Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey stage III and IV) - A prospective outcome and cost analysis

PURPOSE: Our hypothesis was that in patients with perforated sigmoid colon diverticulitis and peritonitis (Hinchey Stage III and IV) a one-stage sigmo id colon resection is safe and cost effective when performed by an experien ced colorectal surgeon. We evaluated outcome and cost of one-stage vs, two- stage sigmoid colon resection after diverticulitis perforation and peritoni tis, METHODS: Patients undergoing emergency resection for perforated sigmoi d colon diverticulitis and peritonitis (Hinchey Stage III and IV). Outcome, costs, and insurers reimbursement mere compared between 13 patients underg oing sigmoid colon resection and primary anastomosis (Group A) and 42 patie nts undergoing sigmoid colon resection with Hartmann's procedure and second ary descendorectostomy (Group B). RESULTS: Group A patients were comparable to Group B patients in age, gender, preoperative risk and severity of peri tonitis (Mannheim Peritonitis Index; and C-reactive protein). Operating roo m time for sigmoid colon resection with primary anastomosis (3.3 +/- 1.2 ho urs) was identical to the time for sigmoid colon resection with colostomy ( 3.3 +/- 1 hour), and morbidity and mortality, intensive care unit, and in-h ospital stay were not significantly different between the two groups. In Gr oup B patients' intestinal continuity was restored 169 +/- 74 days after th e primary resection in 32 of 42 patients only (78 percent). The second proc edure took on average 1.4 hours longer than the first procedure. Patients i n Group B received more antibiotics (2.2 vs. 2) albeit for a shorter period of time (4.5 vs. 5.7 days, P = not significant). Overall expenses for rest oration of intestinal continuity were between 74 and 229 percent higher for Group B patients than for Group A patients. Reimbursement was 18,191 +/- 1 6,761 SFr (Group A) and 41,321 +/- 26,983 SFr (Group B) respectively. CONCL USION: With meticulous surgical technique and extensive intraoperative lava ge, perforated sigmoid colon diverticulitis with peritonitis can be treated by a one-stage sigmoid colon resection and anastomosis with a low mortalit y and morbidity. A one-stage procedure is considerably cheaper and patients are rehabilitated faster and to a higher percentage.