title: Treatment of Hinchey stage III-IV diverticulitis: a systematic review and meta-analysis.
abstract: BACKGROUND
  This manuscript is a review of different surgical techniques to manage perforated colon diverticulitis.
  
  
  OBJECTIVE
  This study was conducted to compare the benefits and disadvantages of different surgical treatments for Hinchey III or IV type of colon diverticulitis.
  
  
  METHODS
  A systematic search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials, and the Science Citation Index (1990 and 2011). A total of 1,809 publications were identified and 14 studies with 1,041 patients were included in the study. Any surgical treatment was considered in this review. Mortality was considered the primary outcome, whereas hospital stay and reoperation rate were considered secondary outcomes.
  
  
  RESULTS
  Primary resection with anastomosis has a significant advantage in terms of lower mortality rate with respect to Hartmann's procedure (P = 0.02). The postoperative length of hospitalization was significantly shorter in the resection with anastomosis group (P < 0.001). Different findings have emerged from studies of patients with the primary resection with anastomosis vs laparoscopic peritoneal lavage and subsequent resection: overall surgical morbidity and hospital stay were lower in the laparoscopic peritoneal lavage group compared to the primary resection and anastomosis group (P < 0.001).
  
  
  CONCLUSIONS
  Despite numerous published articles on operative treatments for patients with generalized peritonitis from perforated diverticulitis, we found a marked heterogeneity between included studies limiting the possibility to summarize in a metanalytical method the data provided and make difficult to synthesize data in a quantitative fashion. The advantages in the group of colon resection with primary anastomosis in terms of lower mortality rate and postoperative stay should be interpreted with caution because of several limitations. Future randomized controlled trials are needed to further evaluate different surgical treatments for patients with generalized peritonitis from perforated diverticulitis.
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Chiara
authors.initials: C
authors.lastname: Listorti
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.forename: Liu
authors.initials: L
authors.lastname: Liu
mesh_terms: D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery; D003125:Colostomy; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy; D010533:Peritoneal Lavage; D013536:Suture Techniques