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Surgical management of complicated colonic diverticulitis.
Br J Surg 1997; 84(3):380-3BJ

Abstract

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 treatment 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 acute phlegmon without pus formation (92 patients), paracolic abscess and/or localized peritonitis (99), diffuse purulent peritonitis (33), complete obstruction of the sigmoid colon (eight) and paracolic abscess complicated by fistula (27).

RESULTS

The overall mortality rate was two (1 per cent) of 183 for resection with primary anastomosis, seven of 31 for Hartmann's operation and four of ten for the delayed three-stage procedure. The anastomosis was made by instruments employing the double-stapled technique in 130 patients and hand-sutured in 94. Reversal 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 the safest procedure for all stages of complicated diverticulitis, and reduces costs. There is no longer any clinical indication for the three-stage operation.

Authors+Show Affiliations

Department of General and Thoracic Surgery, Academic Teaching Hospital Herford, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9117315

Citation

Wedell, J, et al. "Surgical Management of Complicated Colonic Diverticulitis." The British Journal of Surgery, vol. 84, no. 3, 1997, pp. 380-3.
Wedell J, Banzhaf G, Chaoui R, et al. Surgical management of complicated colonic diverticulitis. Br J Surg. 1997;84(3):380-3.
Wedell, J., Banzhaf, G., Chaoui, R., Fischer, R., & Reichmann, J. (1997). Surgical management of complicated colonic diverticulitis. The British Journal of Surgery, 84(3), pp. 380-3.
Wedell J, et al. Surgical Management of Complicated Colonic Diverticulitis. Br J Surg. 1997;84(3):380-3. PubMed PMID: 9117315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of complicated colonic diverticulitis. AU - Wedell,J, AU - Banzhaf,G, AU - Chaoui,R, AU - Fischer,R, AU - Reichmann,J, PY - 1997/3/1/pubmed PY - 1997/3/1/medline PY - 1997/3/1/entrez SP - 380 EP - 3 JF - The British journal of surgery JO - Br J Surg VL - 84 IS - 3 N2 - 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 treatment 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 acute phlegmon without pus formation (92 patients), paracolic abscess and/or localized peritonitis (99), diffuse purulent peritonitis (33), complete obstruction of the sigmoid colon (eight) and paracolic abscess complicated by fistula (27). RESULTS: The overall mortality rate was two (1 per cent) of 183 for resection with primary anastomosis, seven of 31 for Hartmann's operation and four of ten for the delayed three-stage procedure. The anastomosis was made by instruments employing the double-stapled technique in 130 patients and hand-sutured in 94. Reversal 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 the safest procedure for all stages of complicated diverticulitis, and reduces costs. There is no longer any clinical indication for the three-stage operation. SN - 0007-1323 UR - https://www.unboundmedicine.com/medline/citation/9117315/Surgical_management_of_complicated_colonic_diverticulitis_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0007-1323&date=1997&volume=84&issue=3&spage=380 DB - PRIME DP - Unbound Medicine ER -