Emergency Surgery for Diverticulitis: Relationship of Outcomes to Patient Age and Surgical Procedure

Quinn, Seth A.; Akram, Warqaa; Hao, Scarlett; Honaker, Michael D

doi:10.1016/j.jamda.2022.02.001

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Over the past 20 years, there has been a gradual abandonment of this intervention in patients with good performance status. [22][23][24][25][26][27] It is acceptable to think, analysing our data, that a high ASA score or a Hinchey 4 lead the surgeon to lean towards the most invasive operation; our study it emerges how surgeons take into account both conditions (comorbidity and presence of stercoraceous peritonitis) for the choice of the type of surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgical Decision-making for the Treatment of Acute Diverticulitis: a Single-centre Retrospective Study

Inversini,

Adla,

Vigezzi

et al. 2023

Preprint

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BACKGROUND: Several studies suggest that laparoscopic peritoneal lavage might be associated with an increased event rate. The WSES guidelines recommend performing laparoscopic peritoneal lavage only in highly selected patients; however, selection criteria remain poorly described. OBJECTIVE: This study aimed to assess the complication and long-term outcomes of the lavage group, and to report our experience of acute diverticulitis. DESIGN: This was based on a retrospective cohort study. SETTINGS: This was a study conducted in Fondazione Macchi, Italy. PATIENTS: Patients presenting with acute diverticulitis and undergoing surgery in the hospital of Varese between 2018 and 2022 were included. INTERVENTION: Operative management of acute sigmoid diverticulitis was involved, in particular laparoscopic peritoneal lavage, primary resection and the Hartmann procedure. MAIN OUTCOME MEASURES: The main outcome measures were short-term and long-term outcomes. RESULTS: Long-term follow-up showed the occurrence of complications Clavien-Dindo ≥ 2 in 21.9% (16/73) of patients in the sigmoidectomy group versus 61.1% (11/18) of patients in the lavage group. Among the 11 patients complicated after laparoscopic lavage, 9 required a second surgery. After a comparison between the complicated and uncomplicated patients who were managed with laparoscopic lavage, descriptive differences were found regarding the BMI (95% CI, 21.7-24.3 vs 95% CI, 24.7-31.3, p=0.0419). In analysis, BMI ≥ 27 Kg/m2 (OR, 16 p=0.049) was associated with short and long-term complications in the lavage group. There was no evidence for an association between complications and BMI ≥ 27 Kg/m2 in the primary resection (OR, 1.61 p=1) and the Hartmann procedure group (OR, 4.25 p=0.1438). LIMITATIONS: The study was limited by its retrospective nature and small sample size. CONCLUSIONS: Perforated colonic diverticulitis treated with laparoscopic peritoneal lavage was associated with a high morbidity rate; however, BMI could be a prognostic factor for long-term outcomes, including recurrent diverticulitis and the occurrence of abscesses.

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Section: Discussionmentioning

confidence: 99%

Surgical Decision-making for the Treatment of Acute Diverticulitis: a Single-centre Retrospective Study

Inversini,

Adla,

Vigezzi

et al. 2023

Preprint

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“…For class 2, medical treatment is still considered amajor approach, and surgery is regarded as asalvage strategy (8). Hinchey class 3 and 4 are considered to indicate surgical treatment(2), withHartman's operation or colectomy with primary resection both representing common choices (9).Still, emergent surgery for diverticulitis is riskier, and Hartmann's operation for this condition has a lower likelihood of closure ostomy (10).…”

Section: Discussionmentioning

confidence: 99%

Will right versus left acute colonic diverticulitis location affect the likelihood of emergent operation?

Po-Cheng

Chen

et al. 2022

Preprint

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Purpose Modified Hinchey classification with computed tomography (CT)providesa good predictive factorfor medical failure. By using CT, the location of diverticulitis is proved as an important factor for medical treatment and right-sided diverticulitis is successfully treated medicallymore. However, will more accurate location for diverticulitis affect treatment is not evaluated. Methods Patients who were diagnosed withacute colonic diverticulitis by abdominopelvic CT were retrospectively recorded and analyzed.Patient demographics and clinical features were obtained from patients’ records.Abdominopelvic CT findings were categorized using the location in the colon, distribution of free air in the bowel lumen, fluid accumulation, and type of extra-luminal free air. RESULTS Patients with right-sided diverticulitis were more likely to be younger and elevation of C-reactive protein (CRP) in patients with left-sided diverticulitiswithout significantly different.Only 6.3% of patients received surgical treatment and left-sided diverticulitis is more suitablefor operation (P = 0.02).Most patients with local free air underwent successful medical treatment. The distribution of diverticulitis is different between right- and left-sided diverticulitis and lateral distribution included more cases of surgery. CONCLUSIONS Although there wasno statistical difference between location and emergent operation, we observed that location in the lateral region was an indicatorfor emergent operation. Right-and left-sided diverticulitis manifest indifferent locations, which maybe one of the causes of medical treatmentfailure. Asfeweremergent operations have been performed in recent years, we suggest conducting additionalstudies with larger cohortsto confirm the relationship between location and surgery.

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“…El procedimiendo de Hartmann es el que se realiza con mayor frecuencia. No obstante, también se ha descrito la anastomosis primaria con ileostomía como alternativa [16]. La elección de una u otra, se realiza en función de las características del paciente y preferencia del cirujano [8,16].…”

Section: Manejounclassified

Diverticulitis: una patología que aumenta con la edad

Navarro Alvarado

2024

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La diverticulitis se encuentra como uno de los principales diagnósticos diferenciales en pacientes que se presentan con dolor en el cuadrante inferior izquierdo del abdomen. En efecto, no es nada despreciable su prevalencia en personas mayores. Una influencia importante se ha descrito con la alimentación. De hecho, es por esto que es una de las principales razones de mayor impacto en la población occidental. Otros factores importantes descritos son la disminución en la distención del colon sigmoides, aumento de presión intraluminal y factores como el tabaco, obesidad y genéticos. Por su parte, desde los años 70s se describe la importancia del consumo de fibra como factor beneficioso. La clínica asociada a estudios de imagen son trascendentales para su clasificación y posteriormente poder brindar un manejo adecuado. De ellas, Hinchey es la clasificación más comúnmente utilizada. Por otro lado, dentro de las opciones terapéuticas se establece la antibioticoterapia, drenaje percutáneo y cirugía. La gran mayoría de pacientes no complicados se manejan de manera ambulatoria. Sin embargo, aquellos con complicaciones podrían ser candidatos a procedimientos más invasivos, de los cuales el más conocido es el procedimiento de Hartmann.

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Emergency Surgery for Diverticulitis: Relationship of Outcomes to Patient Age and Surgical Procedure

Cited by 7 publications

References 24 publications

Surgical Decision-making for the Treatment of Acute Diverticulitis: a Single-centre Retrospective Study

Surgical Decision-making for the Treatment of Acute Diverticulitis: a Single-centre Retrospective Study

Will right versus left acute colonic diverticulitis location affect the likelihood of emergent operation?

Diverticulitis: una patología que aumenta con la edad

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