator><creator>Benoist, Stéphane</creator><creator>Penna, Christophe</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients</title><author>Catry, Jonathan ; Brouquet, Antoine ; Peschaud, Frédérique ; Vychnevskaia, Karina ; Abdalla, Solafah ; Malafosse, Robert ; Lambert, Benoit ; Costaglioli, Bruno ; Benoist, Stéphane ; Penna, Christophe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-6f3450288080176a3350133dbf2823a092e06fb524441826688f874b719285003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Anastomosis, Surgical</topic><topic>Care and treatment</topic><topic>Colon, Sigmoid - surgery</topic><topic>Diverticulitis</topic><topic>Diverticulitis - complications</topic><topic>Diverticulitis - surgery</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Ileostomy - methods</topic><topic>Internal Medicine</topic><topic>Intestinal Perforation - complications</topic><topic>Intestinal Perforation - surgery</topic><topic>Laparoscopic surgery</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Original Article</topic><topic>Patient outcomes</topic><topic>Peritoneal Lavage</topic><topic>Peritonitis</topic><topic>Peritonitis - complications</topic><topic>Peritonitis - surgery</topic><topic>Postoperative Care</topic><topic>Preoperative Care</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Catry, Jonathan</creatorcontrib><creatorcontrib>Brouquet, Antoine</creatorcontrib><creatorcontrib>Peschaud, Frédérique</creatorcontrib><creatorcontrib>Vychnevskaia, Karina</creatorcontrib><creatorcontrib>Abdalla, Solafah</creatorcontrib><creatorcontrib>Malafosse, Robert</creatorcontrib><creatorcontrib>Lambert, Benoit</creatorcontrib><creatorcontrib>Costaglioli, Bruno</creatorcontrib><creatorcontrib>Benoist, Stéphane</creatorcontrib><creatorcontrib>Penna, Christophe</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Catry, Jonathan</au><au>Brouquet, Antoine</au><au>Peschaud, Frédérique</au><au>Vychnevskaia, Karina</au><au>Abdalla, Solafah</au><au>Malafosse, Robert</au><au>Lambert, Benoit</au><au>Costaglioli, Bruno</au><au>Benoist, Stéphane</au><au>Penna, Christophe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>31</volume><issue>10</issue><spage>1693</spage><epage>1699</epage><pages>1693-1699</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Purpose
This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA).
Methods
From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL or RPA. Patients with Hinchey II or IV peritonitis and patients who underwent an upfront Hartmann procedure were excluded. Primary endpoint was overall 30-day or in-hospital postoperative morbidity after surgical treatment of peritonitis.
Results
Twenty-five patients underwent RPA and 15 LPL. Overall postoperative morbidity and mortality rates were not significantly different after RPA and LPL (40 vs 67 %,
p
= 0.19; 4 vs 6.7 %,
p
= 1, respectively). Intra-abdominal morbidity and reoperation rates were significantly higher after LPL compared to RPA (53 vs 12 %,
p
< 0.01; 40 vs 4 %,
p
= 0.02, respectively). Multivariate analysis showed that LPL (
p
= 0.028, HR = 18.936, CI 95 % = 1.369–261.886) was associated with an increased risk of postoperative intra-abdominal septic morbidity. Among 6 patients who underwent reoperation after LPL, 4 had a Hartmann procedure. All surviving patients who had a procedure requiring stoma creation underwent stoma reversal after a median delay of 92 days after LPL and 72 days after RPA (
p
= 0.07).
Conclusion
LPL for perforated diverticulitis is associated with a high risk of inadequate intra-abdominal sepsis control requiring a Hartmann procedure in up to 25 % of patients. RPA appears to be safer and more effective. It may represent the best option in this context.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27631642</pmid><doi>10.1007/s00384-016-2642-2</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-1958 |
| ispartof | International journal of colorectal disease, 2016-10, Vol.31 (10), p.1693-1699 |
| issn | 0179-1958 1432-1262 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1827913363 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Aged, 80 and over Analysis Anastomosis, Surgical Care and treatment Colon, Sigmoid - surgery Diverticulitis Diverticulitis - complications Diverticulitis - surgery Female Gastroenterology Hepatology Humans Ileostomy - methods Internal Medicine Intestinal Perforation - complications Intestinal Perforation - surgery Laparoscopic surgery Laparoscopy Male Medicine Medicine & Public Health Middle Aged Mortality Multivariate Analysis Original Article Patient outcomes Peritoneal Lavage Peritonitis Peritonitis - complications Peritonitis - surgery Postoperative Care Preoperative Care Proctology Prospective Studies Risk Factors Surgery Treatment Outcome |
| title | Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients |
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