title: One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV).
abstract: BACKGROUND
  Guidelines for the treatment of complicated sigmoid diverticulitis recommend Hartmann's procedure or anastomosis with protective colostomy for Hinchey stage III diverticulitis and Hartmann's procedure only for Hinchey stage IV diverticulitis. We evaluated the outcome of patients with perforated sigmoid diverticulitis Hinchey III/IV undergoing one-stage colon resection and primary anastomosis without protective colostomy.
  
  
  METHODS
  After implementation of a protocol to treat Hinchey III/IV diverticulitis with primary anastomosis without protective ileocolostomy, the patients' data were recorded prospectively between August 2001 and August 2003 and analyzed retrospectively from a computer-related database.
  
  
  RESULTS
  Of 41 patients, 34 (81%) underwent one-stage sigmoid resection and primary anastomosis, 3 of 41 patients (7%) underwent primary anatomosis with protective ileostomy, and 5 of 41 patients (12%) had a Hartmann's procedure. The mortality was 11% in patients undergoing primary anastomosis and 60% in patients with Hartmann's procedure. The relative risk of co-morbidity factors for lethal outcome after sigmoid resection was 6.94 for preceding operations, 3.75 for renal failure or renal transplantation, and 3.25 for immunosuppression.
  
  
  CONCLUSIONS
  One-stage sigmoid resection and primary anastomosis can be performed safely in nearly 90% of all patients with perforated sigmoid diverticulitis (Hinchey III/IV) by surgeons of different training levels. Patients with immunosuppression, chronic renal failure, liver cirrhosis, or previous organ transplantation or complex cardiovascular reconstructive procedures have a significantly increased risk of dying after sigmoid resection for perforated diverticulitis.
authors.affiliation: Clinic of General, Visceral, Vascular, and Pediatric Surgery, University Hospital of the Saarland, Kirrberger Strasse, D-66421 Homburg/Saar, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Richter
authors.forename: Werner
authors.initials: W
authors.lastname: Lindemann
authors.forename: Otto
authors.initials: O
authors.lastname: Kollmar
authors.forename: Georg A
authors.initials: GA
authors.lastname: Pistorius
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Maurer
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
mesh_terms: D000714:Anastomosis, Surgical; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications; D012810:Sigmoid Diseases / Q000150:complications / Q000601:surgery*