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 the outcome of acute complicated diverticular disease.

DESIGN

Retrospective study.

SETTING

Teaching hospital, The Netherlands.

SUBJECTS: 60 patients who presented with acute complicated diverticular disease.

INTERVENTIONS: 28 patient were treated by sigmoid resection and a Hartmann operation, and 32 by resection with primary anastomosis and defunctioning stoma.

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 and 5 in the primary anastomosis group). There were 3 radiological leaks with no clinical implications in the primary anastomosis group. 6 patients in the Hartmann group and 5 in the primary anastomosis group required reoperations for intra-abdominal abscess or infection. 7 and 3 patients, respectively, 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 leaks after closure of their stomas, 1 of whom required reoperation but died. No patient developed an anastomotic leak after closure of the stoma in the primary anastomosis group.

CONCLUSION

Both regimens are accepted treatments for patients with acute complicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.