title: Primary anastomosis with a defunctioning stoma versus Hartmann's procedure for perforated diverticulitis--a comparison of stoma reversal rates.
abstract: OBJECTIVE
  The ideal treatment of patients with perforated diverticulitis is still controversial. Hartmann's procedure has been the treatment of choice for decades, but primary anastomosis with a defunctioning stoma has become an accepted alternative. The aim of this study was to evaluate the stoma reversal rates after these two surgical strategies.
  
  
  METHODS
  A retrospective review of the data from patients with perforated sigmoid diverticulitis between 2002 and 2011 undergoing a Hartmann's procedure (HP) versus a primary anastomosis with a defunctioning stoma (PA) was performed. Additionally, patients were contacted by mail or telephone in March 2012 using a standardized questionnaire.
  
  
  RESULTS
  A total of 98 patients were identified: 72 undergoing HP and 26 patients receiving PA. The median follow-up time was 63 months (range 4-118). Whilst 85 % of patients with PA have had their stoma reversed, only 58 % of patients with an HP had a stoma reversal (p = 0.046). The median period until stoma reversal was significantly longer for HP (19 weeks) than for PA (12 weeks; p = 0.03). The 30-day mortality for PA was 12 % as opposed to 25 % for HP (p = 0.167). According to the Clavien-Dindo classification, surgical complications occurred significantly less frequently in patients with PA (p = 0.014).
  
  
  CONCLUSIONS
  The stoma reversal rates for PA are significantly higher than for HP. Thus, depending on the overall clinical situation, primary resection and anastomosis with a proximal defunctioning stoma might be the optimal procedure for selected patients with perforated diverticular disease.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany, palizai@ukaachen.de.
authors.forename: P H
authors.initials: PH
authors.lastname: Alizai
authors.forename: M
authors.initials: M
authors.lastname: Schulze-Hagen
authors.forename: C D
authors.initials: CD
authors.lastname: Klink
authors.forename: F
authors.initials: F
authors.lastname: Ulmer
authors.forename: A A
authors.initials: AA
authors.lastname: Roeth
authors.forename: U P
authors.initials: UP
authors.lastname: Neumann
authors.forename: M
authors.initials: M
authors.lastname: Jansen
authors.forename: R
authors.initials: R
authors.lastname: Rosch
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004238:Diverticulitis / Q000150:complications* / Q000601:surgery*; D004240:Diverticulum / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery*; D008297:Male; D054047:Surgical Stomas / Q000473:pathology*
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