Surgical treatment of acute diverticulitis. A retrospective multicentre study

Abstract

Introduction: To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD).

Methods: Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD.

Results: A series of 385 patients: 218 men and 167 women, mean age 64.4±15.6 years, operated on in 10 hospitals were included. The median (25^th-75^th percentile) time from symptoms to surgery was 48 (24-72) h, being peritonitis the main surgical indication in a 66% of cases. Surgical approach was usually open (95.1%), and the commonest findings, a purulent peritonitis (34.8%) or pericolonic abscess (28.6%). Hartmann procedure (HP) was the most used technique in 278 (72.2%) patients, followed by resection and primary anastomosis (RPA) in 69 (17.9%). The overall postoperative morbidity and mortality was 53.2% and 13% respectively. Age, immunosupression, presence of general risk factors and faecal peritonitis were associated with increased mortality. Laparoscopic peritoneal lavage (LPL) was associated with an increased reoperation rate frequently involving a stoma, and anastomotic leaks presented in 13.7 patients after RPA, without differences in morbimortality when compared with HP. Median postoperative length of stay was 12 days, and was correlated with age, surgical risk, ASA score, hospital and postoperative complications.

Conclusions: Surgery for CAD has important morbidity and mortality and is frequently associated with an end-stoma. Moreover LPL presented high reoperation rates. It seems better to resect and anastomose in most cases, even with an associated protective stoma.

Keywords: Anastomosis primaria; Complicated acute diverticulitis; Diverticulitis aguda complicada; Hartmann's operation; Intervención de Hartmann; Laparoscopic peritoneal lavage; Lavado peritoneal laparoscópico; Peritonitis; Primary anastomosis.