医学
随机对照试验
憩室炎
优势比
外科
荟萃分析
内科学
作者
Nir Horesh,Sameh Hany Emile,Sualeh Muslim Khan,Michael R. Freund,Zoe Garoufalia,Emanuela Silva‐Alvarenga,Rachel Gefen,Steven D. Wexner
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2023-05-30
卷期号:278 (5): e966-e972
标识
DOI:10.1097/sla.0000000000005909
摘要
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.
科研通智能强力驱动
Strongly Powered by AbleSci AI