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One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV)

Sven Richter1, Werner Lindemann, Otto Kollmar

  • 1Clinic of General, Visceral, Vascular, and Pediatric Surgery, University Hospital of the Saarland, Kirrberger Strasse, D-66421 Homburg/Saar, Germany.

World Journal of Surgery
|June 1, 2006
PubMed

Insights

One-stage sigmoid resection with primary anastomosis is a safe and effective treatment for perforated diverticulitis (Hinchey III/IV), showing lower mortality than Hartmann's procedure. Patient comorbidities significantly impact outcomes.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Background:

  • Current guidelines for complicated sigmoid diverticulitis (Hinchey III/IV) recommend Hartmann's procedure or colostomy with anastomosis.
  • This study evaluates the outcomes of one-stage colon resection and primary anastomosis without protective colostomy for perforated sigmoid diverticulitis.

Purpose of the Study:

  • To assess the safety and efficacy of one-stage sigmoid resection and primary anastomosis for Hinchey stage III/IV perforated diverticulitis.
  • To compare outcomes with traditional methods like Hartmann's procedure.

Main Methods:

  • A prospective protocol was implemented for treating Hinchey III/IV diverticulitis with primary anastomosis without protective ileocolostomy.
  • Patient data from August 2001 to August 2003 were analyzed retrospectively.

Main Results:

  • 81% of patients (34/41) underwent one-stage sigmoid resection and primary anastomosis.
  • Mortality was 11% for primary anastomosis versus 60% for Hartmann's procedure.
  • Comorbidities like prior operations, renal failure, and immunosuppression increased mortality risk.

Conclusions:

  • One-stage sigmoid resection and primary anastomosis are safe in nearly 90% of patients with perforated diverticulitis (Hinchey III/IV).
  • Patients with immunosuppression, renal failure, liver cirrhosis, or prior transplants face significantly higher mortality risks.
Abstract

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