• Anders Peter Skovsen, Jakob Burcharth, Ismail Gögenur, and Mai-Britt Tolstrup.
• Surgical Department, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark. skovsen@dadlnet.dk.
• Eur J Trauma Emerg Surg. 2023 Oct 1; 49 (5): 204720552047-2055.

PurposeAnastomotic 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.MethodsA 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.ResultsThis 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.ConclusionThere 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 RegistrationThe review was registered with the PROSPERO register of systematic reviews on 14/07/2020 with the ID: CRD42020168670.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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