Surgery of complicated sigmoid diverticulitis should be as gentle as possible. Serious time pressure, unpredictable operation fields and unprepared bowel determine the surgical strategy. Hence, we examine whether minimal invasive surgery (MIS) (i. e., Hartmann procedure) is suited for emergency conditions in selected patients. Furthermore, the objective of the study was to -assess the feasibility of the reversal of Hartmann procedure in appropriate patients after a preceding classical or laparoscopic intervention. -Between 2005 and 2009 128 patients with sigma diverticulitis were operated, 72 patients of them with complicated sigmoid diverticulitis (peritonitis, haemorrhage, ileus, perforation), The classical Hartmann procedure was performed in 45 (35 %) patients, 39 of them being treated within 24 hours. The laparoscopically assisted Hartmann procedure was realised in 15 patients and could be successfully completed in 13 cases. The cor-responding mortality rate was 0 %. A Hartmann reversal could be performed in 26 patients (58 %). A laparoscopic approach was chosen in 16 patients and could be successfully completed in 14 cases. 12 patients were operated with classical Hartmann reversal. The respective mortality rates in both groups were 0 %. We therefore conclude that in cases of peritonitis due to sigmoid diverticulitis laparoscopic surgery, like laparoscopically assisted Hartmann procedure and a subsequent laparoscopically assisted reversal could be recommended in selected patients.

In carefully selected cases, placement of SEMS in malignant stenosis of the left hemicolon with ileus can be considered a reasonable therapeutic alternative to emergency surgery since it allows surgical intervention with curative intention under more favorable conditions and also avoids a colostoma.

Provided that a well developed laparoscopic expertise exists, it turned out i) that there are no serious reasons to resist a quick inauguration and establishment of NA for selected cases as well as ii) even to facilitate further clinical distribution of NA. Further systematic data collection appears to be indicated to analyse long-term outcome as parameters of an appropriate quality assurance.

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SP is (in case of well-developed laparoscopic expertise) a surgical method that can be easily inaugurated and considered as a feasible approach in daily surgical practice; it is comparable to LA with regard to outcome and general costs. Based on this, SP can be gradually added to the spectrum of surgical procedures in clinical practice and can be performed in suitable cases. A further systematic institutional or even country-wide case register appears to be recommendable to recruit a larger case number and, thus, to achieve a better knowledge on the perioperative management as well as the especially interesting long-term outcome for an appropriate assessment of treatment quality.