Original Paper

Outcome after Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases
Jefrey Vermeulen^a, George P. Akkersdijk^b, Martijn P. Gosselink^a, Wim C.J. Hop^c, Guido H. Mannaerts^d, Erwin van der Harst^a, Peter-Paul L.O. Coene^a, Wibo F. Weidema^b, Johan F. Lange<sup>e

a</sup>Department of Surgery, MCRZ St. Clara Hospital and Zuider Hospital, Rotterdam,
^bDepartment of Surgery, Ikazia Hospital, Rotterdam,
^cDepartment of Epidemiology and Biostatistics, EMC Rotterdam, Rotterdam,
^dDepartment of Surgery, Sint Franciscus Hospital, Rotterdam, and
^eDepartment of Surgery, EMC Rotterdam, Rotterdam, The Netherlands

Address of Corresponding Author

Dig Surg 2007;24:361-366 (DOI: 10.1159/000107719)

  Key Words

• Perforated diverticulitis
• Hartmann's procedure
• Primary anastomosis
• Mortality
• Reintervention
• Surgeon's experience

  Abstract

Background: Mortality and morbidity rates of acute perforated diverticulitis remain high. The ideal treatment is still controversial. The object of this study was to compare patients with perforated diverticulitis treated either by resection with primary anastomosis (PA) or Hartmann's procedure (HP). Methods: A multicenter study was carried out on 200 consecutive patients with acute perforated diverticulitis who were presented in the surgical units of four affiliated teaching hospitals in Rotterdam, The Netherlands, between 1995 and 2005. Mortality and morbidity were compared in relation to type of surgery, ASA classification, age, gender, Mannheim Peritonitis Index (MPI), Hinchey score, surgeon's experience, and the time of operation. Results: There was a tendency for more severely affected patients (Hinchey, MPI, ASA and age) to undergo HP. Multivariate logistic regression analysis showed no significant difference in mortality between HP and PA. After HP, more patients needed one or more reinterventions to treat postoperative complications compared to PA. Besides, HP resulted in a longer total hospital and intensive care unit stay. Specialist colorectal surgeons performed significantly more frequently a PA instead of a HP and had fewer postoperative complications than general surgeons. The time of operation did not influence the choice of surgical procedure. Conclusion: Selected patients with perforated diverticulitis can be managed well by PA, as it does not seem to be inferior to HP in terms of severe postoperative complications that need surgical or radiological reintervention and mortality. This decision should be made while taking into account the patient's concomitant diseases, response on preoperative resuscitation and the availability of a surgeon experienced in colorectal surgery.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Jefrey Vermeulen, MD
Department of Colorectal Surgery, MCRZ Zuider Hospital
Groene Hilledijk 315, NL-3075 EA Rotterdam (The Netherlands)
Tel. +31 102 912 347, Fax +31 102 903 805
E-Mail VermeulenJ@MCRZ.nl

  Article Information

Received: November 29, 2006
Accepted: June 15, 2007
Published online: August 30, 2007
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 5, Number of References : 27