[Surgical therapy of complicated sigmoid diverticulitis: single stage or multi-stage operation?]

Surgical tactics for the teatment of complicated diverticulitis are in constant evolution and remain a subject of controversy. Amongst 53 patients operated on for complicated sigmoid diverticulits over a 10 year period in our hospital, 29 underwent a Hartmann's procedure (3 Hinchey's stage II, 19 stage III and 7 stage IV). Only 11 out of 20 having survived the operation underwent restoration of bowel continuity (55%). This experience is in line with the literature. Surgeons have become conscious that in reality the colostomy was permanent in a significant proportion of patients who were poor candidates for a second operation. Therefore there is a tendency to perform as far as possible a resection of the sigmoid and a colo-rectal anastomosis in a one-stage procedure. In the absence of prospective randomized studies and objective criteria, the decision to resect the sigmoid in a one-stage or in a multi-stage procedure is based on consensus and clinical judgement.