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Introduction: Colonic diverticulosis, as diverticulitis, is a frequent disease in different stages of evolution. There is uncertainty about treatment options that are used in secondary peritonitis. The aim of this study is to determine the best treatment option for patients with peritonitis secondary to diverticulitis of the left colon in terms of postoperative morbidity (POM) and mortality, comparing Hartmann's procedure (HP) and resection with primary anastomosis (RPA). Material and Methods: Systematic review. Studies in adults with peritonitis secondary to diverticulitis of the left colon treated with HP and RPA published between 1990 and 2011 were analyzed. TRIPDATABSE, IWO, MEDLINE, SciELO and LILACS databases were consulted and search strategies were applied using MeSH and free terms. Selected studies were analyzed using a score of methodological quality (MQ). The following variables were considered: mortality, POM, hospital stay, percentage of bowel transit reconstitution in patients undergoing HP and MQ of primary studies. Results: 26 primary studies were analyzed (47 series). There were no significant differences in the variable mortality (p = 0.0805), but significant difference was observed in POM (incompletely reported) (p = 0.0187). The median of MQ of the studies was 11 points for HP series and 10 for RPA series. Conclusion: The available evidence to determine the best treatment option in terms of mortality and POM in this kind of patients is insufficient. Studies with better level evidence and MQ are needed to clarify the uncertain. [ABSTRACT FROM AUTHOR]

The presence of acute peritonitis was considered a contraindication to primary anastomosis in emergency colonic surgery, but the management of colonic lesions has changed in recent decades. The risks of performing a primary anastomosis are unclear and the literature does not specify them, so the main objective of this study was to demonstrate that the primary anastomosis without protective colostomy in patients with colon injuries and peritonitis is a safe procedure. An observational analytical study was performed on 60 patients with colonic injury and acute peritonitis managed by the emergency surgical department of the Hospital Universitario de Los Andes from January 2009 to June 2011. They were divided in 2 groups, cases (primary anastomosis) and control (primary anastomosis with protective colostomy). The exclusion criteria were haemodynamics instability, multiorganic injury, severe decompensated comorbidity and history of steroids use. Both groups were analyzed according to complications with special emphasis on the anastomotic dehiscence. A total of 60 patients were operated, with 30 patients assigned to each group. The mean age was 35 years old with predominance of the male sex. There was no mortality in any group nor increased morbidity in the cases group. The most common complication in both groups was the infection of the surgical wound with a predominance in the control group with 63.3% vs. 16.7% for the cases group, with significant difference. The anastomotic dehiscence, which is the most dreaded complication of the primary anastomosis, was 10% for cases and 20% for the control group, with no significant difference. We conclude that primary anastomosis without protective colostomy, in colonic injuries with peritonitis, is a safe procedure to be performed in selected patients without increasing their morbidity or mortality. [ABSTRACT FROM AUTHOR]

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