One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV).
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.
Richter
Sven
S
Clinic of General, Visceral, Vascular, and Pediatric Surgery, University Hospital of the Saarland, Kirrberger Strasse, D-66421 Homburg/Saar, Germany.
Lindemann
Werner
W
Kollmar
Otto
O
Pistorius
Georg A
GA
Maurer
Christoph A
CA
Schilling
Martin K
MK
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*