Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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Comparative Study
Primary anastomosis vs Hartmann's procedure in patients undergoing emergency left colectomy for perforated diverticulitis.
Comparison of primary anastomosis (PA) and Hartmann's procedure (HP) in perforated diverticulitis is biased as the patient groups are different in age, comorbidity and severity of disease. Still, PA has been advocated as the procedure of choice. The aim of this study was to compare the two surgical procedures after eliminating this selection bias using a propensity score model. ⋯ The theory that PA is generally superior to HP cannot be supported. HP remains a safe technique for emergency colectomy in perforated diverticulitis, especially in elderly patients with multiple comorbidities. If PA is performed, a protective ileostomy must be considered.
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Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative lengths of stay (LOS). Laparoscopic surgery shares the same objective. Whether or not laparoscopic surgery conveys additional benefits over and above those achievable with ERAS alone is unclear. ⋯ The limited evidence presently available suggests that no further benefit is obtained by the inclusion of laparoscopic surgery in ERAS protocols. Further research is needed to derive more definitive conclusions.
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Letter Case Reports
Gabapentin therapy for chronic proctalgia following stapled haemorrhoidopexy.