One‐stage procedure in non‐elective surgery for diverticular disease complications

Abstract

Objective Admission of patients with acute complications of diverticular disease is frequent and operative management remains controversial. The aim of this study was to investigate the ef®cacy and safety of resection, intra-operative colonic lavage and primary anastomosis in patients who require urgent laparotomy to treat complications of diverticular disease.Patients and methods From January 1992 to December 1999, 124 surgical patients underwent emergency operation for complicated diverticular disease. Resection, intra-operative colonic lavage and primary anastomosis were carried out in 55 patients: four with obstruction, two with massive bleeding and 49 with diverticulitis. In the diverticulitis group, 33 (67.3%) patients presented with localized peritonitis and 16 (32.7%) with generalized purulent peritonitis. No patient with faecal peritonitis was treated by a one-stage procedure.Results One or more complications were detected in 25 patients (45.4%). Four patients (7.2%) required reintervention. Mortality occurred in four patients (7.2%). Two patients (3.6%) presented with anastomotic leakage. Wound infection was detected in 16 cases (29%). The overall mean (s.d.) Hospital stay was 18.5 (12.1) days.Conclusion Resection, intra-operative colonic lavage and primary anastomosis provide an alternative procedure for achieving one-stage resection in selected patients who require emergency operation for complication of diverticular disease.

Impact of age on recurrence and severity of left colonic diverticulitis

“…It is uncommon under 40 years and it affects between 5% and 10% of the population in the fifth decade of life, 30% at age 60 and over 60% of people over the age of 80 [3]. Most patients with diverticulosis remain asymptomatic during their life and surgery is rarely necessary [7].…”

Emergency surgery for perforated diverticulitis in the immunosuppressed patient

“…IMS patients are at higher risk of septic complications; therefore, the decision‐making process in these fragile patients benefits from clear criteria for deciding on the operation choice in the emergency setting . The PSS score is a validated tool to estimate the postoperative mortality that can help in these circumstances.…”

“…In our institution, RPA, with or without defunctioning IL (in selected patients), is our preferred surgical strategy for left‐sided colonic perforation . However, whether to restore gastrointestinal continuity or perform an HP is decided by the responsible surgeon and is dependent on intra‐operative findings, haemodynamic stability, the PSS as well as the surgeon's own expertise in performing a more demanding operation.…”

“…In the last decade, retrospective studies and meta‐analyses suggest that RPA may be safe in selected patients. Moreover, this alternative seems to offer lower postoperative morbidity and mortality .…”

Treatment of left‐sided colonic emergencies: a comparison of US and UK surgical practices

“…Two factors may account for this disparity in transatlantic practice. The technique of on‐table lavage in the emergency setting was originally popularized in the UK [14], with further European series confirming the safety of the procedure [6,15,16]. In contrast, to date, only one centre in the USA has described its experience of the practice [17].…”