Does primary anastomosis with diversion have any advantages over Hartmann's procedure in acute diverticulitis?.
BACKGROUND
The optimal treatment for acute complicated diverticulitis is still a matter of debate. We evaluated outcomes of primary anastomosis with proximal diversion (PAD) versus Hartman's procedure (HP) in acute diverticulitis.


METHODS
Using the National Inpatient Sample database, we examined the clinical data of patients who underwent an urgent open colorectal resection (sigmoidectomy or anterior resection) for acute diverticulitis from 2002 to 2007 in the United States. We evaluated patient characteristics, patient comorbidities, perioperative complications, in-hospital mortality, length of hospital stay and total hospital charges between two groups.


RESULTS
A total of 99,259 patients underwent urgent surgery for acute diverticulitis during these years (Primary anastomosis without diversion: 39.3%; HP: 57.3% and PAD: 3.4%). The overall complication rate was lower in the PAD group compared with the HP group (PAD: 39.06% vs. HP: 40.84%; p = 0.04). Patients in the HP group had a shorter mean length of stay (12.5 vs.14.4 days, p < 0.001) and lower mean hospital costs (USD 65,037 vs. USD 73,440, p < 0.01) compared with the PAD group. Mortality was higher in the HP group (4.82 vs. 3.99%, p = 0.03).


CONCLUSIONS
PAD has improved outcomes compared with HP, and should be considered in patients who are deemed candidates for two-stage operations for acute diverticulitis.
Department of Surgery, Division of Colorectal Surgery, University of California, Irvine, Medical Center, Orange, CA 92868, USA.
Hossein
H
Masoomi
Michael J
MJ
Stamos
Joseph C
JC
Carmichael
Brian
B
Nguyen
Brian
B
Buchberg
Steven
S
Mills
D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002140:California; D003082:Colectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004239:Diverticulitis, Colonic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D012307:Risk Factors; D012494:Sampling Studies; D016896:Treatment Outcome