SP8.2.8 Resection and primary anastomosis is safe in selected patients with perforated diverticulitis; a cohort study

Abstract

Abstract Aims Historically, the preferred procedure for perforated diverticular disease is Hartmann's procedure (HP). Although reliably achieving source control, it's associated with a high rate of post-operative complications and a stoma which often becomes permanent. We reviewed our experience of patients undergoing HP vs primary anastomosis (PA) for perforated diverticulitis. Methods All patients undergoing emergency resectional surgery for perforated diverticulitis between March 2015 and Jan 2021 were identified from the Hospital Episode Statistics (HES) data. Demographics were collected and the patient groups were case matched for age and Charleson Comorbidity Index (CCI), Computed Tomography (CT) appearance and intraoperative contamination data. Post-operative morbidity/mortality data was compared. Results 105 patients were included. 15 patients had PA (without diversion) and 90 HP. In the PA cohort were 10 males, median age 52 (range 27–76). There were no anastomotic leaks. 30-day morbidities were superficial wound dehiscence (1) and early incisional hernia (1). Median post-operative stay was 9 days (range 5–25). HP control group (age below 76, Charlson score 10 and below, Hinchey 1–3 intraoperatively). Included 58 patients, 26 males, median age 60.5 (range 30–76). Median post-operative stay was 10.5 days (range 5–227). 2 patients required re-operation. 5 patients developed wound infections. At the time of the study 18 patients have undergone reversal, 6 are on active waiting-list for reversal. There was a single 30-day mortality (post-discharge). Conclusion We have shown that PA is safe in selected cohort of patients and have identified that over 50% of patients undergoing HP could have been considered for PA.