title: Avoiding or reversing Hartmann's procedure provides improved quality of life after perforated diverticulitis.
abstract: BACKGROUND
  The existing literature regarding acute perforated diverticulitis only reports about short-term outcome; long-term following outcomes have not been assessed before. The aim of this study was to assess long-term quality of life (QOL) after emergency surgery for perforated diverticulitis.
  
  
  METHODS
  Validated QOL questionnaires (EQ-VAS, EQ-5D index, QLQ-C30, and QLQ-CR38) were sent to all eligible patients who had undergone emergency surgery for perforated diverticulitis in five teaching hospitals between 1990 and 2005. Differences were compared between patients that had undergone Hartmann's procedure (HP) or resection with primary anastomosis (PA) and also compared to a sex- and age-matched sample of healthy subjects.
  
  
  RESULTS
  Of a total of 340 patients, only 150 patients (44%) were found still alive in July 2007 (median follow-up 71 months). The response rate was 87%. In patients with PA, QOL was similar to the general population, whereas QOL after HP was significantly lower. The presence of a stoma was found to be an independent factor related to worse QOL. The deterioration in QOL was mainly due to problems in physical function and body image.
  
  
  CONCLUSIONS
  Survivors after perforated diverticulitis had a worse QOL than the general population, which was mainly due to the presence of an end colostomy. QOL may improve if these stomas are reversed or not be performed in the first place.
authors.affiliation: Department of Surgery, Erasmus University Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. j.vermeulen.1@erasmusmc.nl
authors.forename: Jefrey
authors.initials: J
authors.lastname: Vermeulen
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Gosselink
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome