Diagnosis and treatment of diverticular disease

Köhler, L.; Sauerland, Stefan; Neugebauer, E.; Caprilli, R.; Fingerhut, Abe; Haboubi, Najib; Hultén, L; Hüscher, C; Jansen, A.; Kauczor, HU; Keighley, M. R. B.; Köckerling, F.; Kruis, Wolfgang; Lacy, A.M.; Lauterbach, Karl W.; Leroy, Joël; Müller, Jochen; Myrvold, H. E.; Spinelli, P

doi:10.1007/s004649901007

Cited by 425 publications

(80 citation statements)

References 77 publications

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“…There is a general consensus that conservative treatment is indicated in new cases of uncomplicated diverticular disease as shown by previous studies [3, 11]. 50–70% of patients treated for the first episode will recover and remain asymptomatic [3].…”

Section: Discussionmentioning

confidence: 99%

“…Our findings raised the possibility that a proportion of these patients would benefit from prophylactic colonic resection as 9 of 14 patients operated had previous recurrent acute admissions for diverticulitis [3]. This policy is not often followed in our hospital and we incline towards conservative management in the presence of patients’ medical co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

“…A consensus development conference in 1998 defined diverticular disease as a condition seen mostly in the sigmoid colon, characterised by mucosal herniation through the colonic wall, generally accompanied by elastosis of the taenia coli and mucosal folding [3, 4]. The asymptomatic condition is known as diverticulosis.…”

Section: Introductionmentioning

confidence: 99%

“…The term ‘diverticulitis’is used to indicate superadded inflammation and or infection involving the bowel wall. Perforation, fistula, obstruction and bleeding are the other complications described [3]. …”

Section: Introductionmentioning

confidence: 99%

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A Prospective Study of Acute Admissions in a Surgical Unit due to Diverticular Disease

2007

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Introduction: Considerable controversy exists in the surgical literature on the most appropriate treatment modality for patients with recurrent diverticular disease. We aim to assess the clinical outcome of acute surgical admissions with diverticular disease, and in particular patients with recurrent admissions. Methods: 100 consecutive emergency admissions with suspected diverticular disease were prospectively recruited from November 1, 2002 to May 31, 2004. Results: The majority of the patients were female (64%) and the median age was 74 (45–97) years. The follow-up period was up to 30 months. Four patients with tumour and polyps as definitive diagnosis were excluded from further analysis. Fifty-four patients had a known history of diverticular disease with a median duration of 4 (range 1–40) years; 44 of them had 1–7 previous emergency admissions (median 2). Acute diverticulitis (42%) and acute rectal bleeding (23%) were the commonest presentations. Patients with complicated diverticulitis requiring an emergency operation had a median C-reactive protein of 281 mg/l compared to 58 mg/l in the conservatively treated patients with acute diverticulitis (Mann- Whitney U test, Z –3.943, p < 0.001). Nine of 14 patients operated had at least two previous admissions with complications of diverticular disease. Emergency operative treatment was associated with prolonged hospital stay (21 vs. 5 days; Mann-Whitney U test, Z –4.367, p < 0.001), increased morbidity and postoperative mortality. Conclusions: Symptomatic diverticular disease is associated with recurrent emergency admissions. The majority of patients who required emergency laparotomy had previous recurrent emergency admissions, which was associated with increased morbidity and prolonged hospital stay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Prospective Study of Acute Admissions in a Surgical Unit due to Diverticular Disease

2007

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“…Generally, internal fistulas that complicate diverticulitis are associated with high conversion rates and post-operative morbidity, resulting from close adhesions as well as insufficient surgical experience [16,18,[21][22][23]. However, several recent series have reported acceptable conversion rates [24].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic conservative treatment of colo-vesical fistulas following trauma and diverticulitis: report of two different cases

et al. 2013

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Laparoscopic vs Open Colectomy

et al. 2003

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Hypothesis: Laparoscopic colectomy has significant advantages over open colectomy in the treatment of diverticular disease with respect to the length of hospital stay, routine hospital discharge, and postoperative morbidity and mortality. Design: Retrospective secondary data analysis. Patients and Setting: Patients with primary International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for laparoscopic (709 patients [3.8%]) and open sigmoid resection (17735 patients [96.2%]) were selected from the 1998, 1999, and 2000 Nationwide Inpatient Samples. These databases represent 20% stratified probability samples of all US community hospital discharges. Sampling weights were used to allow generalization of the study findings to the overall US population. Multiple linear and logistic regression analyses were performed to assess the riskadjusted association between the surgery type and patient outcomes. Main Outcome Measures: Length of hospital stay, inhospital complications, in-hospital mortality, and the rate of routine discharge. Results: The patients had a mean age of 59.8 years; they were preponderantly white (89.1%) and female (54.0%). After adjusting for other covariates, laparoscopic sigmoidectomy was associated with a shorter mean hospital stay (laparoscopic sigmoidectomy vs open sigmoidectomy, 7.47 vs 9.37 days; PϽ.001), fewer gastrointestinal tract complications (odds ratio, 0.57; 95% confidence interval, 0.35-0.93; P=.03), a lower overall complication rate (odds ratio, 0.64; 95% confidence interval, 0.47-0.88; P=.007), and a higher routine hospital discharge rate (odds ratio, 2.21; 95% confidence interval, 1.51-3.21; PϽ.001). Conclusion: Laparoscopic sigmoid resection in patients with diverticular disease has statistically and clinically significant advantages over open sigmoid resection with respect to the length of hospital stay, rate of routine hospital discharge, and postoperative in-hospital morbidity.

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Diagnosis and treatment of diverticular disease

Abstract: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Cited by 425 publications

References 77 publications

A Prospective Study of Acute Admissions in a Surgical Unit due to Diverticular Disease

A Prospective Study of Acute Admissions in a Surgical Unit due to Diverticular Disease

Laparoscopic conservative treatment of colo-vesical fistulas following trauma and diverticulitis: report of two different cases

Laparoscopic vs Open Colectomy

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