COMPLICATIONS IN COLONIC DIVERTICULOSIS C HANGES IN TREATMENT AND RESULTS OVER THE LAST 22 YEARS

Objectives: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic div erticular disease. Methods: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 fe males) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males , 44 females). Results: Patients in the two groups were comparable; on ly the rate of peritonitis (20 vs 8%) was different (p < 0.05). The mo st frequent operations in Group A were colostomy-drainage (43%) and Ha rtman's procedure (26%) in emergency situations and resection with imm ediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a diffe rent pattern of operations, 4 and 56% in emergency, and 94 and 2% in e lective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mort ality was particularly important in emergency cases (31 vs 4%; p < 0.0 2). Morbidity in emergency surgery fell from 21 to 4% (p < 0.0006). In terrupting the use of colostomy drainage was a major factor in reducti ng mortality followed by a sharp fall in mortality after Hartmann's pr ocedure (28.5 vs 0%). Conclusion: The marked improvement in results be tween the two groups was mainly due to preferring resections of pathol ogical colonic segments over colostomy-drainage.