[Value of Hartmann's operation as an emergency intervention in sigmoid diverticulitis]

M Röthlin, G Rietschi, F Largiadèr
Swiss Surgery, Schweizer Chirurgie, Chirurgie Suisse, Chirurgia Svizzera 1997, 3 (3): 107-11

INTRODUCTION: Improvements in antibiotic and intensive care treatment have facilitated the conservative therapy of patients suffering from complicated diverticulitis of the sigmoid for the time necessary for preparation in view of early elective resection of the sigmoid colon. Consequently, early elective resection of the sigmoid colon with primary anastomosis has become very popular as the treatment of choice in complicated diverticulitis. This has led us to a retrospective evaluation of our own results with both Hartmann's operation and resection with primary anastomosis.

PATIENTS AND METHODS: 55 patients with complicated diverticulitis of the sigmoid colon were operated on at our institution between 1981 and 1990. Group I consisted of 33 patients (17 females and 16 males) aged 39 to 89 years who underwent Hartmann's operation. Group II included 11 patients (6 females and 5 males) aged 39 to 85 years treated by resection and primary anastomosis. The remainder of the patients was treated by a three-step procedure and should not be considered here.

RESULTS: In group I 25 patients (76%) suffered complications either at the Hartmann's operation or at descendorectostomy or both. Mortality was 6%. Only 76% of patients had their stoma closed after an average of 3.8 months. The average hospital stay of both operations combined amounted to 61 days. In group II 3 patients had complications, one of which was lethal (lung emboly). The total hospital stay in this group averaged 22 days.

CONCLUSIONS: For Hinchey stages I and II conservative treatment, bowel preparation and early elective resection with primary anastomosis should be attempted. In cases of general peritonitis (Stages III and IV) Hartmann's operation is still the treatment of our choice.

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