The choice of operation for complicated diverticular disease is contentious.
Dr Constantinides and colleagues investigated adverse events following restorative and non-restorative surgery for complicated diverticular disease.
The restorative procedure evaluated was primary resection and anastomosis, and and the non-restorative was Hartmann's procedure.
The research team considered 539 patients who presented with complicated diverticular disease in 42 centres over a 12-month period from 2003.
Data were collected prospectively from 248 patients who underwent primary resection and anastomosis, and 167 who had Hartmann's procedure.
A propensity score was developed for case-mix adjustment.
|Mortality with primary resection and anastomosis was 4%|
|British Journal of Surgery|
The researchers used multifactorial logistic regression to evaluate differences in operative outcomes.
The team found that mortality, surgical and medical complication rates were 4%, 31% and 14%, respectively after primary resection and anastomosis.
After Hartmann's procedure, the mortality, surgical and medical complications rates were 23%, 53% and 41%.
After adjusting for the propensity score, the Hartmann's procedure group had a 2-fold increase in medical and surgical complications.
The researchers found that the operative mortality rate was not significantly different between the groups.
Non-colorectal surgeons performed a significantly higher proportion of Hartmann's procedure in the non-elective setting than colorectal surgeons.
Dr Constantinides' team commented, “Primary resection and anastomosis with or without a proximal diversion is more often performed non-electively by specialist colorectal surgeons.”
“It may be a safe procedure for complicated diverticular disease in selected patients as it may be associated with fewer postoperative adverse events.”