Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon.
OBJECTIVE
For complicated diverticulitis Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease, but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. This study compared primary resection with intraoperative colonic lavage and Hartmann's procedure.


METHODS
Between January 1994 and November 2001, 60 patients underwent emergency laparotomy for diverticular peritonitis (Hinchey stages III and IV). Primary resection and anastomosis with intraoperative colonic lavage was performed in 27 patients and Hartmann's procedure in 33. All data were collected prospectively on a standardized form.


RESULTS
Mortality with intraoperative colonic lavage was 11% and with Hartmann's procedure 12%. The incidence of postoperative complication was significantly higher after Hartmann's procedure. The mean hospital stay was significantly longer after Hartmann's procedure than after primary resection with intraoperative colic lavage.


CONCLUSIONS
Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to Hartmann's procedure in stercoral peritonitis.
Regenet
N
N
Department of Visceral Surgery, C.H.U. Angers, 4 rue Larrey, 49033, Angers Cedex 01, France. nicoregenet@yahoo.fr
Pessaux
P
P
Hennekinne
S
S
Lermite
E
E
Tuech
J J
JJ
Brehant
O
O
Arnaud
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003125:Colostomy; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000601:surgery*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D007507:Therapeutic Irrigation / Q000379:methods