Modificazioni del trattamento chirurgico della malattia diverticolare del colon in urgenza negli ultimi 30 anni


Paolo Del Rio, Paolo Dell’Abate, Paolo Soliani, Stefanie Ziegler, Maria Francesca Arcuri, Mario Sianesi

Ann. Ital. Chir., 2005; 76: 529-533

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BACKGROUND: The surgical management of diverticulitis in emergency is controversial: The primary reconstructive surgery
or Hartmann’s procedure?
METHODS: The Authors have analyzed our experience on 409 cases of diverticulitis from January 1975 to December
2004; 101/409 were treated in emergency and divided in two groups before and after December 1994.
The patients were divided on Hinchey’s classification, type of surgical procedure, ASA status and complications.
The Authors have analyzed all cases by t-Student and χ2 analysis.
RESULTS: No difference between two groups on age, sex, concomitant diseases are observed. The hospital stay in patients
treated in emergency was 10.2 days to 7.1 days in patients operated after 24 hours (p<0.05). The incidence of primary anastomosis in the second group is higher (p<0.03). The incidence of leaks in two groups was respectively 27.2% and 10.3% (p<0.005). The deaths were 12/101 (11.8%); 9 of these in III°-IV° stages of Hinchey’s classification. DISCUSSION: In the lasts ten years the surgical approach to diverticulitis in emergency is changed. The individual risks factors, the Hinchey’s stage, play an important role in decision making. The Authors have registered a major indications to primary anastomosis in emergency.