Surgical Management of Perforated Colonic Diverticulitis

Comparison of POSSUM Scoring Systems and the Surgical Risk Scale in Patients Undergoing Surgery for Complicated Diverticular Disease

“…Patients presenting with generalized perito- nitis and patients undergoing operations in the nonelective setting had a 25.3 and 18.2 percent mortality rate respectively. This is in line with previously published series reporting mortality rates of 6 to 35 percent for perforated diverticulitis, [21][22][23][24] and up to 20.2 percent after emergency operations. 25 Patients with diffuse peritoneal contamination (Hinchey III and IV) were associated with a 49.4 percent surgical and with a 40 percent medical complication rate, the results of which are consistent with the 48 percent complication rate reported by Nagorney et al 21 in a series of 121 patients with perforated sigmoid diverticulitis.…”

“…There was no systematic underreporting of variables and no evidence of bias from the reported results, because demographics and outcomes from the included dataset closely replicated those reported in other series. [21][22][23][24] There is, however, potential for selection bias because some hospitals or surgeons may have selectively submitted cases to the database that do not reflect the true picture of complicated diverticular disease in the relevant population concerned.…”

Hartmann's Colectomy and Reversal in Diverticulitis: A Population-Level Assessment

“…tient, the extent of prior disease, and scarring in the pelvis. The reported adverse outcomes with colostomy reversal include a mortality rate of 0 to 8.3 percent, 6,32,36,51 morbidity of 20 to 33 percent, 14,19,52,53 and reoperation of 0 to 10 percent. 19,26,[54][55][56] In our study, the mortality rate among those undergoing colostomy reversal (generally a younger group) was 0.36 percent and the reoperation rate was 0.6 percent.…”

Laparoscopic surgery for diverticulitis

“…Auguste et al [1] reported zero mortality with stage I disease treated by primary resection vs 5% mortality for stage II and 18% for stage III. We categorized patients according to a modified Hinchey grading system.…”

“…However, morbidity and mortality were prohibitively high and sepsis persisted when the diseased segment was left in situ. In the 1980s, it became clear that the perforated segment should be resected whenever possible and the Hartmann's procedure was popularized [1,10]. After realizing the difficulty of Hartmann reversals, surgeons began to perform resection with primary anastomosis with or without loop ileostomies in select cases.…”