The Experts below are selected from a list of 171 Experts worldwide ranked by ideXlab platform
Robert D Smink - One of the best experts on this subject based on the ideXlab platform.
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the utility of the Hartmann Procedure
American Journal of Surgery, 1998Co-Authors: Darius C Desai, E J Brennan, James F Reilly, Robert D SminkAbstract:BACKGROUND: In 1923 the French surgeon Henri Hartmann described an operation for rectosigmoid cancer as an alternative to abdomino-perineal resection for high-risk patients. In the subsequent years, the indications for performing the Hartmann Procedure have broadened to include complicated diverticulitis, ischemic bowel, iatrogenic perforations, volvulus, and colitis. METHODS: We have retrospectively reviewed our experience in 185 patients who underwent the Hartmann Procedure from January 1981 to December 1995. Charts were reviewed for indications, morbidity, and mortality and to determine the outcome of patients who underwent the Hartmann Procedure. RESULTS: The main indications for performing the Hartmann Procedure were complicated diverticulitis (including perforation, obstruction, and abscesses) in 108 patients, rectosigmoid cancer in 31 patients, and other indications in 46 patients. There were a total of 27 deaths for an in-hospital mortality of 14%. All complications occurred at a rate of less than 9%. Of the 158 surviving patients, 90 (57%) eventually underwent the second stage of the operation to restore bowel continuity. The average length of time between initial resection and reanastomosis was 149 days. There were no deaths associated with the second stage of the Procedure and complications occurred at a rate less than 4%. CONCLUSIONS: This is the largest reviewed series of the Hartmann Procedure. Mortality is lower than in other reported series, and morbidity is low. Our data demonstrate that the second stage of the Procedure, in properly selected individuals, is a Procedure that can be performed with minimal morbidity and no mortality. This is different from other published reports. We conclude that the Hartmann Procedure is a safe and efficacious option for the surgeon confronted with the complex pathology of the rectosigmoid area, with acceptable morbidity and mortality.
Stefan Breitenstein - One of the best experts on this subject based on the ideXlab platform.
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Meta-analysis of surgical strategies in perforated left colonic diverticulitis with generalized peritonitis
Langenbeck's Archives of Surgery, 2018Co-Authors: Sina Schmidt, Tarek Ismail, Milo A. Puhan, Christopher Soll, Stefan BreitensteinAbstract:Purpose Surgical strategies for perforated diverticulitis (Hinchey stages III and IV) remain controversial. This systematic review aimed to compare the outcome of primary anastomosis, Hartmann Procedure and laparoscopic lavage. Methods A systematic literature search was conducted through Medline, Embase, Cochrane Central Register and Health Technology Assessment Database to identify randomized and non-randomized controlled trials involving patients with perforated left-sided colonic diverticulitis comparing different surgical strategies. The methodological quality of the included studies was assessed systematically (Grading of Recommendations, Assessment, Development and Evaluation) and a meta-analysis was performed. Results After screening 4090 titles and abstracts published between 1958 and January 2018, 148 were selected for full text assessment. Sixteen trials (7 RCTs, 9 non-RCTs) with 1223 patients were included. Mortality rates were not significantly different between Hartmann Procedure and primary anastomosis for Hinchey III and IV, neither in the meta-analysis of three RCTs (RR 2.03 (95% CI 0.79 to 5.25); p = 0.14, moderate quality of evidence) nor in the meta-analysis of six observational studies (RR 1.53 (95% CI 0.89 to 2.65); p = 0.13, very low quality of evidence). However, stoma reversal rates were significantly higher in the primary anastomosis group (RR 0.73 (95% CI 0.58 to 0.98); p = 0.008, moderate quality of evidence). Meta-analysis of four RCTs showed no significant difference between laparoscopic lavage for Hinchey III compared to sigmoid resection neither for mortality (RR 1.07 (95% CI 0.65 to 1.76); p = 0.79, moderate quality of evidence) nor for major complications (RR 0.86 (95% CI 0.69 to 1.08); p = 0.20, moderate quality of evidence). Conclusions This systematic review suggests similar rates of complications but higher rates of colonic restoration after primary anastomosis compared to Hartmann Procedure in perforated diverticulitis with generalized peritonitis (Hinchey III and IV). Results in laparoscopic lavage for Hinchey III are not superior to primary resection. However, further studies with a careful interpretation of the meaning of re-interventions are required.
E Schloricke - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic versus open reversal of a Hartmann Procedure a single center study
World Journal of Surgery, 2014Co-Authors: M Zimmermann, Martin Hoffmann, Tilman Laubert, Karlfrederik Meyer, T Jungbluth, U J Roblick, H P Bruch, E SchlorickeAbstract:Purpose Re-anastomosis after a Hartmann Procedure is associated with a higher morbidity and mortality than other elective colorectal operations. The goal of this comparative study was to evaluate whether laparoscopic reversal is a justified operative approach, although the initial operation is most often an emergency laparotomy.
Christophe Penna - One of the best experts on this subject based on the ideXlab platform.
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Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients
International Journal of Colorectal Disease, 2016Co-Authors: Jonathan Catry, Antoine Brouquet, Frédérique Peschaud, Karina Vychnevskaia, Solafah Abdalla, Robert Malafosse, Benoit Lambert, Bruno Costaglioli, Stéphane Benoist, Christophe PennaAbstract:Purpose This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA). Methods From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL or RPA. Patients with Hinchey II or IV peritonitis and patients who underwent an upfront Hartmann Procedure were excluded. Primary endpoint was overall 30-day or in-hospital postoperative morbidity after surgical treatment of peritonitis. Results Twenty-five patients underwent RPA and 15 LPL. Overall postoperative morbidity and mortality rates were not significantly different after RPA and LPL (40 vs 67 %, p = 0.19; 4 vs 6.7 %, p = 1, respectively). Intra-abdominal morbidity and reoperation rates were significantly higher after LPL compared to RPA (53 vs 12 %, p
Darius C Desai - One of the best experts on this subject based on the ideXlab platform.
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the utility of the Hartmann Procedure
American Journal of Surgery, 1998Co-Authors: Darius C Desai, E J Brennan, James F Reilly, Robert D SminkAbstract:BACKGROUND: In 1923 the French surgeon Henri Hartmann described an operation for rectosigmoid cancer as an alternative to abdomino-perineal resection for high-risk patients. In the subsequent years, the indications for performing the Hartmann Procedure have broadened to include complicated diverticulitis, ischemic bowel, iatrogenic perforations, volvulus, and colitis. METHODS: We have retrospectively reviewed our experience in 185 patients who underwent the Hartmann Procedure from January 1981 to December 1995. Charts were reviewed for indications, morbidity, and mortality and to determine the outcome of patients who underwent the Hartmann Procedure. RESULTS: The main indications for performing the Hartmann Procedure were complicated diverticulitis (including perforation, obstruction, and abscesses) in 108 patients, rectosigmoid cancer in 31 patients, and other indications in 46 patients. There were a total of 27 deaths for an in-hospital mortality of 14%. All complications occurred at a rate of less than 9%. Of the 158 surviving patients, 90 (57%) eventually underwent the second stage of the operation to restore bowel continuity. The average length of time between initial resection and reanastomosis was 149 days. There were no deaths associated with the second stage of the Procedure and complications occurred at a rate less than 4%. CONCLUSIONS: This is the largest reviewed series of the Hartmann Procedure. Mortality is lower than in other reported series, and morbidity is low. Our data demonstrate that the second stage of the Procedure, in properly selected individuals, is a Procedure that can be performed with minimal morbidity and no mortality. This is different from other published reports. We conclude that the Hartmann Procedure is a safe and efficacious option for the surgeon confronted with the complex pathology of the rectosigmoid area, with acceptable morbidity and mortality.
