Mortality of the surgical treatment of diverticulitis

Botsford, Thomas W.; Zollinger, Robert M.; Hicks, Richard J.

doi:10.1016/0002-9610(71)90050-x

Cited by 44 publications

(3 citation statements)

References 6 publications

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“…13 These patients require emergent operation with mortality rates reported in the literature ranging from 0% to 100%. 14,15 The conventional surgical approach in the man-agement of these patients with generalized peritonitis included a 3-stage drainage procedure as advocated by Smithwick 3 in 1942. This was associated with an unacceptably high morbidity and mortality 16,17 attributed to the diseased segment of colon, which was left in situ.…”

Section: Iverticulosis Of the Co-mentioning

confidence: 99%

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

2004

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Background: Primary resection has replaced the conventional drainage procedure in the management of patients with generalized peritonitis complicating diverticular disease of the colon. This study investigates the impact of primary resection on operative mortality, identifies predictors of mortality, and compares the results with those of our earlier experience. Hypothesis: Primary resection of the perforated diseased segment of the colon is associated with lower mortality rates than the drainage procedure in patients with Hinchey stages 3 and 4 diverticulitis. Design: Retrospective analysis. Setting: Tertiary care referral center. Patients: We included 138 consecutive patients who underwent emergent operation for generalized peritonitis complicating diverticular disease of the colon (Hinchey stages 3 and 4) during a period of 16 years (January 1983 to May 1999). Main Outcome Measures: The 30-day mortality rate was analyzed and predictors of mortality identified. Results: Patients were classified as having spreading purulent peritonitis (n=44, 31.9%), diffuse peritonitis (n=64, 46.4%), or fecal peritonitis (n=30, 21.7%). One hundred thirty-one patients (94.9%) underwent primary resection, 6 patients (4.3%) underwent resection and primary anastomosis, and 1 patient required total colectomy and end ileostomy. Thirteen of the 138 patients in the present group died (1983-1998), representing a perioperative mortality rate of 9%. There was no significant difference in mortality when compared with our earlier study (1972-1982), which had a mortality rate of 12%, considering that more than 25% of the patients in that group were managed by colostomy and drainage alone. Factors identified univariately as predictors of mortality were age of more than 70 years (P=.047), 2 or more comorbid conditions (PϽ.01), obstipation at initial examination (P=.02), use of steroids (P=.01), and perioperative sepsis (PϽ.001). Conclusions: Primary resection has become the standard practice for patients with generalized peritonitis complicating diverticulitis. Mortality rates have not significantly declined despite more aggressive surgical management of the septic source. Because advanced age, comorbid conditions, and perioperative sepsis predict mortality, it is suggested that further reduction in mortality will require improvement in medical management of perioperative sepsis and comorbid conditions.

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Section: Iverticulosis Of the Co-mentioning

confidence: 99%

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

2004

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“…When generalized fecal peritonitis exists, the mortality rate varies and ranges from 50% to 100% [6]. Our mortality rate was 80%.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Response during Laparotomy

Mahamid

Jabarin

Almogy

2014

International Journal of Inflammation

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Background. The aim of this study was to analyze the influence of laparotomy on the systemic inflammatory response in human patients suffering from secondary peritonitis. Study Design. A prospective study investigating the levels of white blood cells, C-reactive protein, platelets, interleukin-six, and tumor necrosis factor-alpha during laparotomy in five patients who suffered from secondary peritonitis. Six venous blood samples were collected perioperatively from each patient. The data were summarized by descriptive statistics and presented in a box plot. The hypothesis was that laparotomy increases the systemic inflammatory response, as has been described in animal models in previous studies. Results. The median age of the patients in this study was 84 years, the male to female ratio was 2 : 3, and the mortality rate was 80%. The most common cause of generalized peritonitis was ischemia of the colon. Analysis of the data showed no significant changes in the level of plasma inflammatory mediators during the surgical procedure, except for the platelet count which showed a significant decrease (P = 0.001). Conclusions. In contrast to experience with animal models, laparotomy in human patients with secondary peritonitis did not significantly increase the systemic inflammatory response. Furthermore, it contributed in significantly decreasing some of the systemic inflammatory mediators.

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“…Many authors, therefore, recommend an ad ditional proximal protective colostomy for mation. However, a high rate of complica tions ensures colostomy formation and sub sequent closure [1,4,11,14,16,22], Fur thermore, leakage rates of 6.7-15% with proximal colostomies have been reported [2,3,7,15,25], Several authors have reported that proxi mal fecal diversion provides no guarantee against anastomotic leaks, and that the mor bidity of the latter remains unchanged [5,12,21,24], With the use of staplers, the inci dence of leakage stays almost the same [23]. The use of intraluminal bypass graft was suc cessfully examined in other situations [8,[18][19][20],…”

Section: Discussionmentioning

confidence: 99%

Intrarectal Bypass Graft in Low Anterior Resection and Sigmoid Obstruction – An Experimental Study

Goldman¹,

Aladgem²,

Kahn³

et al. 1988

Eur Surg Res

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The most common causes for morbidity and mortality in colorectal resections are anastomotic leaks. In low anterior resection, the incidence of anastomotic leakage ranges from 17 to 50%. With the use of the stapler technique, leakage incidence rate remains high and ranges from 10 to 25%. Colostomy formation and closures are associated with considerable morbidity and mortality. Due to the high incidence of anastomotic leakage rate in low anterior resection, and the additional complications of diverting colostomy formation and closure, the use of a rectal stent-intrarectal bypass graft has been instituted. This is carried out by means of a silastic graft, which prevents the fecal stream and gas pressure from coming into contact with the anastomotic site at the low rectum. The efficacy of intrarectal bypass graft was examined in two high-risk surgical situations, the first in very low anterior resection and the other, after early sigmoid obstruction. In both situations the intrarectal bypass graft provided for a safe anastomosis. Even when dehiscence and early obstructions occur, the tube may prevent leakage. This procedure presents effective practical implications which obviate the need for a proximal colostomy formation, thereby eliminating the physical and psychological stress that accompanies colostomies.

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Mortality of the surgical treatment of diverticulitis

Cited by 44 publications

References 6 publications

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

Systemic Inflammatory Response during Laparotomy

Intrarectal Bypass Graft in Low Anterior Resection and Sigmoid Obstruction – An Experimental Study

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Mortality of the surgical treatment of diverticulitis

Cited by 44 publications

References 6 publications

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

Systemic Inflammatory Response during Laparotomy

Intrarectal Bypass Graft in Low Anterior Resection and Sigmoid Obstruction &ndash; An Experimental Study

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Intrarectal Bypass Graft in Low Anterior Resection and Sigmoid Obstruction – An Experimental Study