Abstract:
Background. Choosing the optimal procedure for acute
Hinchey III-IV perforated diverticulitis with purulent or fecal
peritonitis remains uncertain because of potential selection
bias. Objective of the study. The determine the efficiency
of different surgical option (Hartmann’s procedure (HP) vs
colonic resection and primary anastomosis (PA) in terms of
length of the hospital stays, economic worthiness, clinical
outcomes, likelihood of stoma reversal, morbidity, and mortality rate. Material and methods. A bibliographic search
for specialized free available English literature was performed in PubMed database according to the MeSH terms:
“acute diverticulitis”, “Hartmann’s procedure”, “colonic resection and primary anastomosis”, “Hinchey classification”,
article type – clinical trials, publication period – 2014-2024.
Results. A total of 4 trials demonstrating the competence
of HP and PA met the inclusion criteria and were reviewed.
The prospective multicenter randomized clinical trial DIVERTI demonstrated the advantage of PA in terms of lower
rate of patients with definitive stoma (4% vs 35% respectively). The LADIES trial and the DIVA arm found that the
patients in PA group had significantly better stoma-free survival (92% vs 81%), less in-hospital days and lower risk for
parastomal hernia occurrence (1,8% vs 16,1%). Also, it was
shown PA was more cost-effective (4382€ vs 8372€). The
clinical trial NCT04034407 revealed that applying the principles of damage control surgery may enhance reconstruction of bowel continuity. Goodbye Hartmann trial supported
the use of PA as the gold standard for surgery in patients
with left-sided colonic emergencies. Conclusion. PA is associated with better clinical outcomes for the management
of left-sided complicated colonic diverticulitis due to lower incidence of complications, better quality of life, higher
stoma-free rates, and greater cost-effectiveness.
