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To analyze the morbidity and mortality amongprimary resection and anastomosis (PA) to Hartmannprocedure (HP) in patients with diverticulitis Hinchey III and IV.We studied all patients undergoing surgery for diverticular disease complicated by generalized peritonitis between 2001 and 2009. Two groups were analyzed: Group 1 (PA) and group 2 (HP). Data were obtained from a databaseprospectively and analyzed retrospectively. We used Hinchey classification of the severity and the rate of peritonitis Manheilm (IPM). Also analyzed the body mass index (BMI), albumin, age, sex, hospital stay, morbidity, mortality and time to reconnect.Analysis of 32 patients, 16 in each group. The average hospital stay was 18.6 ± 7. Comorbidity, Hinchey, albumin, IPM, BMI were comparable in both groups. As for morbidity and mortality in PA was 25% lower morbidity versus 56% in HP with a significant trend of 0.06, mortality in the study was only one patient which can not be compared, in regard to hospital stay was not significant between both groups but a trend towards fewer days PA versus HP, finally we analyze the morbidity in the closure of stoma which was higher in the HP 42% vs 11% PA (P = 0.014).The PA has less morbidity compared with HP, in the first surgery and in the stoma closure. We suggest that PA is a safe option for patients with diverticulitis Hinchey III and IV.