title: Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection.
abstract: OBJECTIVE
  To assess the comparative effects of two surgical regimens on the outcome of acute complicated diverticular disease.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Teaching hospital, The Netherlands.
  
  
  METHODS
  60 patients who presented with acute complicated diverticular disease.
  
  
  METHODS
  28 patient were treated by sigmoid resection and a Hartmann operation, and 32 by resection with primary anastomosis and defunctioning stoma.
  
  
  METHODS
  Morbidity and mortality.
  
  
  RESULTS
  The severity of peritonitis and the amount of faecal contamination were similar in the 2 groups. 12 patients died (7 in the Hartmann group and 5 in the primary anastomosis group). There were 3 radiological leaks with no clinical implications in the primary anastomosis group. 6 patients in the Hartmann group and 5 in the primary anastomosis group required reoperations for intra-abdominal abscess or infection. 7 and 3 patients, respectively, developed dysfunction of their stomas, and 9/21 and 3/27, respectively, required a permanent stoma (p = 0.02, 95% confidence interval of difference 0.07 to 0.56). 3 patients in the Hartmann group developed anastomotic leaks after closure of their stomas, 1 of whom required reoperation but died. No patient developed an anastomotic leak after closure of the stoma in the primary anastomosis group.
  
  
  CONCLUSIONS
  Both regimens are accepted treatments for patients with acute complicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, The Netherlands.
authors.forename: A W
authors.initials: AW
authors.lastname: Gooszen
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: W
authors.initials: W
authors.lastname: Veerman
authors.forename: V M
authors.initials: VM
authors.lastname: Van Dongen
authors.forename: J
authors.initials: J
authors.lastname: Hermans
authors.forename: E
authors.initials: E
authors.lastname: Klien Kranenbarg
authors.forename: R A
authors.initials: RA
authors.lastname: Tollenaar
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index