Hartmann's Procedure or Primary Anastomosis?

Perforation following acute diverticulitis is a typical scenario during the first attack. Different classification systems exist to classify acute perforated diverticulitis. While the Hinchey classification, which is based on intraoperative findings, is internationally best known, the German Hansen-Stock classification which is based on CT scan is widely accepted within Germany. When surgery is necessary, sigmoid colectomy is the standard of care. An important question is whether patients should receive primary anastomosis or a Hartmann procedure subsequently. A priori there are several arguments for both procedures. Hartmann's operation is extremely safe and, therefore, represents the best option in severely ill patients and/or extensive peritonitis. However, this operation carries a high risk of stoma nonreversal, or, when reversal is attempted, a high risk in terms of morbidity and mortality. In contrast, primary anastomosis with or without loop ileostoma is a slightly more lengthy procedure as normally the splenic flexure needs to be mobilized and construction of the anastomosis may consume more time than the Hartmann operation. The big advantage of primary anastomosis, however, is that there is no need for the potentially risky stoma reversal operation. The most interesting question is when to do the Hartmann operation or primary anastomosis. Several comparative case series were published showing that primary anastomosis is feasible in many patients. However, no randomized trial is available to date. It is of note, that all non-randomized case series are biased, i.e. that patients in better condition received anastomosis and those with severe peritonitis underwent Hartmann's operation. This bias is undoubtedly likely to be present, even if not obvious, in the published papers! Our own data suggest that this decision should not be based on the extent of peritonitis but rather on patient condition and comorbidity. In conclusion, sigmoid colectomy and primary anastomosis is feasible and safe in many patients who need surgery for perforated diverticulitis, particularly when combined with loop ileostomy. Based on our own published analysis, however, we recommend performing Hartmann's operation in severely ill patients who carry substantial comorbidity, while the extent of peritonitis appears not to be of predominant importance. Copyright (C) 2012 S. Karger AG, Base

Search for dark matter in association with a Higgs boson decaying to b-quarks in pp collisions at s=13 TeV with the ATLAS detector

A search for dark matter pair production in association with a Higgs boson decaying to a pair of bottom quarks is presented, using 3.2 fb(-1) of pp collisions at a centre-of-mass energy of 13 TeV collected by the ATLAS detector at the LHC. The decay of the Higgs boson is reconstructed as a high-momentum b (b) over bar system with either a pair of small-radius jets, or a single large-radius jet with substructure. The observed data are found to be consistent with the expected backgrounds. Results are interpreted using a simplified model with a gauge boson mediating the interaction between dark matter and the Standard Model as well as a two-Higgs-doublet model containing an additional Z' boson which decays to a Standard Model Higgs boson and a new pseudoscalar Higgs boson, the latter decaying into a pair of dark matter particles. (C) 2016 The Author(s). Published by Elsevier B.V