Is Hartmann still alive?

Area of Science:

• Colorectal Surgery
• Gastrointestinal Disease Management
• Surgical Oncology

Background:

• Optimal management of colonic diverticular disease with peritonitis remains controversial.
• Historically, Hartmann's procedure was favored over primary anastomosis due to peritonitis concerns.
• Feasibility studies suggest primary anastomosis can be a safe option.

Purpose of the Study:

• To evaluate the current evidence comparing primary anastomosis with Hartmann's procedure for complicated diverticular disease.
• To assess the safety and efficacy of primary anastomosis in selected patients.

Main Methods:

• Literature review comparing primary anastomosis and Hartmann's procedure.
• Analysis of existing studies on surgical management of diverticular peritonitis.
• Discussion of current trends and evidence for different surgical approaches.

Main Results:

• Evidence suggests primary anastomosis is comparable to Hartmann's procedure in selected patients, especially with experienced surgeons.
• Primary anastomosis may avoid the need for a subsequent risky restorative procedure.
• A trend exists towards advocating primary anastomosis with a defunctioning ileostomy for Hinchey stages I-III.

Conclusions:

• Primary anastomosis is a viable option for selected patients with colonic diverticular disease and peritonitis.
• Further randomized controlled trials are needed to definitively prove the safety and superiority of primary anastomosis over Hartmann's procedure.
• Current evidence supports primary anastomosis for specific patient groups, but definitive proof requires more robust research.