[Surgical tactics in complicated sigmoid diverticulitis].

Area of Science:

• Gastroenterology
• Surgical Procedures
• Colorectal Surgery

Background:

• Diverticulitis is a common condition requiring surgical intervention in some cases.
• Optimal surgical management for complicated diverticulitis remains a subject of debate.
• Evaluating different surgical approaches is crucial for patient outcomes.

Purpose of the Study:

• To compare the outcomes of various surgical treatments for diverticulitis.
• To assess the efficacy and complication rates of different surgical procedures.
• To provide guidance on selecting the most appropriate surgical strategy.

Main Methods:

• Retrospective analysis of 139 diverticulitis admissions between 1972 and 1988.
• Categorization of treatments into conservative management, elective surgery, and emergency laparotomy.
• Detailed review of surgical techniques including three-stage resection, Hartmann resection, and primary resection with anastomosis.

Main Results:

• Three-stage resection yielded good results when perforations were managed effectively.
• Primary resection with anastomosis shortened treatment duration but requires careful case selection.
• Hartmann resection was associated with a high incidence of persistent stomas (40% in this series).
• Emergency operations had a hospital lethality of 5.8% and overall lethality of 8.7%.

Conclusions:

• Three-stage resection is effective for complicated diverticulitis, emphasizing secure oversewing of perforations.
• Primary resection with anastomosis is a viable option for selected cases, reducing treatment time.
• Surgeons should individualize treatment based on patient factors and disease severity.
• High rates of persistent stoma with Hartmann resection make it a second choice.
• Restoration of intestinal continuity was achieved in 94% of surviving patients.