title: Laparoscopic versus open Hartmann procedure for the emergency treatment of diverticulitis: a propensity-matched analysis.
abstract: BACKGROUND
  A laparoscopic approach has been proposed to reduce the high morbidity and mortality associated with the Hartmann procedure for the emergency treatment of diverticulitis.
  
  
  OBJECTIVE
  The objective of our study was to determine whether a laparoscopic Hartmann procedure reduces early morbidity or mortality for patients undergoing an emergency operation for diverticulitis.
  
  
  METHODS
  This is a comparative effectiveness study. A subset of the entire American College of Surgeons National Surgical Quality Improvement Program patient sample matched on propensity for undergoing their procedure with the laparoscopic approach were used to compare postoperative outcomes between laparoscopic and open groups.
  
  
  METHODS
  This study uses data from the American College of Surgeons National Surgical Quality Improvement Program Participant User Files from 2005 through 2009.
  
  
  METHODS
  All patients who underwent an emergency laparoscopic or open partial colectomy with end colostomy for colonic diverticulitis were reviewed.
  
  
  METHODS
  The main outcome measures were 30-day mortality and morbidity.
  
  
  RESULTS
  Included in the analysis were 1186 patients undergoing emergency partial colectomy with end colostomy for diverticulitis. Among the entire cohort, the laparoscopic group had fewer overall complications (26% vs 41.7%, p = 0.008) and shorter mean length of hospitalization (8.9 vs 11.6 days, p = 0.0008). Operative times were not significantly different between groups. When controlling for potential confounders, a laparoscopic approach was not associated with a decrease in morbidity or mortality. In comparison with a propensity-match cohort, the laparoscopic approach did not reduce postoperative morbidity or mortality.
  
  
  CONCLUSIONS
  This study is limited by its retrospective nature and the absence of pertinent variables such as postoperative pain indices, time for return of bowel function, and rates of readmission.
  
  
  CONCLUSIONS
  A laparoscopic approach to the Hartmann procedure for the emergency treatment of complicated diverticulitis does not significantly decrease postoperative morbidity or mortality in comparison with the open technique.
authors.affiliation: Department of General Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. ryan.turley@duke.edu
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lidsky
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: John
authors.initials: J
authors.lastname: Migaly
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D003125:Colostomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D057186:Comparative Effectiveness Research; D004238:Diverticulitis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D058996:Quality Improvement; D018570:Risk Assessment; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D013997:Time Factors