SURGICAL-MANAGEMENT OF THE SEPTIC COMPLICATIONS OF DIVERTICULAR-DISEASE

This retrospective study has reviewed the surgical management of the s eptic complications of diverticular disease involving the left colon i n 77 patients who presented between 1980 and 1992. Over this period, H artmann's resection continued to be the predominant surgical procedure . The overall mortality and morbidity rates in the study period were 1 0% and 31%, respectively. However, a marked improvement in survival wa s recorded in the latter half of the study (17% vs 6%). The mortality from Hartmann's resection was also reduced substantially in the second half of the study (24% vs 7.5%). These improvements occurred despite having a higher number of poor-risk patients (APACHE II score) with mo re severe pathology (generalised peritonitis, 35% vs 50%; faecal perit onitis, 9% vs 25%) in the latter half. There was a significantly worse survival in patients who were over 70 years of age (P < 0.03), those who had a severe concomitant medical illness (P < 0.02), those who had a generalised peritonitis (P < 0.02), and in those patients who had a n APACHE II score of over 11 (P < 0.05) (Fisher's exact test). There w as no difference in outcome (morbidity, mortality) between the various grades of surgeon involved in performing the emergency surgical proce dures.