Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?
OBJECTIVE
Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience.


METHODS
From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP.


RESULTS
A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P < 0.05). Three out of the 27 patients with RPA (11.1%) developed a clinical anastomotic leakage and needed re-operation.


CONCLUSIONS
RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.
Department of Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Bellvitge Biomedical Investigation Institute, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Loris
L
Trenti
Sebastiano
S
Biondo
Thomas
T
Golda
Millan
M
Monica
Esther
E
Kreisler
Domenico
D
Fraccalvieri
Ricardo
R
Frago
Eduardo
E
Jaurrieta
D000368:Aged; D000714:Anastomosis, Surgical; D003710:Demography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004238:Diverticulitis / Q000150:complications*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D011182:Postoperative Care; D019651:Plastic Surgery Procedures; D012720:Severity of Illness Index