How has Changed The Surgical Approach for The Management of Acute Inflammatory Complications of Diverticular Disease of The Colon: Analysis Of Two Periods

Michele Grande, Giorgio Lisi, Flavio De Sanctis, Casimiro Nigro, Dario Venditti, Michela Campanelli, Simona Grande, Massimo Villa

Background: The aim of this study was to analyze the most appropriate surgical strategy in the management of patients with major inflammatory complications of colonic diverticular disease.

Materials and Methods: Out of 539 patients affect­ed by complicated diverticular disease of the colon, 125 consecutive patients (23.2%) who underwent urgent or emergency surgical intervention for diverticular per­foration during a 13 year period (2000-2013),  were ret­rospectively analyzed. According to the changes in the surgical approach over the time, the series was divid­ed into two groups: 2000-2005 Group A (n=59), 2006-2013 Group B (n=66). The clinical diagnosis was con­firmed by operative and pathologic findings.

Results: Out of 109 patients, 28 underwent derivative procedure and 81 resection. There were no significant differences among the two groups of patients accord­ing to sex ratio and mean age. The overall percentage of patients in group B who underwent resective proce­dure (91%) was significantly greater in comparison with that in group A (53%). Colostomy and drainage was employed only during the first period (30%), (Group A vs Group B, p<0.05) and the proportion of patients who underwent primary resection and anas­tomosis was significantly higher during the second period (41%), (Group B vs Group A, p<0.05).

Conclusions: It must be stressed that resection of the diseased segment at initial operation appears manda­tory; one-stage procedure is indicated when infection is confined to the mesentery, while resection and anas­tomosis with covering colostomy (two-stage procedure) is preferable whenever peritoneal contamination has occurred. According to the literature Hartmann’s operation may be the proce­dure of choice in the patients presenting known impaired immunity or fecal contamination.