Journal Article Ppublish
PubMed: 40659954 DOI: 10.1007/s00464-025-11906-y
Hartmann's procedure versus primary anastomosis for Hinchey III or IV sigmoid diverticulitis: a propensity score analysis of a retrospective national cohort study.
Surg Endosc 39(9):5676-5688
Authors: Alexandra Pellegrin, Arnaud Alves, Laura Beyer-Berjot, Philippe Zerbib, Valérie Bridoux, Gilles Manceau, Yves Panis, Etienne Buscail, Aurélien Venara, Iman Khaoudy, Martin Gaillard, Pablo Ortega-Deballon, Alexandre Thobie, Benjamin Menahem, Clarisse Eveno, Catherine Bonnel, Jean-Yves Mabrut, Bogdan Badic, Camille Godet, Yassine Eid, Emilie Duchalais, Zaher Lakkis, Eddy Cotte, Anaïs Laforest, Véronique Desfourneaux, Léon Maggiori, Lionel Rebibo, Christou Niki, Ali Talal, Diane Mege, Cécile Bonnamy, Adeline Germain, François Mauvais, Christophe Tresallet, Jean Roudie, Alexis Laurent, Bertrand Trilling, Bertrand Martin, Damien Massalou, Benoit Romain, Hadrien Tranchart, Urs Giger, Mehdi Ouaissi, Anaïs R Briant, J J Parienti, Charles Sabbagh
Affiliations
- Department of Digestive Surgery Service, Amiens University Hospital, Rond point du Pr Cabrol, 80054, Amiens Cedex 01, France.
- Department of Digestive Surgery, Digestive Cancer Registry of Calvados, "ANTICIPE" U1086 INSERM-UCN, Normandie University UNICAEN, Caen University Hospital, Caen, France.
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France.
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Lille University North France, Lille, France.
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France.
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France.
- Department of Colorectal Surgery, APHP North, Hospital Beaujon, Clichy, Hauts-de-Seine, France.
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France.
- Department of Digestive Surgery, University Hospital of Angers, Angers, France.
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France.
- Department of Digestive Surgery, Cochin Hospital, Paris, France.
- Department of General Surgery, University Hospital of Bocage, Dijon, France.
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France.
- Department of Digestive Surgery, University Hospital of Lille, Lille, France.
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France.
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France.
- Department of General and Digestive Surgery, University Hospital, Brest, France.
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France.
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France.
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France.
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France.
- Department of Digestive Surgery, Lyon South Hospital, Lyon, France.
- Department of Digestive Surgery, Montsouris Institute, Paris, France.
- Department of Digestive Surgery, CHU Rennes, Rennes, France.
- Department of Digestive Surgery, Saint-Louis Hospital, Paris University VII, APHP, Paris, France.
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat-Claude-Bernard Hospital, Paris, France.
- Department of Digestive Surgery, Limoges Hospital, Limoges, France.
- Department of Digestive Surgery, Argentan Hospital, Argentan, France.
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France.
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France.
- Department of Digestive Surgery, CHRU Nancy, Nancy, France.
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France.
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France.
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France.
- Department of Digestive Surgery, Créteil Hospital, Créteil, France.
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France.
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France.
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France.
- Fliedner Fachhochschule, University of Applied Science, Düsseldorf, Germany.
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplantation, Trousseau Hospital, University Hospital of Tours, Tours, France.
- Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France.
- Department of Digestive Surgery Service, Amiens University Hospital, Rond point du Pr Cabrol, 80054, Amiens Cedex 01, France.
Abstract
INTRODUCTION
Primary anastomosis with a diverting stoma (PA) has been evaluated relative to Hartmann's procedure (HP) for Hinchey III/IV peritonitis in four randomized trials, all of which lacked power. We aimed to evaluate the safety of PA for this indication in real-life settings.
PATIENTS AND METHODS
Patients who underwent surgery for Hinchey III/IV diverticulitis at 43 French centers from 2010 to 2021 were included in this retrospective multicenter study. The primary endpoint was the rate of severe complications at 90 days (Clavien-Dindo III-V). Secondary endpoints included the overall complication rate and stoma-free survival at one year. Two groups of patients (PA vs. HP) were created by propensity score matching (PSM).
RESULTS
In total, 651 patients were included (112 with PA and 539 with HP). We matched 102 of the patients with PA with 102 patients who underwent HP. On day 90, there was no difference in the rate of severe complications (31% vs. 29%, p = 0.75) between these groups in subgroup analyses for Hinchey III (p = 0.99) or Hinchey IV (p = 0.35) diverticulitis. The percentages of patients with Hinchey III or IV diverticulitis did not differ significantly between the groups (SMD = 0.03). After inverse probability treatment weighting, mortality was significantly higher in the HP group than in the PA group (6% vs. 1%, p = 0.019). Stoma-free survival at one year was higher in the PA group (85% vs. 73%, p = 0.03). The reoperation rate at 90 days was higher in the PA group than in the HP group (unadjusted: 21% vs. 13%, p = 0.028; PSM: 21% vs. 7%, p = 0.007, respectively).
CONCLUSION
PA did not increase the overall rate of complications. Conversely, it decreased mortality and the rate of definitive stomas in a large cohort of patients with Hinchey III/IV sigmoid diverticulitis.
MeSH
Mortality, Colon, Sigmoid, Diverticulitis, Cohort Studies, Propensity Score, Endoscopy