Our Summary

This research paper is a review of previous studies to find out the risk of two types of hernias (parastomal and incisional) after emergency surgery for a severe form of diverticulitis, which is a condition affecting the digestive tract. The authors specifically compared the risk of these hernias after different surgical methods, including the Hartmann procedure.

The researchers looked at five studies involving 699 patients. They found that the rates of hernias varied greatly depending on the surgical technique used. For example, the rate of parastomal hernias was between 15% and 46% for the Hartmann procedure, while it was 0% to 85% for primary anastomosis, another surgical method.

In terms of incisional hernias, the rates were between 5% and 38% for the Hartmann procedure, and between 5% and 27% for primary anastomosis.

The researchers concluded that the rates of these hernias are not well-documented or reported in research, and the rates varied widely from study to study. This suggests that more research needs to be done to better understand the risks of these hernias after different surgical procedures for diverticulitis.

FAQs

  1. What were the primary and secondary endpoints of this systematic review on diverticulitis surgery?
  2. What were the incidences of parastomal and incisional hernias after different surgical techniques for Hinchey III-IV diverticulitis?
  3. How were the hernia incidences evaluated and reported in the studies included in the systematic review?

Doctor’s Tip

A doctor may advise a patient undergoing diverticulitis surgery to discuss the risk of developing parastomal and incisional hernias with their surgeon. It is important to follow post-operative instructions and attend follow-up appointments to monitor for any signs of hernia formation. Maintaining a healthy lifestyle, including proper nutrition and regular exercise, can also help reduce the risk of hernia development after surgery.

Suitable For

Patients with Hinchey III-IV diverticulitis who require emergency surgery are typically recommended diverticulitis surgery. These patients may have severe complications such as abscesses, perforations, or peritonitis that require immediate surgical intervention. The choice of surgical technique, such as the Hartmann procedure, primary anastomosis, resection, or laparoscopic lavage, may depend on the severity of the diverticulitis and the individual patient’s health status.

It is important to note that the risk of developing parastomal hernias and incisional hernias after diverticulitis surgery should also be considered. Parastomal hernias occur around a stoma created during surgery, while incisional hernias occur at the site of the surgical incision. These hernias can cause discomfort, pain, and potential complications that may require further surgical intervention.

Overall, the decision to recommend diverticulitis surgery for patients with Hinchey III-IV diverticulitis should take into account the potential risks and benefits of the procedure, including the risk of developing parastomal and incisional hernias.

Timeline

  • Before diverticulitis surgery:
  1. Patient presents with symptoms of diverticulitis such as abdominal pain, fever, and changes in bowel habits.
  2. Diagnosis is made through imaging studies such as CT scans or colonoscopy.
  3. Patient may be hospitalized for intravenous antibiotics and bowel rest to treat the acute infection.
  4. Surgery is recommended if the diverticulitis is severe or recurrent, or if there are complications such as abscess or perforation.
  5. Patient undergoes preoperative evaluation and preparation for surgery, including bowel preparation and antibiotic prophylaxis.
  • After diverticulitis surgery:
  1. Patient undergoes surgery, which may involve a Hartmann procedure (removal of part of the colon with formation of a colostomy), primary anastomosis (reconnecting the remaining parts of the colon), resection (removal of the affected part of the colon), or laparoscopic lavage (washing out the infection).
  2. Patient is monitored in the hospital for postoperative complications such as infection, bleeding, or bowel obstruction.
  3. Patient may need a temporary colostomy or ileostomy to allow the colon to heal.
  4. Patient undergoes follow-up visits with the surgeon to monitor for complications and assess recovery.
  5. Patient may require physical therapy or dietary changes to aid in recovery and prevent future episodes of diverticulitis.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with diverticulitis surgery?

  2. What is the likelihood of developing a parastomal hernia or incisional hernia after surgery?

  3. How will my quality of life be affected after surgery, especially in terms of managing a hernia?

  4. What are the different surgical techniques available for treating diverticulitis, and how do they compare in terms of hernia risk?

  5. How long is the recovery period after surgery, and what kind of post-operative care will be required?

  6. Are there any lifestyle changes or dietary modifications I should make to prevent complications after surgery?

  7. Will I need any additional procedures or treatments in the future to address hernia-related issues?

  8. What are the success rates of diverticulitis surgery in terms of preventing future flare-ups and complications?

  9. Are there any alternative treatment options to surgery that I should consider?

  10. How experienced are you in performing diverticulitis surgery, and what is your success rate in terms of minimizing hernia risk for your patients?

Reference

Authors: Mäkäräinen E, Rautio T, Rintala J, Muysoms F, Kauppila JH. Journal: Scand J Surg. 2022 Apr-Jun;111(2):14574969221107276. doi: 10.1177/14574969221107276. PMID: 35748305