Operative treatment of acute complications of diverticular disease: Primary or secondary anastomosis after sigmoid resection

Objective: To assess the comparative effects of two surgical regimens on th e outcome of acute complicated diverticular disease. Design: Retrospective study. Setting: Teaching hospital, The Netherlands. Subjects: 60 patients who presented with acute complicated diverticular dis ease. Interventions: 28 patient were treated by sigmoid resection and a Hartmann operation, and 32 by resection with primary anastomosis and defunctioning s toma. Main outcome measures: Morbidity and mortality Results: The severity of peritonitis and the amount of faecal contamination were similar in the 2 groups. 12 patients died (7 in the Hartmann group an d 5 in the primary anastomosis group). There were 3 radiological leaks with no clinical implications in the primary anastomosis group. 6 patients in t he Hartmann group and 5 in the primary anastomosis group required reoperati ons for intra-abdominal abscess or infection. 7 and 3 patients, respectivel y, developed dysfunction of their stomas, and 9/21 and 3/27, respectively, required a permanent stoma (p = 0.02, 95% confidence interval of difference 0.07 to 0.56). 3 patients in the Hartmann group developed anastomotic leak s after closure of their stomas, 1 of whom required reoperation but died. N o patient developed an anastomotic leak after closure of the stoma in the p rimary anastomosis group. Conclusion: Both regimens are accepted treatments for patients with acute c omplicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.