[Diverticular disease. Our experience].

The authors herein present their personal experience on the surgical treatment of complicated diverticular disease. The series consists of 243 patients seen between January 1974 and May 1994. One hundred and fifty nine (65.4%) were admitted in an elective and 84 (34.6%) in an emergency setting. Medical therapy was efficacious in resolving the clinical symptoms in 133. One hundred and ten pts. were treated surgically: 91 (82.7%) underwent a left hemicolectomy (one-step surgery), 13 (11.8%) the Hartmann's procedure and 6 (5.4%) a sigmoid resection. Between 1974 and 1980, when anastomoses were performed manually and an excluding colostomy was the procedure of choice, the reported rate of anastomotic dehiscence was 21%. With the technological break-through of mechanical staplers, that enabled the performance of colostomies "on demand" such rate decreased to 8% and finally to 2%, as reported during 1987-94. The operative mortality, between 1974-84, of those patients who underwent emergency surgery was 14% and decreased to 3% between 1985-94. The operative mortality of patients who underwent elective surgery between 1974-84 was 1.3% and decreased to 0% between 1985-1994. The authors underline the importance of respecting the surgical indications and the proper evaluation of pre-operative parameters aiming at a one-step surgery, that reduces both post-operative complications and recovery time.