SURGICAL-MANAGEMENT OF COMPLICATED COLONIC DIVERTICULITIS

Background improvements in surgical techniques, advances in intensive care medicine and progress in the management of peritoneal sepsis have recently favoured colonic resection with primary anastomosis in the t reatment of complicated diverticulitis. Methods Some 224 patients with complicated diverticulitis who had undergone surgery in the preceding 22 years were reviewed. Complications present on admission included a cute phlegmon without pus formation (92 patients), paracolic abscess a nd/or localized peritonitis (99), diffuse purulent peritonitis (33), c omplete obstruction of the sigmoid colon (eight) and paracolic abscess complicated by fistula (27). Results The overall mortality rate was t wo (1 per cent) of 183 for resection with primary anastomosis, seven o f 31 for Hartmann's operation and four of ten for the delayed three-st age procedure. The anastomosis was made by instruments employing the d ouble-stapled technique in 130 patients and hand-sutured in 94. Revers al of Hartmann's operation was undertaken in only 31 per cent compared with 89 per cent for closure of the protective colostomy in patients with primary anastomosis. Conclusion The Hartmann operation may be the most popular at present, but resection with primary anastomosis is th e safest procedure for all stages of complicated diverticulitis, and r educes costs. There is no longer any clinical indication for the three -stage operation.