Purpose: Hartman’s procedure is the gold standard for treating complicated diverticular disease. This is meant to reduce the risk of septic complications such as anastomotic leak. However, a significant number of patients are not being reversed and this delayed approach may be unnecessary. The objective of any colorectal disease is to remove pathology and re-establish normal anatomy. We aim to illustrate that primary anastomosis with or without loop ileostomy is a valid alternative. Methodology: Retrospective review of 31 complicated diverticular disease patient’s medical records, who underwent surgery at Rockhampton Hospital from 2013 to 2018. HBCIS database along with ICD10 coding was used. Inclusion criteria was anyone who had a Hartman’s, primary anastomosis with or without loop ileostomy. Primary endpoint was anastomotic leak, secondary endpoints included other complications such as abscess or fistula. Results: 16 primary anastomosis patients, 7 Hartman’s, 8 primary anastomosis plus loop ileostomy. 1/16 had an anastomotic leak, nil in the other groups. 2/16 had adhesion related obstruction, requiring surgical adhesiolysis. Average length of stay for primary anastomosis was 7.4 days, Hartman’s 14.9, loop ileostomy 13.8. 3/7 Hartman’s had secondary complications of abscess or wound breakdown with 2/7 being reversed (average 16 months). 2/8 loop ileostomy had superficial/deep wound dehiscence, 6/7 reversed (average 6.4 months). Conclusion: Primary anastomosis with or without loop ileostomy in the setting of complicated diverticular disease is a valid and safe alternative to Hartman’s procedure. These procedures have a favourable risk profile, can be single stage or easily reversible. Larger randomised controlled trails are required.