The place of sigmoid myotomy in diverticular disease

The place of longitudinal myotomy in the treatment of diverticular disease of the sigmoid colon is discussed, with passing reference to the drawbacks of transverse myotomy. The prime indication for longitudinal myotomy is in the longstanding uncomplicated case of troublesome diverticular disease that has not responded to correct medical treatment, which should include high-residue diet and bran. Such cases are usually over 50 years of age, when a functional and reversible obstruction has become organic and irreversible. They comprise 75% of a series of 104 cases described. A secondary indication is in cases of diverticular disease which have been complicated by perforation, abscess formation, acute intestinal obstruction or fistulae. Such cases comprise 25% of the present series. They may settle after drainage and/or defunctioning colostomy. Myotomy can be carried out later, with or without limited resection, provided that all signs of pus or peritonitis have disappeared. The technique of the operation is described and the results are analysed.