Early experience of primary intestinal anastomosis in diverticular abscesses: a cohort study

BACKGROUND: Over the last decade, studies have reported that primary colorectal anastomosis can be used to manage purulent inflammatory complications of diverticular disease. However, the indications for this intervention remain debatable.

AIM: To review early experiences with primary anastomosis for diverticular abscesses.

METHODS: The treatment outcomes of 58 patients with diverticular abscesses were studied. The evaluated abscesses were located in pericolic (32 [55.2%] patients), pelvic (19 [32.7%]), and distant sites (7 [12.1%]). Treatment included drug therapy, minimally invasive interventions, and combined surgical interventions. Treatment outcomes in 26 patients who underwent bowel resection with primary anastomosis and 11 patients who underwent Hartmann’s procedure were compared. Significant differences were assessed using Fisher’s exact test and Student’s t-test for independent samples using the GraphPad QuickCalcs online calculator based on standard statistical analysis algorithms.

RESULTS: Primary anastomosis was performed in 12 patients (37.5%) with pericolic abscesses, 11 patients (57.9%) with pelvic abscesses, and 3 patients (42.9%) with distant abscesses. The surgical option was selected based on the abscess’ location and extent and the patient’s condition, age, and comorbidities. In patients with primary diverticular abscesses who underwent urgent surgeries, anastomosis was conducted in 10 of 21 (47.6%) patients, and in all 16 patients with recurrent abscesses. Young and middle-aged individuals (55.5 ± 9.42 years) predominated in the primary anastomosis group, while elderly and senile individuals (71.6 ± 8.94 years) predominated in the stoma group. Bowel resection, although more technically complex than Hartmann’s procedure, showed no significant increase in complications (p = 0.119) and resulted in less severe outcomes.

CONCLUSION: Primary anastomosis for diverticular abscesses is a surgical option for young and middle-aged individuals without comorbidities and generalized inflammation.