Randomized clinical trial of elective resection <i>versus</i> observation in diverticulitis with extraluminal air or abscess initially managed conservatively

You, Jeehyun Karen; Bendl, Ryan; Taut, C; Sullivan, Ryan J.; Gachabayov, Mahir; Bergamaschi, Roberto; Connolly, Timothy M.; Yang, Kun‐Lin; Giuratrabocchetta, Simona; Denoya, Paula; Zawin, Marlene; Ferretti, John; Baer, Alan N.; Wertheim, W A

doi:10.1002/bjs.10868

Cited by 52 publications

(42 citation statements)

References 35 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Elective colectomy had a higher cost, longer diverticulitis‐related inpatient stay, and greater risk of stoma. Similar results have been observed in other studies of extraluminal gas or abscess initially managed conservatively or with a drain.…”

supporting

confidence: 90%

The diminishing role of surgery for acute diverticulitis

Biondo

2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

supporting

confidence: 90%

The diminishing role of surgery for acute diverticulitis

Biondo

2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Such recurrence rates are in line with the current literature including retrospective data [2] as well as a recent randomized trial [3]. However, we are concerned that the breakdown of recurrence rates by drainage (23.6%) or antibiotics (15.5%) emphasized in the Abstract may be misleading to naïve readers.…”

supporting

confidence: 77%

The coroner does not know!

Lee

Gachabayov

Bergamaschi

2018

Int J Colorectal Dis

Self Cite

View full text Add to dashboard Cite

Dear Editor:We read with interest the study entitled BLong-term mortality and recurrence in patients treated for colonic diverticulitis with abscess formation: a nationwide register-based cohort study^by Gregersen et al. and would like to congratulate the authors [1].Higher recurrence rates were reported in patients following nonoperative management as compared to patients having undergone surgery. Such recurrence rates are in line with the current literature including retrospective data [2] as well as a recent randomized trial [3]. However, we are concerned that the breakdown of recurrence rates by drainage (23.6%) or antibiotics (15.5%) emphasized in the Abstract may be misleading to naïve readers. In fact, the authors did acknowledge at the end of the Discussion that abscess size and location were not known. Moreover, we hope that patients undergoing drainage have received antibiotics. Similarly, highlighting in the Abstract the breakdown of mortality rates by type of treatment for recurrence seems to insinuate a causality. On the other hand, the authors stated that Bthe cause of death was not extracted, and it was therefore not certain whether deaths were correlated wholly or partly to diverticulitis or other unrelated causes.^Furthermore, death rates related to drainage (2%) or antibiotics (1.1%) seem to be taken out of context and can be misleading as the reader is not provided with key details. It is also questionable whether the patients in the operative group were correctly identified as surgery is not the standard of care for diverticulitis complicated by abscess [4]. Many of the study's limitations stem from the inherent flaws of administrative databases with data collection carried out by clerical employees of a government. Compulsory databases are created for quality assurance purposes and lack details necessary for clinical research. Moreover, a large sample size may lead to statistical significance from small variations within the data that may confer no clinical significance [5]. These problems were not adequately addressed by the authors.In conclusion, although we are impressed with the exhaustive work that lies behind such a large database, we believe that attributing mortality to a disease may be misleading when the cause of death is unknown. Compliance with ethical standardsConflict of interest None.Previously copyrighted material None.Presentations None.

show abstract

“…The role of percutaneous drainage for diverticulitis with abscess formation has been debated 36,37 . Subsequently, follow-up without elective colectomy after non-operative treatment of an initial episode of diverticulitis with abscess formation or local extraluminal air seems justified 38,39 . Moreover, evidence shows that HP for perforated diverticulitis should be avoided if possible and that PA is preferred [9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Lambrichts

Bemelman²,

Lange

2020

British Journal of Surgery

View full text Add to dashboard Cite

Background: Several studies have been published favouring sigmoidectomy with primary anastomosis over Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis (Hinchey grade III or IV), but cost-related outcomes were rarely reported. The present study aimed to evaluate costs and cost-effectiveness within the DIVA arm of the Ladies trial. Methods: This was a cost-effectiveness analysis of the DIVA arm of the multicentre randomized Ladies trial, comparing primary anastomosis over Hartmann's procedure for Hinchey grade III or IV diverticulitis. During 12-month follow-up, data on resource use, indirect costs (Short Form Health and Labour Questionnaire) and quality of life (EuroQol Five Dimensions) were collected prospectively, and analysed according to the modified intention-to-treat principle. Main outcomes were incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, expressed as the ratio of incremental costs and the incremental probability of being stoma-free or incremental quality-adjusted life-years respectively. Results: Overall, 130 patients were included, of whom 64 were allocated to primary anastomosis (46 and 18 with Hinchey III and IV disease respectively) and 66 to Hartmann's procedure (46 and 20 respectively). Overall mean costs per patient were lower for primary anastomosis (€20 544, 95 per cent c.i. 19 569 to 21 519) than Hartmann's procedure (€28 670, 26 636 to 30 704), with a mean difference of €-8126 (-14 660 to-1592). The ICER was €-39 094 (95 per cent bias-corrected and accelerated (BCa) c.i.-1213 to-116), indicating primary anastomosis to be more cost-effective. The ICUR was €-101 435 (BCa c.i.-1 113 264 to 251 840). Conclusion: Primary anastomosis is more cost-effective than Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis.

show abstract

Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively

Abstract: The majority of patients observed following conservative management of diverticulitis with local extraluminal air do not require elective surgery. Registration number: NCT01986686 (http://www.clinicaltrials.gov).

Cited by 52 publications

References 35 publications

The diminishing role of surgery for acute diverticulitis

The diminishing role of surgery for acute diverticulitis

The coroner does not know!

Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial

Contact Info

Product

Resources

About