An ideal operation for diverticulitis of the colon

A review has been made of the records of 208 patients operated on for complications of diverticulitis of the colon. One hundred forty patients had emergency operations and 68, elective operations. Resection and anastomosis, with or without temporary diverting colostomy, practiced in the majority of emergency cases in the earlier years covered in this review, has been replaced in the past 10 years by resection without anastomosis. Transverse colostomy, first carried out as part of a three-stage procedure, has been partially replaced by descending colostomy in the past few years. A comparison of the findings at exploration in patient who underwent resection, anastomosis, and temporary transverse colostomy with the findings in those who had the Hartmann procedure showed a slightly higher incidence of free perforation or abscess in those who had the former procedure. The hospital stay was similar in the two groups, but time in the operating room and days of disability were much less in the resection group. Only 14 of the 23 patients who survived the Hartmann procedure underwent restoration of continuity, whereas all of those in the resection group did. Follow-up of the patients who had descending colostomy showed that only 6 of 11 surviving patients underwent resection and anastomosis, but that inflammation regularly subsided, and all those with continent sphincters under age 80 eventually had restoration of continuity. This is in contrast to a more than 20 percent incidence of permanent stomas in the transverse colostomy group, all of which were in patients under age 70.