title: Surgical treatment of acute diverticulitis. A retrospective multicentre study.
abstract: BACKGROUND
  To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD).
  
  
  METHODS
  Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD.
  
  
  RESULTS
  A series of 385 patients: 218 men and 167 women, mean age 64.4±15.6 years, operated on in 10 hospitals were included. The median (25th-75thpercentile) time from symptoms to surgery was 48 (24-72) h, being peritonitis the main surgical indication in a 66% of cases. Surgical approach was usually open (95.1%), and the commonest findings, a purulent peritonitis (34.8%) or pericolonic abscess (28.6%). Hartmann procedure (HP) was the most used technique in 278 (72.2%) patients, followed by resection and primary anastomosis (RPA) in 69 (17.9%). The overall postoperative morbidity and mortality was 53.2% and 13% respectively. Age, immunosupression, presence of general risk factors and faecal peritonitis were associated with increased mortality. Laparoscopic peritoneal lavage (LPL) was associated with an increased reoperation rate frequently involving a stoma, and anastomotic leaks presented in 13.7 patients after RPA, without differences in morbimortality when compared with HP. Median postoperative length of stay was 12 days, and was correlated with age, surgical risk, ASA score, hospital and postoperative complications.
  
  
  CONCLUSIONS
  Surgery for CAD has important morbidity and mortality and is frequently associated with an end-stoma. Moreover LPL presented high reoperation rates. It seems better to resect and anastomose in most cases, even with an associated protective stoma.
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España; Unidad de Coloproctología, Hospital Nisa 9 de Octubre, Valencia, España. Electronic address: roigvila@telefonica.net.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Roig
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; Servicios de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frasson
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Míriam
authors.initials: M
authors.lastname: Cantos
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Celia
authors.initials: C
authors.lastname: Villodre
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova, Valencia, España.
authors.forename: Zutoia
authors.initials: Z
authors.lastname: Balciscueta
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: García-Calvo
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital Lluís Alcanyís de Xàtiva, Xàtiva (Valencia), España.
authors.forename: Javier
authors.initials: J
authors.lastname: Aguiló
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital General de Elda, Elda (Alicante), España.
authors.forename: Juan
authors.initials: J
authors.lastname: Hernandis
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital de Sagunto, Valencia, España.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Rodríguez
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital General de Requena, Valencia, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Landete
authors.affiliation: Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; Servicios de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia.
authors.forename: Eduardo
authors.initials: E
authors.lastname: García-Granero
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Anastomosis primaria; Complicated acute diverticulitis; Diverticulitis aguda complicada; Hartmann's operation; Intervención de Hartmann; Laparoscopic peritoneal lavage; Lavado peritoneal laparoscópico; Peritonitis; Primary anastomosis