Terapéutica en diverticulitis aguda: una actualización de la evidencia disponible / Therapeutics in acute diverticulitis: an update of the available evidence

La prevalencia de enfermedad diverticular en Chile se estima en 28% y cada vez es más frecuente su presentación como diverticulitis complicada. Durante los últimos años ha surgido evidencia que ha hecho replantear el manejo de la diverticulitis aguda. Históricamen-te los antibióticos han sido pilar fundamental del tratamiento de la diverticulitis aguda, sin embargo, evidencia reciente muestra que pacientes con un episodio de diverticulitis aguda no complicada pueden ser tratados sin ellos. Con respecto al manejo quirúrgico, la cirugía de emergencia está indicada en peritonitis difusa, absceso no puncionable asociado a sepsis y fracaso de tratamiento; tanto la cirugía de Hartmann como resección y anastomosis primaria son opciones válidas según el escenario. La cirugía electiva debe indicarse caso a caso y se debe optar por abordaje laparoscópico dentro de lo posible. Al enfrentarse a pacientes inmunosuprimidos se debe ser más agresivo en el manejo. La indicación de colonoscopía posterior a un episodio de diverticulitis aguda se reserva para pacientes en los que se haya presentado como un episodio de diverticulitis complicada, en aquellos que corresponda realizar tamizaje para cáncer colorrectal y en los que presenten síntomas o signos sugerentes de neoplasia colorrectal.

The prevalence of diverticular disease in Chile is estimated to be 28%, and its presentation as complicated diverticulitis is becoming more common. Recently, new evidence has emerged, questioning the traditional management of acute diverticulitis. Historically, anti-biotics have been accepted as a cornerstone of the treatment for acute diverticulitis. However, current studies show that patients with documented non-complicated acute diverticulitis could be safely treated without them. Regarding surgical management, emergency surgery is indicated in those with diffuse peritonitis, percutaneously undrainable abscesses associated with sepsis and treatment failure. Both Hartmann's procedure and resection with primary anastomosis are acceptable choices according to different settings. Elective surgery should be indicated on a case-by-case basis, and a laparoscopic approach is the preferable option. When facing immunosu-ppressed patients, management should be more aggressive. Surveillance colonoscopy after an episode of acute diverticulitis is reserved for patients presenting with complicated diverticulitis, those with a formal indication of colorectal cancer screening and patients with symptoms or signs suggestive of colorectal malignancy.

La enfermedad diverticular hoy: revisión de la evidencia / Diverticular disease today: evidence review

Resumen La enfermedad diverticular es muy prevalente con gran repercusión económica y médica. A pesar de las múltiples guías para protocolizar el diagnóstico y tratamiento no existe unanimidad en su manejo. Hemos realizado una revisión actualizada con el objetivo de analizar los nuevos estudios de esta enfermedad, para manejarla adecuadamente y realizar el tratamiento más adecuado en cada momento. La enfermedad diverticular tiene un componente hereditario (40%) y presenta una relación directa con la dieta pobre en fibra, la obesidad, el consumo de carne roja, la inactividad, el alcohol y los AINEs. Por su clínica inespecífica, es difícil realizar un diagnóstico diferencial. La ecografía y el TC abdominal son métodos apropiados para el diagnóstico y se recomienda una colonoscopia de manera precoz (4ᵃ-8ᵃ semana) tras el cuadro agudo. La clasificación más seguida es la de Hinchey. En el tratamiento médico de la diverticulosis sintomática no se ha demostrado evidencia clara de ningún medicamento. La diverticulitis aguda no complicada se puede manejar ambulatoriamente y no es necesario el uso de antibióticos en pacientes sin factores de riesgo. En la diverticulitis complicada se tiende a un manejo conservador, aunque en el Hinchey III y IV el tratamiento es quirúrgico, recomendando la resección de la zona afecta y si es posible anastomosis con o sin estoma de protección. No se recomienda el lavado y drenaje en el Hinchey III. Hay que consensuar tratamiento de forma individualizada ya que no se recomienda tratamiento quirúrgico por el número de recurrencias ni por edad del paciente.

The diverticular disease is a prevalent condition with a great economic and medical repercussion. Despite the multiple guidelines available to protocolize diagnosis and treatment, there is not unanimity in its management. We have carried out an updated review with the aim of analyzing new studies of the disease, to manage it properly and to carry out the most appropriate treatment at each time. Diverticular disease has an inherited component (40%) and it is directly related to low fiber diet, obesity, consumption of red meat, inactivity, alcohol and NSAIDs. Due to its nonspecific symptoms, it is difficult to make a differential diagnosis. Ultrasound and abdominal CT are appropriate methods for diagnosis and early colonoscopy is recommended (4th-8th week) after acute symptoms. The most followed classification is the Hinchey Score. There is no clear evidence of the superiority of any drug in the treatment of symptomatic diverticulosis. Acute uncomplicated diverticulitis can be managed on an outpatient and the use of antibiotics is not necessary in patients without risk factors. Conservative management tends to be used in complicated diverticulitis, although in Hinchey III and IV the treatment is surgical, recommending resection of the affected area and, if possible, anastomosis with or without a protective stoma. Washing and draining is not recommended in the Hinchey III. Treatment must be agreed on an individual basis since surgical treatment is not recommended due to the number of recurrences or the age of the patient.

Diverticulitis aguda del colon izquierdo, nivel de consenso y de aplicación de las Guías de Práctica Clínica: entre miembros de la SACP / Left colonic acute diverticulitis. Level of consensus and Clinical Guidelines Implementation: paper to apply for SACP active membership

Contexto y antecedentes: La elaboración e implementación de guías clínicas pretende brindar ayuda en la toma de decisiones respecto de un determinado problema de salud, sintetizando en forma de recomendaciones la mejor evidencia disponible. Con respecto a la diverticulitis aguda, pese a la gran cantidad de guías que se han elaborado, aún hoy se observa un bajo nivel de consenso en varios aspectos de su manejo. Objetivos: Este trabajo representa la primera encuesta que mide el nivel de consenso y la aplicación de guías internacionales sobre el manejo de la diverticulitis aguda entre los miembros de la SACP o entre cualquier otra agrupación médica a nivel nacional. Métodos: Se distribuyó una encuesta online a 313 miembros de la SACP, las respuestas se recolectaron en un período de 2 meses. Resultados: La encuesta obtuvo una tasa de respuesta de 19,5%. Solo 17 enunciados superaron el corte de 70% de nivel de consenso. De ellos, 11 enunciados estuvieron de acuerdo mientras que 2 enunciados estuvieron en desacuerdo con las recomendaciones de las guías internacionales y en los 4 enunciados restantes no pudo valorarse la concordancia debido a falta de respuesta univoca en las guías. Conclusiones: La amplia heterogeneidad en el manejo de la diverticulitis aguda entre los miembros de la SACP junto con la baja evidencia de los trabajos científicos, la pobre metodología empleada en las guías internacionales y la necesidad de contar con datos locales sobre costos y preferencias, hacen evidente la necesidad que en nuestro ámbito se comience a investigar en forma sistematizada para lograr una guía y consenso nacional.

Background: Construction and elaboration of clinical guidelines aim to provide help to decision-taking process about a specific health issue, synthesizing the best available evidence in the form of recommendations. About acute diverticulitis, although many guidelines were published in the last years, even now, there is a low consensus level in many aspects of its management. Aim: This survey is the first one that measures the consensus level and the application of international guidelines, about acute diverticulitis, within the SACP members, or any other medical society in Argentina. Methods: An online survey was distributed to 313 SACP members; the responses were collected over two months. Results: The response rate obtained by the survey was 19,5%. Only 17 statements passed the consensus level of 70%, 11 of them agreed and 2 disagreed with the recommendations of the international guidelines, in the last 4 statements comparison was impossible because the guidelines lacked one single response. Conclusions: The large heterogeneity in the management of acute diverticulitis within the SACP members, along with the low evidence of the scientific publications, the poor methodology used in the guidelines, and the need of local data about costs and preferences, clearly demonstrates the necessity to start to investigate in a systematic way, in order to achieve a national guideline and consensus about acute diverticulitis.

Hartmann procedure or resection with primary anastomosis for treatment of perforated diverticulitis? systematic review and meta-analysis / Procedimento de hartmann ou ressecção com anastomose primária para tratamento da diverticulite perfurada? revisão sistematizada e metanálise

ABSTRACT Background: The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

RESUMO Racional: O procedimento a Hartmann permanece sendo o tratamento de escolha da maioria dos cirurgiões para o tratamento cirúrgico de urgência da diverticulite perfurada, entretanto está associado com altas taxas de não reversão da ostomia e de morbidade pós-operatória. Objetivo: Estudar os resultados após o procedimento de Hartmann vs. ressecção com anastomose primária, com ou sem ileostomia, para o tratamento da diverticulite perfurada com peritonite purulenta ou fecal (grau de Hinchey III ou IV), e comparar as vantagens entre as duas formas de tratamento. Método: Busca sistemática na literatura de artigos observacionais e randomizados comparando ressecção com anastomose primária vs. procedimento de Hartmann no tratamento de urgência da diverticulite perfurada. Analisar como desfechos primários a mortalidade após a operação de urgência e a morbidade geral após ela; como desfechos secundários, a morbidade severa após a operação de urgência, as taxas de não reversão da ostomia, a morbidade geral e severa após a reversão. Resultados: Não houve diferenças significativas entre os procedimentos cirúrgicos para mortalidade, morbidade geral e morbidade severa. Contudo, as diferenças foram significativas estatisticamente favorecendo anastomose primária na comparação com procedimento de Hartmann nos desfechos taxas de não reversão do estoma, morbidade geral e morbidade severa após reversão. Conclusão: A anastomose primária apresenta-se como boa alternativa ao procedimento de Hartmann, sem aumento de mortalidade e morbidade, e com melhores resultados na operação de reconstrução do trânsito intestinal.

Diverticulitis aguda: revisando antibióticos, seguimiento e indicación quirúrgica / Acute diverticulitis: reviewing antibiotics, follow-up and surgical indication

The presence of colonic diverticulae is a common occurrence in middle-aged and elderly patients. Most of them will remain asymptomatic for life; however, between 10-25% will go on to develop acute diverticulitis (AD). Traditionally, AD has been thought of as a disease having a bacterial etiology with a high recurrence rate and a significant proportion of underlying colorectal cancer. This has been the foundation for conventional treatment with antibiotics and an indication for resective surgery after a second episode. Also, a routine colonoscopy has been recommended on the resolution of inflammatory symptoms, to rule out malignancy. Recent evidence has questioned the appropriateness of this traditional approach to AD. In this review, we critically appraise the need for antibiotics, prophylactic surgery and endoscopic follow-up after AD.

La presencia de divertículos en el colon es un hallazgo frecuente en la población mayor de 60 años. Si bien la mayoría nunca presentará síntomas, 10-25% desarrollará una diverticulitis aguda (DA). Tradicionalmente se ha postulado que la DA es una enfermedad de etiología bacteriana, con una alta tasa de recurrencia, y un porcentaje importante de casos en que puede confundirse con un cáncer colorrectal. Debido a esto el manejo clásico incluye antibióticos e históricamente se ha recomendado una cirugía resectiva del segmento afectado después de un segundo episodio. También se ha tenido como dogma el realizar una colonoscopia de control una vez resuelto el episodio agudo, para descartar una neoplasia subyacente. Sin embargo, la nueva evidencia disponible ha cuestionado la idoneidad de este enfoque clásico frente a la DA. En esta revisión analizamos de manera crítica la necesidad del uso de antibióticos, la cirugía profiláctica y el control endoscópico posterior a DA.

Prevención de la Diverticulitis Aguda Recurrente on Bacillus clausii

La Enfermedad Diverticular (ED) o Diverticulosis, es una de las enfermedades gastrointestinales más comunes que afectan a la población general en el mundo occidental, un 20 % de los pacientes son sintomáticos y el 75 % de ellos tendrá ED dolorosa: diverticulitis aguda, 25-33 % de estos pacientes pueden tener episodios recurrentes.Cambios en la Microbiota del colon, ocasionando inflamación crónica y proliferación de células epiteliales que se desarrollan en la mucosa del colon en y alrededor de los divertículos. Los prebióticos, restauran el microambiente del colon y de aquí, que se han propuesto para el tratamiento de los pacientes con ED asintomática para evitar la Diverticulitis Aguda. Objetivo del estudio fue investigar la proporción de pacientes que mantuvieron la remisión después de un episodio previo de Diverticulitis Aguda no complicada, cuando recibieron como tratamiento Bacillus clausii: 2 billones cada 8 horas por 1 año. Materiales y métodos: Estudio prospectivo y retrospectivo, con un muestreo no probabilístico de tipo intencional, con grupo control. Grupo A: Los 50 pacientes con el diagnostico de Diverticulitis Aguda no complicada, recibieron como único tratamiento Bacillus clausii 2 billones cada 8 horas, permanente por 1 año. Controles clínicos cada 3 meses. Grupo B (control): 50 pacientes conel diagnostico de Diverticulitis Aguda no complicada no tratados.Resultados:Se introdujo la información necesaria para realizar los análisis de varianza en R, encontrándose diferencia significativa entre las medias de los grupos considerados en el estudio, al obtenerse un F(1,48)=5.259, p <0.05.Conclusión: El Bacillus clausii por su características biológicas previene las complicaciones inflamatorias de la Enfermedad Diverticular como es la Diverticulitis Aguda Recurrente.

Diverticular Disease (DD), or Diverticulitis, is one of the most common gastrointestinal diseases affecting the general population in the western world; approximately 20% of patients are symptomatic and 75% suffer from painful DD: acute diverticulitis, 25-33% of those patients may suffer from recurrent episodes. Changes in colon microbiota cause chronic inflammation and epithelial cell proliferation developed in colon mucosa and around the diverticula. Prebiotics restore colon’s microenvironment, from where the treatment of patients with asymptomatic DD is proposed, in order to avoid the Acute Diverticulitis. The study aimed to investigate the proportion of patients who maintained the referral after a previous episode of uncomplicated Acute Diverticulitis, when treated with Bacillus clausii: two billions every eight hour during one year. Materials and Methods: Prospective and retrospective study, with non-probabilistic, intentional-type sampling and control arm. Arm A: Fifty patients diagnosed with uncomplicated Acute Diverticulitis, were administered with a single treatment of Bacillus clausii, two billions, every eight hours during one year. Clinical controls every three months. Arm B (control): 50 untreated patients diagnosed with uncomplicated Acute Diverticulitis. Outcomes: The necessary information to carry out the R variance analysis was introduced; a significant difference was found between the study’s arm averages; a F(1,48)=5.259, p<0.05 was found. Conclusion: because of its biological characteristics, Bacillus clausii prevents Diverticular Disease’s inflammatory complications such as the Recurrent Acute Diverticulitis.

Safety of Nonoperative Management After Acute Diverticulitis

PURPOSE: The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. METHODS: We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. RESULTS: Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458). CONCLUSION: After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively.

Lavado peritoneal laparoscópico como tratamiento de diverticulitis aguda perforada / Laparoscopic peritoneal lavage as treatment for acute perforated diverticulitis

Introduction: Sigmoid diverticular disease is common in the occidental world and it is responsible for a great number of hospitalizations. The prevalence of diverticular disease increases with age and only in few cases it is manifest as diverticulitis. Diverticulitis produces variable clinical manifestations, ranging from simple inflammation that only requires medical management, to a life threatening condition, due to a free perforation that requires urgent surgery. Clinical case: In this article we present a clinical case of complicated diverticulitis with free perforation treated with laparoscopic peritoneal lavage.

Introducción: La enfermedad diverticular es muy común en el mundo occidental y es responsable de un gran número de hospitalizaciones. La prevalencia de la enfermedad diverticular aumenta con la edad y sólo en pocos casos se presenta como diverticulitis. La diverticulitis produce manifestaciones clínicas variables que van desde la simple inflamación que sólo requiere tratamiento médico, a una condición potencialmente mortal, debido a una perforación libre que requiere cirugía de urgencias. Caso clínico: Se presenta un caso clínico de diverticulitis complicada con perforación libre manejado con lavado peritoneal laparoscópico.

Colon Cancer After Acute Diverticulitis Treatment

Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.

A Case of Colon Cancer with Ovarian Metastasis Mimicking Acute Diverticulitis / 대한내과학회지

Colonic diverticulitis develops in 10-25% of patients with colonic diverticulosis. Most patients complain of lower abdominal pain and fever. The complications of diverticulitis are abscess, fistula, bowel obstruction, free perforation, and panperitonitis. The relationship between diverticulitis and colon cancer is complicated and conflicted. We report a 35-year-old woman diagnosed with metastatic colon cancer, who initially presented with acute colonic diverticulitis in the same location 3 months earlier. To the best of our knowledge, this is the first case of colon cancer with ovarian metastasis presenting as acute diverticulitis.

Divertículo de Meckel necrosado / Necrotic Meckel's diverticulum

Se presenta el caso de un paciente que acudió al cuerpo de guardia del CIMEQ en marzo del 2007. Presentaba un cuadro clínico de abdomen agudo quirúrgico y fue intervenido con el diagnóstico de apendicitis aguda complicada. En el transoperatorio se constató la presencia de un gran divertículo de Meckel, que inicialmente se inflamó (diverticulitis aguda) y posteriormente evolucionó hasta la necrosis, por lo que afectó la irrigación de un segmento intestinal en el íleon terminal, el ciego y el tercio inferior del colon ascendente. El apéndice no tenía ninguna alteración, por lo que se realizó una hemicolectomía derecha. El paciente evolucionó favorablemente y fue dado de alta a los 10 días, con una evolución favorable(AU)

This is the case presentation of a patient treated in Emergency Department in March 2007 presenting with a clinical picture of surgical acute abdomen and operated on due to complicated acute appendicitis. At transoperative period presence of a Meckel's diverticulum was verified that initially becomes inflamed (acute diverticulitis) and later process evolved until necrosis affecting the blood stream of an intestinal segment in terminal ileum, cecum ant the lower third of ascending colon. Appendix was not altered and a hemicholectomy was performed. Patient had a favorable course and was discharged at 10 days(AU)

Diverticulitis aguda perforada simulando prostatitis aguda / Perforated acute diverticulitis mimicking acute prostatitis

We present an unfrequent case of acute diverticulitis mimmicking acute prostatitis. Case report: A 72-year-old man suffering from hypogastric and genital pain, fever and dysuria, with an edematous and tender prostate at physical examination, was initially diagnosed of acute prostatitis. 24 hours later the patient developed left lower quadrant pain and abdominal distension. A CT scan was performed, showing pneumoperitoneum and acute sigmoid diverticulitis signs. The patient underwent a Hartmann's procedure.

Presentamos un caso infrecuente de diverticulitis aguda con manifestaciones clínicas sugerentes de prostatitis aguda. Caso clínico: Varón de 72 años, presenta dolor hipogástrico y en región genital, fiebre y disuria, palpándose una próstata edematosa y dolorosa al tacto rectal, por lo que es inicialmente diagnosticado de prostatitis aguda. A las 24 horas el paciente desarrolla un cuadro de distensión abdominal y dolor en fosa ilíaca izquierda. Una TC abdominal mostró neumoperitoneo y signos de diverticulitis aguda. Se intervino al paciente realizando una intervención de Hartmann.

Atualização no tratamento da diverticulite aguda do cólon / Recent evidences in the management of acute diverticulitis

Nas últimas décadas a incidência da moléstia diverticular do cólon e de suas complicações tem aumentado. Durante esse período o número de publicações a respeito do tema se expandiu, bem como as opções terapêuticas. Apesar disso, muitas dúvidas persistem e as decisões terapêuticas continuam relativamente imutadas, baseadas muitas vezes em dados antigos e de baixo poder estatístico. Nesta revisão apresentamos as evidências científicas atuais acerca da terapêutica desta complexa patologia.

During the past decades the incidence of diverticular disease of the colon and its complications has increased as well as the therapeutic options have expanded. However, there are still remaining doubts about the timing of surgery indication, the access (open vs laparoscopic) and the best approach to complicated diverticulitis. The current decisions are mostly based in old data of poor statistic strength. This review shows the present-day evidence about the treatment of diverticular disease.

Morbilidad y mortalidad de la reconexión colorrectal posterior al procedimiento de Hartmann / Morbi-mortality of Hartmann's reversal procedure

Introducción: el procedimiento de Hartmann es una alternativa de tratamiento para cirugías colorrectales de emergencia, sin embargo, su reconexión es difícil y propensa a complicaciones. Se ha propuesto que un periodo de tiempo mayor entre el procedimiento inicial y la reconexión puede disminuir las complicaciones. El objetivo de esta investigación es determinar la morbilidad y mortalidad de la reconexión posHartmann, y analizar la presencia de factores de riesgo para complicaciones. Material y métodos: se analizaron retrospectivamente 48 pacientes cuyas edades oscilaron entre 57 ± 16 años, de los cuales 19 (40 %) eran mayores de 65 años y 21 (44 %) tenían enfermedades crónicas concomitantes. Se buscaron factores de morbilidad y mortalidad con prueba U de Mann- Whitney y prueba exacta de Fisher. Resultados: la indicación más frecuente del procedimiento fue la diverticulitis aguda (42 %). El periodo entre el procedimiento de Hartmann y la reconexión fue de ocho meses, con un rango de 1 a 46 meses. La duración aproximada de la cirugía de reconexión fue de 267 minutos (rango de 120 a 540). Se presentaron complicaciones en 29 pacientes (60 %), incluyendo fístulas de la anastomosis en seis (12 %) y muerte en cuatro (8 %). No se asociaron mayores complicaciones o más tiempo quirúrgico, con un intervalo de tiempo menor entre el procedimiento de Hartmann y la reconexión. Conclusiones: la reconexión posHartmann es un procedimiento con alta morbilidad y mortalidad, sin que se asocie al intervalo de tiempo entre el procedimiento y la reconexión.

BACKGROUND: Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications. METHODS: In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test. RESULTS: Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time. CONCLUSIONS: Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.