Eficacia de la anastomosis colónica primaria versus colostomía en pacientes con diverticulitis aguda Hinchey IV. Revisión sistemática

Abstract

Objectives: To evaluate the perioperative and postoperative efficacy of Primary Colonic Anastomosis (PCA) and colostomy in patients with acute Hinchey IV diverticulitis, as well as to compare postoperative complication rates, length of hospital stay, and mortality among patients undergoing these procedures. Methodology: This is a systematic literature review based on a search of scientific literature in PubMed, the Cochrane Library, Scopus, and Google Scholar. The included studies were published in English and Spanish within the last five years and were selected according to predefined inclusion and exclusion criteria. The results were synthesized using analytical-synthetic and inductive methods. Results: A total of seven articles related to the surgical management of acute Hinchey IV diverticulitis were evaluated, including multicenter and single-center cohort studies. These studies were rated as being of high methodological quality, with scores ranging from 10 to 11 out of 14, reflecting a robust methodology for assessing the outcomes of surgical techniques. Discussion: According to various studies, Primary Colonic Anastomosis (PCA) was associated with lower mortality (5.3%) compared with colostomy (10.6–14%). The main complications of colostomy included surgical site infection, sepsis, and enteric fistulas. PCA was associated with a lower rate of serious complications despite a higher number of hospital admissions. Conclusions: PCA is considered an effective and safe option in stable patients, with lower mortality, fewer complications, and a better quality of life. Colostomy remains useful in cases of emergency, peritonitis, or comorbidities, and is associated with a longer hospital stay. These results support its surgical use in selected patients. Keywords: acute diverticulitis, Hinchey IV, primary colonic anastomosis, colostomy, postoperative complications