Immacolata Iannone (Rome / IT), Cristina De Padua (Rome / IT), Gennaro Mazzarella (Rome / IT), Federica Scarno (Rome / IT), Luigi Simonelli (Rome / IT), Gioia Brachini (Rome / IT), Paolo Sapienza (Rome / IT), Andrea Mingoli (Rome / IT)
Abstract text (incl. references and figure legends)
The incidence of diverticulitis has been increasing in last decades, in elderly patients. The surgical management is challenging for timing and treatment. The choice of surgical procedure varies according to the severity of the disease the age and general status of the patient. The aim of this study was to analyze the outcomes of emergency surgical management of complicated diverticular disease in our elderly population, comparing the results of Hartmann"s procedure versus resection with primary anastomosis
A retrospective analysis of our experience (2010–2022) was performed on a consecutive series of patients undergoing surgery for acute complicated diverticulitis. Patients were assessed for demographic data, operative indications, type of resection, intra- and postoperative complications, stoma reverse. The comparisons were made dividing the population in two groups: elderly patients (>75 age years) (Group 1) and patients aged <75 age years (Group 2).
201 patients underwent emergency surgery for acute complicated diverticulitis (Hinchey III-IV). 94(47%) patients were included in Group 1 and 107(53%) in Group 2. No differences in Hinchey classification were observed (P=NS). Similarly, no differences in intra- and post-operative complication rates and operative time were recorded (P=NS). Furthermore, we observed that patients who underwent primary colonic anastomosis with ileal diversion were recanalized more frequently than those who had a Hartmann"s procedure (P<.05). Noticeably, patients in Group 1 were significantly more represented than patients in Group 2 (P<.05).
Primary anastomosis can be performed safely, in elderly patients. In this subset of patients, the choice of the two surgical options (Hartmann versus primary anastomosis) should be correlated to the severity of diverticulitis and with the general status and co-existing comorbidities of the patients. Therefore, we suggest the use of Hartmann"s procedure only to high-risk patients.
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