Sigmoid Volvulus'ta Rezeksiyon Anastomoz ve Hartmann Prosedürünün Sonuçlarının Karşılaştırılması

Öz

AMAÇ: Sigmoid Volvulus'un (SV) cerrahi tedavisinde Hartmann prosedürü (HP) ya da fekal diversiyonlu- disversiyonsuz rezeksiyon anastomoz (RA) yapılabilir. Bu çalışmada iki prosedürün sonuçlarını karşılaştırarak üstünlüklerini belirlemeyi amaçlamaktadır. GEREÇ VE YÖNTEM: 2010-2022 yılları arasında kliniğimizde SV nedeniyle opere edilen tüm hastalar çalışmaya dahil edildi. Hastaların cinsiyet, yaş, komorbidite, ASA skorları, operasyon tipleri, postoperatif komplikasyonlar, hastanede kalış süreleri gibi demografik verilere hasta veritabanından ulaşıldı. Ameliyat sonrası komplikasyonlar (ameliyattan sonraki 30 gün boyunca) Clavien Dindo (CD) sınıflamasına göre sınıflandırıldı. İstatistiksel analizler Mann Whitney U ve ki-kare testleri ile analiz edildi. p<0,05 olan değerler istatistiksel olarak anlamlı kabul edildi. BULGULAR: Çalışmaya toplam 125 hasta dahil edildi. Bu hastaların 99'unun (%79.2) erkek olduğu kaydedildi. 51 (%40.8) hasta HP grubuna, 74 (%59.2) hasta RA grubuna alındı. Hastanede yatış süreleri açısından ortanca HP grubunda 8 (2-30) gün iken RA grubunda 10 (3-35) gündü (p=0.013). CD Sınıflamasına göre 68 (%54.4) hastada operasyona bağlı komplikasyon, 11 (%8.8) hastada operasyona bağlı mortalite görüldü. Gruplar arası istatistiksel olarak anlamlı gözlenen varyansa rağmen, HP'nin RA'ya göre komplikasyonlar açısından daha üstün performans gösterdiği görüldü (p=0.048). SONUÇ: Hastanede kalış süresi ve postoperatif komplikasyonlar HP yapılan grupta daha azdı. Bu nedenle, klinisyenlere SV nedeniyle ameliyat edilen hastalarda HP yapmasını öneriyoruz.

Anahtar Kelimeler

• bağırsak volvulusu
• cerrahi anastomoz
• kolostomi
• postoperatif komplikasyonlar

Outcomes of Resection Anastomosis versus Hartmann’s Procedure in Sigmoid Volvulus

Öz

AIM: This study seeks to ascertain the comparative efficacy between the Hartmann procedure (HP) and resection anastomosis (RA), with or without concurrent fecal diversion, as surgical interventions for Sigmoid Volvulus (SV). The primary objective is to discern the procedure associated with a more favorable clinical outcome. MATERIAL AND METHOD: The study cohort comprised individuals who underwent surgical intervention for SV within the timeframe of 2010 to 2022 at our clinical facility. Demographic particulars encompassing gender and age, as well as comorbid conditions, ASA scores, procedural modalities, postoperative untoward events, and duration of inpatient care, were sourced from the patient database. Evaluation of postoperative complications, occurring within the 30-day window post-surgery, was undertaken in conformity with the Clavien Dindo (CD) classification schema. Statistical analyses encompassing the Mann Whitney U test and chi-square test were applied for data interpretation. Variables with p-values below 0.05 were deemed to possess statistical significance. RESULTS: The study encompassed a total of 125 patients, of whom 99 (79.2%) were male. Among these, 51 (40.8%) patients were allocated to the HP group, while 74 (59.2%) were assigned to the RA group. Concerning hospitalization duration, the median period was 8 (2-30) days in the HP group and 10 (3-35) days in the RA group (p=0.013). In accordance with the CD Classification, 68 (54.4%) patients encountered complications linked to the surgical procedure, with 11 (8.8%) patients experiencing procedure-associated mortality. Despite the observed statistically significant inter-group variance, it was discerned that HP exhibited a superior performance in terms of complications when compared to RA (p=0.048). CONCLUSION: Significantly reduced durations of hospitalization and fewer occurrences of postoperative complications were observed within the cohort undergoing the Hartmann's procedure. As a result, we advocate that clinicians consider prioritizing the implementation of Hartmann's procedure for patients undergoing surgical intervention for SV.

Anahtar Kelimeler

• Intestinal volvulus
• anastomosis surgical
• colostomy
• postoperative complications

Kaynakça

1. 1. Vogel JD, Feingold DL, Stewart DB, Turner JS, Boutros M, Chun J,et al. Clinical Practice Guidelines for Colon Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum. 2016;59(7):589- 600. doi:10.1097/DCR.0000000000000602
2. 2. Saravia Burgos J, Acosta Canedo A. Megacolon y vólvulo de sigmoides: incidencia y fisiopatología [Megacolon and sigmoid volvulus: incidence and physiopathology]. Rev Gastroenterol Peru. 2015;35(1):38-44. PMID: 25875517.
3. 3. Johansson N, Rosemar A, Angenete E. Risk of recurrence of sigmoid volvulus: a single-centre cohort study. Colorectal Dis. 2018;20(6):529-535. doi:10.1111/codi.13972
4. 4. Atamanalp SS, Aydinli B, Ozturk G, Basoglu M, Yıldırgan MI, Oren D, et al. Classification of sigmoid volvulus. Turk J Med Sci. 2008;38:425-9.
5. 5. Perrot L, Fohlen A, Alves A, Lubrano J. Management of the colonic volvulus in 2016. J Visc Surg. 2016;153(3):183-192. doi: 10.1016/j.jviscsurg.2016.03.006
6. 6. Atamanalp SS. Sigmoid volvulus: An update for Atamanalp classification. Pak J Med Sci. 2020 Jul-Aug;36(5):1137-1139. doi: 10.12669/pjms.36.5.2320. PMID: 32704301; PMCID: PMC7372645.
7. 7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205- 213. doi:10.1097/01.sla.0000133083.54934.ae
8. 8. Halabi WJ, Jafari MD, Kang CY, et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg. 2014;259(2):293-301. doi:10.1097/SLA.0b013e31828c88ac

9. 9. Dolejs SC, Guzman MJ, Fajardo AD, Holcomb BK, Robb BW, Waters JA. Contemporary Management of Sigmoid Volvulus. J Gastrointest Surg. 2018;22(8):1404-1411. doi:10.1007/s11605-018- 3747-4
10. 10. Samuel JC, Akinkuotu A, Msiska N, Cairns BA, Muyco AP, Charles AG. Re-examining treatment strategies for sigmoid volvulus: An analysis of treatment and outcomes in Lilongwe, Malawi. Glob j Surg. 2010 Oct;1(2):149-153. PMID: 22570523; PMCID: PMC3345201.
11. 11. Halim H, Askari A, Nunn R, Hollingshead J. Primary resection anastomosis versus Hartmann's procedure in Hinchey III and IV diverticulitis. World J Emerg Surg. 2019;14:32. Published 2019 Jul 11. 37 doi:10.1186/s13017-019-0251-4
12. 12. Kazem Shahmoradi M, Khoshdani Farahani P, Sharifian M. Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study. Ann Med Surg (Lond). 2021 Jan 19;62:160-163. doi: 10.1016/j. amsu.2021.01.019. PMID: 33520215; PMCID: PMC7820798.
13. 13. Althans AR, Aiello A, Steele SR, Bhama AR. Colectomy for caecal and sigmoid volvulus: a national analysis of outcomes and risk factors for postoperative complications. Colorectal Dis. 2019;21(12):1445-1452. doi:10.1111/codi.14747
14. 14. Mulas C, Bruna M, García-Armengol J, Roig JV. Management of colonic volvulus. Experience in 75 patients. Rev Esp Enferm Dig. 2010;102(4):239-248. doi:10.4321/s1130-01082010000400004
15. 15. Halabi WJ, Jafari MD, Kang CY,Nguyen VQ, Carmichael JC, Mills S, et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg. 2014;259(2):293-301. doi:10.1097/SLA.0b013e31828c88ac
16. 16. Moro-Valdezate D, Martín-Arévalo J, Pla-Martí V, García- Botello S, Izquierdo-Moreno A, Pérez-Santiago L, et al. Sigmoid volvulus: outcomes of treatment and predictors of morbidity and mortality. Langenbecks Arch Surg. 2022 May;407(3):1161-1171. doi: 10.1007/s00423-022-02428-5. Epub 2022 Jan 14. PMID: 35028738; PMCID: PMC9151547.
17. 17. Lambrichts DPV, Vennix S, Musters GD, Mulder IM, Swank HA, Hoofwijk AGM, et al. Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial. Lancet Gastroenterol Hepatol. 2019;4(8):599-610. doi:10.1016/S2468-1253(19)30174-8