Primary resection and anastomosis for treatment of acute diverticulitis.

The patterns of presentation and associated treatments of 65 patients with acute perforated diverticulitis of the left colon have been reviewed. Four types of operations were identified: primary resection with anastomosis (group I, N = 29), primary resection with anastomosis and protective colostomy (group II, N = 5), primary resection with Hartmann procedure (group III, N = 26), and delayed resection three-staged procedure (group IV, N = 5). The severity of disease was also classified (stages I to IV). Postoperative mortality rates in the first two groups were lower than that of the Hartmann group (3.4 vs. 15.3 percent). The mean length of initial hospitalization was 16 +/- 1.2 days for group I, 18.2 +/- 4.4 days for group II, 19.4 +/- 2 days for group III, 26.4 +/- 4.4 days for group IV (P less than .05, t-test group IV vs. groups I, II, and III). Complications in the Hartmann group were high with a 23 percent wound infection rate and mortality after closure of colostomy and bowel reconstruction was 3.8 percent. These data demonstrate that primary resection with anastomosis is a satisfactory operation for the majority of patients with perforated diverticulitis (stages I to III), and there appears to be no clinical indication to use the three-staged operation.