Operative Treatment of Acute Complications of Diverticular Disease: Primary or Secondary Anastomosis after Sigmoid Resection

Gooszen, A. W.; Gooszen, Hein G.; Veerman, W.; Dongen, van; Hermans, J.; Kranenbarg, E. Klein; Tollenaar, Rob A.E.M.

doi:10.1080/110241501750069792

Cited by 76 publications

(10 citation statements)

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“…Long-standing recommendations from ASCRS based on data from the 1960s were that elective resection be considered after the second episode of diverticulitis 18-20 and in patients under 50 years of age, after the first episode. 18,20,21 Studies in the last decade challenged this thinking citing a 5-11% risk of recurrence after resection 7,12 and demonstrating a similar, small rate of recurrent hospitalized events (4-13%) for those who do not have elective resection. 10 Elective resection also carries the risk (1-3%) of “rescue colostomy” 11, 22 for anastomotic failure.…”

Section: Discussionmentioning

confidence: 99%

“…This theory was popularized by advocates for early resection in younger patients (described as age < 50 years) 9,21,28 due to the belief that younger people were more likely to have severe recurrences requiring emergency surgery. 10, 18, 29, 30 However, recent studies offer conflicting evidence about whether diverticulitis in the young is a more virulent entity, 30-33 and the newest ASCRS guidelines do not recommend resection in younger patients either.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Elective Colon Resection on Rates of Emergency Surgery for Diverticulitis

et al. 2016

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Objective To determine the impact of elective colectomy on emergency diverticulitis surgery at the population level. Summary Background Data Current recommendations suggest avoiding elective colon resection for uncomplicated diverticulitis because of uncertain effectiveness at reducing recurrence and emergency surgery. The influence of these recommendations on use of elective colectomy or rates of emergency surgery remains undetermined. Methods A retrospective cohort study using a statewide hospital discharge database identified all patients admitted for diverticulitis in Washington State (1987–2012). Sex and age-adjusted rates (standardized to the 2000 state census) of admissions, elective and emergency/urgent surgical and percutaneous interventions for diverticulitis were calculated and temporal changes assessed. Results 84,313 patients (mean age 63.3 years and 58.9% female) were hospitalized for diverticulitis (72.2% emergent/urgent). Elective colectomy increased from 7.9 to 17.2/100,000 people (p<0.001), rising fastest since 2000. Emergency/urgent colectomy increased from 7.1 to 10.2 per 100,000 (p<0.001), non-elective percutaneous interventions increased from 0.1 to 3.7 per 100,000 (p=0.04) and the frequency of emergency/urgent admissions (with or without a resection) increased from 34.0 to 85.0 per 100,000 (p<0.001). In 2012, 47.5% of elective resections were performed laparoscopically compared to 17.5% in 2008 (when the code was introduced). Conclusions The elective colectomy rate for diverticulitis more than doubled, without a decrease in emergency surgery, percutaneous interventions or admissions for diverticulitis. This may reflect changes in thresholds for elective surgery and/or an increase in the frequency or severity of the disease. These trends do not support the practice of elective colectomy to prevent emergency surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Elective Colon Resection on Rates of Emergency Surgery for Diverticulitis

et al. 2016

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“…Fatal complications of diverticular disease are rare and occur in less than 1 in 10,000 cases of colonic diverticulosis [104]. In case of complicated diverticular disease, surgical mortality can even be 20% [105]. Fatal complications after surgical intervention for GCD is probably much higher because of selection of patients (most data in this review come from case reports).…”

Section: Therapymentioning

confidence: 99%

Giant Colonic Diverticula

Steenvoorde

Vogelaar²,

Oskam³

et al. 2004

Dig Surg

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Background: A rare complication of diverticulosis of the colon is giant colonic diverticula (GCD). The condition was first described in English literature in 1953 [1, 2]. Methods: A Medline search was undertaken for English, French and German language articles on ’giant colonic diverticula’. Results: A total of 135 patients were identified, presenting with a total of 155 GCD [1–98]. With a complication rate of 28% and an operative mortality of 5%, GCD seems to have a high clinical significance. Radiological examination of choice seems to be plain abdominal X-ray and CT examination, barium enema carries the risk of perforation of the diverticulum, and should not be performed. Conclusions: There are different therapeutic options, in our opinion diverticulectomy alone is not the treatment of choice. Because of the possibility of recurrence and oncological reasons, colectomy seems to be the best treatment. The creation of a protecting colostomy depends on other operative findings.

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“…However, in the modern literature a trend can be observed towards more definitive surgery. Resection and primary anastomosis has been claimed to be feasible even if complicated [7, 8, 9]. Thirty to 20 years ago, primary resection was dissuaded under such circumstances.…”

Section: Risk Factors For Septic Complicationsmentioning

confidence: 99%

Colorectal Surgery and Anastomotic Leakage

et al. 2002

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Operative Treatment of Acute Complications of Diverticular Disease: Primary or Secondary Anastomosis after Sigmoid Resection

Abstract: Both regimens are accepted treatments for patients with acute complicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.

Cited by 76 publications

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The Impact of Elective Colon Resection on Rates of Emergency Surgery for Diverticulitis

The Impact of Elective Colon Resection on Rates of Emergency Surgery for Diverticulitis

Giant Colonic Diverticula

Colorectal Surgery and Anastomotic Leakage

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