Complicated sigmoid diverticulitis--Hartmann's procedure or primary anastomosis?
BACKGROUND
Diverticular disease of the colon is a common condition in developed countries. For perforated diverticulitis Hartmann's procedure is a safe and quick treatment option. But intestinal restoration needs further interventions. This leads to high complication rates and cost. Therefore a critical evaluation of surgical treatment options is necessary.


METHODS
During a period of 18 months 88 patients underwent surgical resection for diverticulitis. Forty patients had emergency surgery. Among those a primary anastomosis was performed in 21 patients. The other 19 patients had interval colostomy. Among 21 patients with primary anastomosis major complications occurred in two patients, vs. twelve in patients with Hartmann's operation (p = 0.03). In the Hartmann group eight patients had major general complications, vs. one patient in the group with primary anastomosis (p = 0.06). The mean hospital stay was 38 days after Hartmann's procedure, vs. 13 days for patients with primary anastomosis (p < 0.01).


CONCLUSIONS
In emergency surgery for complicated diverticulitis primary anastomosis is not associated with an increased postoperative morbidity. A primary anastomosis reduces the need for further surgical interventions and complex re-operations. Thus, an overall reduction of morbidity, cost, complication rate and hospital stay is possible. Therefore this technique is advantageous for patients and hospitals.
Department of Surgery, St. Josef Hospital, Ruhr-University Bochum, School of Medicine, Germany.
T
T
Herzog
M
M
Janot
O
O
Belyaev
D
D
Sülberg
A M
AM
Chromik
U
U
Bergmann
C A
CA
Mueller
W
W
Uhl
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003125:Colostomy / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004238:Diverticulitis / Q000401:mortality / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000401:mortality* / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007416:Intestinal Perforation / Q000150:complications / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012810:Sigmoid Diseases / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome