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Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review
European Journal of Trauma and Emergency Surgery ( IF 1.9 ) Pub Date : 2022-12-16 , DOI: 10.1007/s00068-022-02192-7
Anders Peter Skovsen 1 , Jakob Burcharth 2 , Ismail Gögenur 3, 4 , Mai-Britt Tolstrup 1
Affiliation  

Purpose

Anastomotic leakage after small bowel resection in emergency laparotomy is a severe complication. A consensus on the risk factors for anastomotic leakage has not been established, and it is still unclear if peritonitis is a risk factor. This systematic review aimed to evaluate if an entero-entero/entero-colonic anastomosis is safe in patients with peritonitis undergoing abdominal acute care surgery.

Methods

A systematic literature review based on PRISMA guidelines was performed, searching the databases Pubmed/MEDLINE, Cochrane Library, and Science Direct for studies of anastomosis in peritonitis. Patients with an anastomosis after non-planned small bowel resection (ischemia, perforation, or strangulation), including secondary peritonitis, were included. Elective laparotomies and colo-colonic anastomoses were excluded. Due to the etiology, traumatic perforation, in-vitro, and animal studies were excluded.

Results

This review identified 26 studies of small-bowel anastomosis in peritonitis with a total of 2807 patients. This population included a total of 889 small-bowel/right colonic resections with anastomoses, and 242 enterostomies. All studies, except two, were retrospective reviews or case series. The overall mortality rates were 0–20% and anastomotic leakage rates 0–36%. After performing a risk of bias evaluation there was no basis for conducting a meta-analysis. The quality of evidence was rated as low.

Conclusion

There was no evidence to refute performing a primary small-bowel anastomosis in acute laparotomy with peritonitis. There is currently insufficient evidence to label peritonitis as a risk factor for anastomotic leakage in acute care laparotomy with small-bowel resection.

Trial registration

The review was registered with the PROSPERO register of systematic reviews on 14/07/2020 with the ID: CRD42020168670.



中文翻译:

腹膜炎小肠吻合术与肠造口术的比较:系统评价

目的

紧急剖腹手术中小肠切除术后的吻合口漏是一种严重的并发症。关于吻合口瘘的危险因素尚未达成共识,目前尚不清楚腹膜炎是否是一个危险因素。本系统评价旨在评估肠-肠/肠-结肠吻合术对于接受腹部急性护理手术的腹膜炎患者是否安全。

方法

我们根据 PRISMA 指南进行了系统性文献综述,检索了数据库 Pubmed/MEDLINE、Cochrane Library 和 Science Direct 以了解腹膜炎吻合术的研究。非计划小肠切除(缺血、穿孔或绞窄)后接受吻合术(包括继发性腹膜炎)的患者也被纳入其中。选择性剖腹手术和结肠结肠吻合术被排除在外。由于病因学原因,外伤性穿孔、体外和动物研究被排除。

结果

本综述共纳入 2807 名患者,共纳入 26 项腹膜炎小肠吻合术研究。该人群总共包括 889 例小肠/右结肠吻合术切除术和 242 例肠造口术。除两项研究外,所有研究均为回顾性研究或病例系列研究。总死亡率为 0-20%,吻合口漏率为 0-36%。进行偏倚风险评估后,没有进行荟萃分析的基础。证据质量被评为低。

结论

没有证据反对在急性腹膜炎剖腹手术中进行原发性小肠吻合术。目前没有足够的证据表明腹膜炎是急性护理剖腹手术小肠切除术中吻合口瘘的危险因素。

试用注册

该评价已于 2020 年 7 月 14 日在 PROSPERO 系统评价登记册中注册,ID 号:CRD42020168670。

更新日期:2022-12-17
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