Current problems on operative strategy for complicated colon diverticular disease

Perforation of complicated diverticular disease of the colon with generalized peritonitis is common life-threatening emergency requiring surgical intervention. Although the absolute prevalence of perforated diverticulitis complicated by generalized peritonitis is low, its importance lies in the signifcant postoperative mortality, ranging from 4–26%, regardless of selected surgical strategy. The optimal treatment for perforated diverticulitis has been always a matter of debate, changing the ‘‘gold standard’’ several times in the last decades. Primary resection has become the standard practice, but fear of anastomotic leakage of ten deterred many surgeons from performing primary anastomosis. Therefore, for many surgeons Hartmann’s procedure has remained the favored option. We share our 10 years de part mental experience in complicated diverticular disease of the colon studying 146 cases with diverticular disease treated in our clinic between 2000-2010. The indications for operation were diverticulitis complications - perforation, obstructiuon and bleeding, demonstrated on clinically by generalized peritonitis - 21, acute obstruction - 4 and rectorrhagia – 2. Operation was performed in 29 patients in urgent setting. Primary resection with anastomosis was done in 12 patients (41.38%). Manual anastomoses were performed in 4 cases, while mechanical anastomoses with staplers were accomplished in 8 cases. In 6/50%/ of the latter we used our standardized technique for linear stapler latero-lateral/functional end-to-end anastomosis, formerly implemented by as for colonic cancer resections and anastomoses. We had have 2 /6.9%/ anastomosis dehiscenses. Hartmann’s procedure was per formed in 17 patients (58.62%).We did not have any complications or death with standardized stapler resections and anastomoses. Hospital operative mortality was 13.79% /4 cases/. We advocate the primary anastomosis as the standard procedure, especially for older patients. Using a standardized technique with linear stapler for primary colon resection and anastomosis in complicated diverticular disease we favor the patient’s outcome with safety, efficiency and effectiveness.