Emergency Surgery for Colonic Diverticulitis: Differences Between Right-sided and Left-sided Disease in an Asian Population

Abstract
Introduction
Diverticulitis in Asians differs significantly from their Western counterparts in various aspects. This study was performed to review the spectrum of surgery and early outcome of patients who had acute diverticulitis and to identify factors predicting morbidity and mortality. The secondary aim was to compare right and left sided disease.

Methods
A retrospective review of all patients who underwent emergency surgery for acute diverticulitis from July 2003 to April 2008 was performed. Patients were identified from the hospital’s operating records based on the final post-operative diagnosis. Right sided pathology was regarded if it was located from the caecum till the transverse colon. Left sided disease was regarded if it commenced distal to the splenic flexure.

The severity of diverticulitis was assessed using the modified Hinchey staging while the grades of complications (GOC) were in concordance to the classification proposed by Clavian and group.

Results
A total of 104 patients underwent emergency surgery for acute diverticulitis. There were 68 (65.4%) patients with right sided diverticulitis for which the majority had either ASA score 1 or 2. Caecum was the commonest site of disease, and the majority had only mild diverticulitis. Appendicectomy was performed in 39 patients.

Conversely, there were 36 (34.6%) patients with left sided diverticulitis. The majority (63.8%) had a higher ASA score of 3 or 4, with the sigmoid colon being the commonest site of involvement. Most (91.7%) had worse peritoneal contamination (Hinchey stage II to IV) with Hartmann’s procedure was performed in 22 (61.1%) patients. Worse post-operative outcome was also seen in this group.

Some of the variables associated with left sided disease included advanced age, higher ASA score, presence of premorbid conditions, worse Hinchey staging, colonic resection, stoma creation and worse outcome. After multivariate analysis, the independent factors were age, ASA score and stoma creation.

Conclusions
In an Asian population, surgery for right sided diverticulitis is more commonly performed and is associated with lower morbidity and mortality. Patients who underwent surgery for left sided diverticulitis were older, had higher ASA score and worse peritoneal contamination and more likely to have stoma created.

Session: Poster

Program Number: P090