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

Abstract— 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 con-firmed 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.