Practice parameters for the treatment of sigmoid diverticulitis—Supporting documentation

Wong, Douglas; Wexner, Steven D.; Lowry, Ann C.; Vernava, Anthony M.; Burnstein, Marcus J.; Denstman, Frederick; Fazio, Victor W.; Kerner, Bruce; Moore, Richard A.; Oliver, Gregory C.; Peters, Walter R.; Ross, Theodore M.; Senatore, Peter; Simmang, Clifford L.

doi:10.1007/bf02258291

Cited by 391 publications

(215 citation statements)

References 60 publications

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“…This number seems low compared with the 90% reversal after Hartmann's procedure presented by Oomen et al [13]. Other series present reversal rates of 31-85% [14,15]. The primary difference is that the eight Hartmann's procedures in this study all followed anastomotic leakages and not a primary peritonitis in the case of Hinchey stages 3 and 4 diverticulitis.…”

Section: Discussioncontrasting

confidence: 54%

Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial

et al. 2010

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Background The short-term results of the Sigma trial show that laparoscopic sigmoid resection (LSR) used electively for diverticular disease offers advantages over open sigmoid resection (OSR). This study aimed to compare the overall mortality and morbidity rates after evaluation of the clinical outcomes at the 6-month follow-up evaluation. Methods In a prospective, multicenter, double-blind, parallel-arm, randomized control trial, eligible patients were randomized to either LSR or OSR. The short-term results and methodologic details have been published previously. Follow-up evaluation was performed at the outpatient clinic 6 weeks and 6 months after surgery. Results In this trial, 104 patients were randomized for either LSR or OSR, and the conversion rate was 19.2%. The LSR approach was associated with short-term benefits such as a 15.4% reduction in the major complications rate, less pain, and a shorter hospital stay at the cost of a longer operating time. At the 6-month follow-up evaluation, no significant differences in morbidity or mortality rates were found. Two patients died of cardiac causes (overall mortality, 3%). Late complications (7 LSR vs. 12 OSR; p = 0.205) consisted of three incisional hernias, five small bowel obstructions, four enterocutaneous fistulas, one intraabdominal abscess, one retained gauze, two anastomotic strictures, and three recurrent episodes of diverticulitis. Nine of these patients underwent additional surgical interventions. Consideration of the major morbidity over the total follow-up period (0-6 months) shows that the LSR patients experienced significantly fewer complications than the OSR patients (9 LSR vs. 23 OSR; p = 0.003). The Short Form-36 (SF-36) questionnaire showed significantly better quality of life for LSR at the 6-week follow-up assessment. However, at the 6-month follow-up assessment, these differences were decreased. Conclusions The late clinical outcomes did not differ between LSR and OSR during the 30-day to 6-month followup period. Consideration of total postoperative morbidity shows a 27% reduction in major morbidity for patients undergoing laparoscopic surgery for diverticular disease.Keywords Diverticular disease Á Diverticulitis Á Sigmoid resection Á Laparoscopic Laparoscopic surgery for the treatment of diverticular disease has gained popularity over the past two decades. Particularly in an elective setting, laparoscopic sigmoid resections (LSRs) have shown beneficial effects on postoperative outcomes [1,2]. Traditionally, elective open sigmoid resections (OSRs) have been associated with high postoperative complication rates and a mortality rate of

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Section: Discussioncontrasting

confidence: 54%

Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial

et al. 2010

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“…In contrast, practice parameters for the treatment of left colonic diverticulitis do exist [17] . Conservative treatment is recommended for uncomplicated left colonic diverticulitis because it results in resolution of the problem in 70% to 100% of patients [22][23][24][25][26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

“…Patients were categorized into the six stages according to CT, US, or operative findings. Complicated diverticulitis is defined as diverticulitis associated with abscess, fistula, obstruction, or free perforation [17] . Therefore, uncomplicated diverticulitis included stage 0 and Ⅰa, whereas complicated diverticulitis included stage Ⅰb, Ⅱ Ⅲ, and Ⅳ.…”

Section: Patientsmentioning

confidence: 99%

Image-guided conservative management of right colonicdiverticulitis

Park¹,

Choi²,

Lee³

et al. 2009

WJG

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AIM:To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS:The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS:Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ⅰ a, 23 patients (12.2%) in stage Ⅰb, and 1 patient (0.5%) in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ⅰb required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medical therapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION:Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

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“…Only a minority will have complications. The most common complication is acute diverticulitis which occurs in 10%-25% of patients [2][3][4][5][6] . In most patients, the disease is mild, responds well to antibiotic therapy and does not recur [7] .…”

Section: Introductionmentioning

confidence: 99%