The benefit of the discontinuity resection for septic diverticular complications. History or a continuing up-to-date procedure?

Primary anastomosis is becoming increasingly favoured because of the shorte r hospital stay even in emergency operations on the colon and rectum. This appears entirely justified when an objective of cost-effective medicine has been set. At our hospital between September 1985 and February 1999, 365 pa tients were operated on because of diverticular disease. The data from 346 of these patients were evaluated. 202 of these cases were elective; 144 wer e carried out on an emergency or urgent basis. In 223 cases, a primary anas tomosis (Stage I and TI according to Hinchey) and in 56 patients a double-b arreled colostomy with a distal mucus fistula were performed. 57 patients h ad a too short rectum-sigma stump and were operated in two stages, accordin g to Hartmann. Of 223 patients with a primary anastamosis, 6 (2.7 %) develo ped an insufficiency of the anastomosis, whereby 3 (1.3 %) of these patient s subsequently died. Of the patients with Hartmann operation, 11 (19.3 %) d ied due to the sequelae of peritonitis and only 2 patients died following i nsufficiency of the Hartmann's stump. Of the patients with a mucus fistula, 10 patients (17.9 %) died as a result of complications of peritonitis. Of the 113 patients (21 died) with a discontinuity resection, 66 (71 %) had th eir colostomy closed. There were no cases of anastomosis insufficiency and no patient died as a result of the colostomy closure. In the interest of th e patients in septic diverticulitis the safest surgical procedure, the disc ontinuity resection, should be chosen.