Our Summary

This study compared two surgical methods for treating a serious type of intestinal inflammation: Hartmann’s Procedure (HP) and primary anastomosis (PA). The goal was to find the best treatment strategy. To do this, they followed the progress of patients for three years after their surgeries.

The main factor they looked at was how many patients did not have a stoma (an artificial opening for waste removal) three years after the surgery. They also considered other things like the number of patients who still had a stoma after three years, the percentage of stomas that were reversed, additional surgeries related to the stoma, rates of hernias near the stoma, total time spent in the hospital, and overall health issues and deaths.

119 of the original 130 patients completed the three-year follow-up. The results showed that more patients who had the PA surgery were stoma-free after three years compared to those who had the HP surgery. The rate of reversing the stoma and the overall health issues and deaths were similar for both groups. However, more hernias occurred near the stoma in the HP group, and patients in the PA group spent less time in the hospital overall.

In conclusion, the study found that primary anastomosis is a better long-term treatment for this type of serious intestinal inflammation compared to Hartmann’s Procedure. This is because PA results in higher long-term rates of patients being stoma-free, less time in the hospital, and fewer hernias near the stoma.

FAQs

  1. What were the two surgical methods compared in the study for treating serious intestinal inflammation?
  2. What factors did the study consider when comparing Hartmann’s Procedure and primary anastomosis?
  3. Which surgical procedure resulted in a higher long-term rate of patients being stoma-free and fewer complications?

Doctor’s Tip

A doctor might tell a patient undergoing sigmoidectomy that based on recent studies, primary anastomosis (PA) surgery may be a better long-term treatment option compared to Hartmann’s Procedure (HP). PA has been shown to result in higher rates of patients being stoma-free after three years, less time spent in the hospital, and fewer hernias near the stoma. It is important to discuss with your doctor which surgical method is best for your specific condition and situation.

Suitable For

Patients with serious intestinal inflammation, such as those with diverticulitis, colorectal cancer, inflammatory bowel disease, or ischemic colitis, are typically recommended sigmoidectomy. These patients may require surgery to remove a portion of the sigmoid colon, which is the lower part of the large intestine, to treat their condition. Additionally, patients who have complications such as perforation, obstruction, or abscess formation in the sigmoid colon may also be recommended for sigmoidectomy.

Timeline

Before sigmoidectomy:

  • Patient presents with symptoms of serious intestinal inflammation, such as abdominal pain, bloating, diarrhea, and fever.
  • Patient undergoes diagnostic tests, such as imaging studies and blood tests, to confirm the diagnosis.
  • Patient receives medical treatment, such as antibiotics and anti-inflammatory medications, to manage symptoms and reduce inflammation.
  • If medical treatment is ineffective or if there are complications, patient may be recommended for sigmoidectomy surgery.

After sigmoidectomy:

  • Patient undergoes sigmoidectomy surgery to remove the affected part of the colon.
  • Depending on the surgical method used (HP or PA), patient may or may not have a stoma created.
  • Patient is monitored closely in the hospital for complications, such as infection or bowel obstruction.
  • Patient undergoes post-operative care, such as pain management, wound care, and physical therapy.
  • Patient follows up with healthcare providers for long-term monitoring and management of any complications or side effects of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sigmoidectomy include:

  1. What is the reason for recommending a sigmoidectomy in my case?
  2. What are the potential risks and benefits of the surgery?
  3. What is the expected outcome in terms of recovery time and long-term effects?
  4. Will I need a stoma after the surgery? If so, is it temporary or permanent?
  5. What are the alternatives to sigmoidectomy and why is this the recommended treatment?
  6. How many sigmoidectomies have you performed and what is your success rate?
  7. What is the expected timeline for follow-up appointments and monitoring after the surgery?
  8. Are there any specific lifestyle changes or precautions I should take after the surgery?
  9. What are the signs of complications that I should watch out for post-surgery?
  10. Are there any specific dietary restrictions or recommendations I should follow after the surgery?

Reference

Authors: Edomskis PP, Hoek VT, Stark PW, Lambrichts DPV, Draaisma WA, Consten ECJ, Bemelman WA, Lange JF; LADIES trial collaborators. Journal: Int J Surg. 2022 Feb;98:106221. doi: 10.1016/j.ijsu.2021.106221. Epub 2022 Jan 10. PMID: 35026462