Timing of colostomy reversal following Hartmann's procedure for perforated diverticulitis

ConclusionHartmann's Reversal is a complex surgical procedure associated with high rates of complications. In our series, timing of surgery did not affect surgical complications rate or severity or the length of hospital stay.
Source: Journal of Visceral Surgery - Category: Surgery Source Type: research

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ConclusionUsing the obstruction protocol in patients with bowel obstruction reduced emergency surgery and postoperative morbidity and mortality in this pilot study. This protocol seems to be a viable and efficient alternative to emergency surgery.
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
Acute diverticulitis (AD) is a significant clinical and economic burden, with over 200,000 inpatient admissions and costs exceeding 2 billion dollars annually.1 Current guidelines recommend colonoscopy after AD resolution “in an effort to exclude misdiagnosis of colorectal cancer (CRC) in patients who have not undergone recent high-quality colonoscopy.”2 However, this is a conditional recommendation based on low-quality evidence. Some studies suggest that this recommendation may be too broad. Understanding the ri sk of CRC in persons with AD is a necessary starting point for identifying when colonoscopic evalua...
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Original article Source Type: research
Abstract BACKGROUND: Two RCTs (AVOD and DIABOLO) demonstrated no difference in recovery or adverse outcomes when antibiotics for acute uncomplicated diverticulitis were omitted. Both trials showed non-significantly higher rates of complicated diverticulitis and surgery in the non-antibiotic groups. This meta-analysis of individual-patient data aimed to explore adverse outcomes and identify patients at risk who may benefit from antibiotic treatment. METHODS: Individual-patient data from those with uncomplicated diverticulitis from two RCTs were pooled. Risk factors for adverse outcomes and the effect of observ...
Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
Conclusion: The triple-staple technique is a safe alternative to the double-staple anastomosis after anterior resection. It also effectively shortens the operating time. PMID: 32054240 [PubMed - as supplied by publisher]
Source: Annals of Coloproctology - Category: Gastroenterology Tags: Ann Coloproctol Source Type: research
Twice in three shifts now I have had to call the radiologist to point out their mistakes, and it has changed patient care radically. 1. 55 year old fatman. "Its gawtta be muh diverticalosis again, doc." LLQ tenderness. Rebound+. I'm worried about perf. Radiology reads "acute diverticulitis at rectosigmoid junction; no abscess or free air." *RING RING!* "Hello? Dr. Mouthbreather? This is Dr. RustedFox. Take a look at Jack Sprat's CT again. You see all that free air around the spleen? Might... Read your CTs, folks.
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Emergency Medicine Source Type: forums
Abstract Evaluation and management of acute lower gastrointestinal bleeding focus on etiologies originating distally to the ligament of Treitz. Diverticular disease is the most common source, accounting for 40% of cases. Hemorrhoids, angiodysplasia, infectious colitis, and inflammatory bowel disease are other common sources. Initial evaluation should focus on obtaining the patient's history and performing a physical examination, including evaluation of hemodynamic status. Subsequent evaluation should be based on the suspected etiology. Most patients should undergo colonoscopy for diagnostic and therapeutic purpose...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann’s procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The...
Source: Journal of Coloproctology - Category: Gastroenterology Source Type: research
AbstractBackgroundLaparoscopic primary anastomosis (PA) without diversion for diverticulitis has historically been confined to the elective setting. Hartmann ’s procedure is associated with high morbidity rates that might be reduced with less invasive and one-step approaches. The aim of this study was to analyze the results of laparoscopic PA without diversion in Hinchey III perforated diverticulitis.MethodsWe performed a retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic sigmoidectomy for diverticular disease during the period 2000 –2018. The sample was divi...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
CONCLUSIONS: High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Current Status Reviews Source Type: research
Condition:   Diverticulitis Colon Intervention:   Procedure: colon resection, stoma Sponsors:   Uppsala University;   Centrallasarettet Västerås;   Mora Hospital, Landstinget Dalarna;   Uppsala University Hospital;   University Hospital, Linkoeping;   Danderyd Hospital;   Sahlgrenska University Hospital, Sweden;   Stockholm South General Hospital Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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