Optimal operative treatment in acute septic complications of diverticular disease.

There is still no unanimity regarding optimal operative treatment in acute septic complications of diverticular disease. Logistic regression analysis was used to investigate factors influencing inpatient mortality in 100 patients who underwent urgent laparotomy for such complications. Thirteen preoperative and operative factors including operation type were investigated and odds ratios (OR) were calculated to indicate the approximate risk associated with each factor. A significant advantage for excision/exteriorisation operations compared with defunctioning operations was found (OR 0.17, 95% confidence interval (CI) 0.04-0.79). Although more conservative procedures (mainly laparotomy with drainage) were associated with an increased mortality relative to defunctioning procedures, this difference just failed to reach statistical significance (OR 3.83, 95% CI 0.89-16.5). Age (OR 1.14, 95% CI 1.05-1.24), co-existing illness (OR 2.38, 95% CI 1.08-5.25) and preoperative shock (OR 4.63, 95% CI 1.00-21.5) were significant as adverse prognostic factors. A higher proportion of survivors treated by defunction than by excision/exteriorisation underwent colostomy closure, but this was in part due to the higher proportion of excision/exteriorisation operations in the latter part of the series. We conclude that in patients requiring urgent laparotomy for septic complications of diverticular disease, the septic focus should be removed from the abdominal cavity. This is most often achieved using a Hartmann's procedure and we recommend this form of treatment.