Outcome after emergency surgery for acute perforated diverticulitis in 200 cases.
BACKGROUND
Mortality and morbidity rates of acute perforated diverticulitis remain high. The ideal treatment is still controversial. The object of this study was to compare patients with perforated diverticulitis treated either by resection with primary anastomosis (PA) or Hartmann's procedure (HP).


METHODS
A multicenter study was carried out on 200 consecutive patients with acute perforated diverticulitis who were presented in the surgical units of four affiliated teaching hospitals in Rotterdam, The Netherlands, between 1995 and 2005. Mortality and morbidity were compared in relation to type of surgery, ASA classification, age, gender, Mannheim Peritonitis Index (MPI), Hinchey score, surgeon's experience, and the time of operation.


RESULTS
There was a tendency for more severely affected patients (Hinchey, MPI, ASA and age) to undergo HP. Multivariate logistic regression analysis showed no significant difference in mortality between HP and PA. After HP, more patients needed one or more reinterventions to treat postoperative complications compared to PA. Besides, HP resulted in a longer total hospital and intensive care unit stay. Specialist colorectal surgeons performed significantly more frequently a PA instead of a HP and had fewer postoperative complications than general surgeons. The time of operation did not influence the choice of surgical procedure.


CONCLUSIONS
Selected patients with perforated diverticulitis can be managed well by PA, as it does not seem to be inferior to HP in terms of severe postoperative complications that need surgical or radiological reintervention and mortality. This decision should be made while taking into account the patient's concomitant diseases, response on preoperative resuscitation and the availability of a surgeon experienced in colorectal surgery.
Vermeulen
Jefrey
J
Department of Surgery, MCRZ St. Clara Hospital and Zuider Hospital, Rotterdam, The Netherlands. VermeulenJ@MCRZ.nl
Akkersdijk
George P
GP
Gosselink
Martijn P
MP
Hop
Wim C J
WC
Mannaerts
Guido H
GH
van der Harst
Erwin
E
Coene
Peter-Paul L O
PP
Weidema
Wibo F
WF
Lange
Johan F
JF
D000368:Aged; D000714:Anastomosis, Surgical; D003125:Colostomy; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome