[Complicated colonic diverticulosis. Changes in treatment and results over 22 years].
OBJECTIVE
The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease.


METHODS
We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females).


RESULTS
Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%).


CONCLUSIONS
The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.
Rohr
S
S
Service de Chirurgie Générale et Digestive, Hôpital de Hautepierre, Strasbourg.
Thiry
C L
CL
Sadok
H
H
de Manzini
N
N
Hollender
L F
LF
Meyer
C
C
D000038:Abscess / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003125:Colostomy; D004239:Diverticulitis, Colonic / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D004241:Diverticulum, Colon / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery
Diverticulose colique compliquée. Evolution du traitement et des résultats en 22 ans.