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Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon

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Abstract

Background and aims

For complicated diverticulitis Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease, but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. This study compared primary resection with intraoperative colonic lavage and Hartmann's procedure.

Patients and methods

Between January 1994 and November 2001, 60 patients underwent emergency laparotomy for diverticular peritonitis (Hinchey stages III and IV). Primary resection and anastomosis with intraoperative colonic lavage was performed in 27 patients and Hartmann's procedure in 33. All data were collected prospectively on a standardized form.

Results

Mortality with intraoperative colonic lavage was 11% and with Hartmann's procedure 12%. The incidence of postoperative complication was significantly higher after Hartmann's procedure. The mean hospital stay was significantly longer after Hartmann's procedure than after primary resection with intraoperative colic lavage.

Conclusion

Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to Hartmann's procedure in stercoral peritonitis.

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Authors and Affiliations

  1. Department of Visceral Surgery, C.H.U. Angers, 4 rue Larrey, 49033, Angers Cedex 01, France

    N. Regenet, P. Pessaux, S. Hennekinne, E. Lermite, J. J. Tuech, O. Brehant & J. P. Arnaud

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  1. N. Regenet
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  2. P. Pessaux
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  3. S. Hennekinne
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  4. E. Lermite
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  5. J. J. Tuech
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  7. J. P. Arnaud
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Correspondence to J. P. Arnaud.

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Regenet, N., Pessaux, P., Hennekinne, S. et al. Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18, 503–507 (2003). https://doi.org/10.1007/s00384-003-0512-1

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