Lambrichts DPV, et al. - Through a multicentre, randomized, open-label, superiority trial conducted in eight academic hospitals and 34 teaching hospitals in Belgium, Italy, and the Netherlands on 133 subjects aged between 18 and 85 years who manifested with clinical signs of general peritonitis and suspected perforated diverticulitis between July 1, 2010, and Feb 22, 2013, the researchers evaluated the results following Hartmann's procedure vs sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy, for perforated diverticulitis with purulent or faecal peritonitis (Hinchey III or IV disease). A total of 66 subjects in the Hartmann's procedure group and 64 in the primary anastomosis group were randomized. No stoma was constructed in 17 of 64 patients allocated to the primary anastomosis group. In comparison with Hartmann's procedure, 12-month stoma-free survival was markedly better for subjects who had undergone primary anastomosis. No notable variations in short-term morbidity and mortality were observed following the index procedure for Hartmann's procedure compared with primary anastomosis. Therefore, primary anastomosis was concluded as superior to Hartmann's procedure as a treatment for perforated diverticulitis (Hinchey III or Hinchey IV disease) in hemodynamically stable, immunocompetent patients younger than 85 years.