543 Is It the End of Hartmann’s Procedure for Perforated Diverticulitis with Peritonitis? an Updated Systematic Review and Meta-Analysis

Abstract

Abstract Aim Hartmann’s procedure is the standard technique in the management of perforated diverticulitis. However, many recent studies showed that primary resection and anastomosis have better outcomes. Our aim is to compare HP’s outcomes versus PRA for Hinchey III and IV acute diverticulitis. Method PUBMED, Scopus, and Web of science were searched from inception to September 2022 for all studies comparing the outcomes of HP versus RPA for perforated diverticulitis with peritonitis and a systematic review and meta-analysis were done. Results 29 studies with a total of 4314 participants were included in our study. The pooled results of the included studies showed a remarkable decrease in mortality after PRA (Mortality, RR = 1.38, 95% CI = 1.09-1.73, P = 0.007). However, PRA is associated with a slight increase in the incidence of leakage (Leakage, RR = 0.40, 95% CI = 0.16-1.01, P = 0.05). Nevertheless, no difference in the overall incidence of complications between the two surgeries including SSI, wound dehiscence, bleeding, ileus and reoperation. (Overall incidence of complications, RR = 1.01, 95% CI = 0.84-1.21, P = 0.95). However, PRA is associated with shorter hospital stays but longer operative time. Moreover, those who had PRA with ileostomy had a higher stoma closure rate in comparison to HP (Closure rate, RR = 0.63, 95% CI = 0.49-0.81, P = 0.0003). Conclusions With a lower incidence of mortality, equal rates of complication and higher stoma reversal rates, RPA offers an excellent alternative to HP for perforated diverticulitis with purulent or feculent peritonitis.