Outcomes Of Emergency Surgery Of Complicated Diverticulites

Abstract

Background: Advanced complicated diverticulitis, particularly when involving perforation, abscess or peritonitis, presents a management dilemma in emergency surgery. Its management sometimes includes doing procedures such as Hartmann’s or primary anastomosis. However the reality is that emergency surgeries are much more risky compared to elective surgeries even with all the development that has happened in the field. Knowledge of outcomes and predictors condition basic knowledge in regard to surgical interventions and patient management.
Objectives: To assess the safety and efficacy of emergency surgery for complicated diverticular disease; patients’ demographics, operative complications and factors affecting morbidity/ mortality and postoperative recovery to inform future practice and policy.
Study design: A Retrospective study. 
Place and duration of study. Department of General Surgery MTI Lady Reading hospital Peshawar from jan 2021 to july 2021
Methods:  50 emergency surgical patients with complicated diverticulitis in a single institution from January 2015 to December 2020. Information collected were patients’ characteristics, intra operative details and other variables in form of complications recorded after the surgery. The opinions of the respondents were analyzed with reference to mean age, standard deviation t-test. In comparing mortality and complication rates between subgroups, the P values were calculated. Analytic work was done using the Statistical Package for the Social Sciences Version 17 and a significance level of 0.05 was used.
Results: The study targeted fifty patients their mean age was 67.5 ± 12.3 years. Hartmann’s procedure was conducted in 60% of patients, and primary anastomosis in the rest 40% of cases. A postoperative complication rate of 45 percent as marked by wound infections at 20 percent, anastomotic leaks at 5 percent. The mortality rate was 15%. Mortality rates were higher in patients older than 70 years: 27.8 % versus 18.2 % (p = 0.03). Hinchey classification demonstrated that prolonged length of stay connected with Hinchey degree III and IV (p = 0.02). We also divided both patients with sepsis and those receiving primary anastomosis based on surgical treatment; primary anastomosis had shorter recovery time with higher leakages among the septic group (p = 0.04).
Conclusion: Emergency surgery for complicated diverticulitis remains a high-risk procedure, especially among elderly patients and those presenting severe disease features. Although Hartmann’s procedure is the standard management in critically ill patients, primary anastomosis is possible in occasionally stable patients. The care of such patients demands that surgery should be tailored for each of the patients and the perioperative period should be managed optimally. Thus future trials are required to minimize the mortality rate and refine indications for surgical management in emergencies.