Same Hospitalization Resection for Acute Diverticulitis

Wasvary, Harry; Turfah, Fuad; Kadro, Omar; Beauregard, W.

doi:10.1177/000313489906500706

Cited by 227 publications

(43 citation statements)

References 6 publications

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“…Only one study assessed all stages of an acute and chronic complicated as well as non-complicated sigmoid diverticular disease [ 36 ]. Across the included studies four different classification systems of sigmoid diverticular disease (Hinchey, modified Hinchey, Hansen and Stock, and CDD) were applied [ 8 , 37 – 39 ]. Two studies did not mention the underlying classification system [ 26 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

Vaghiri

Prassas

Knoefel

et al. 2022

Langenbecks Arch Surg

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Purpose The aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease. Methods A comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated. Results Eleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427–4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020–0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202–1.0233, p = 0.0131) were significant in favor of the delayed elective approach. Conclusions Delayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.

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Section: Resultsmentioning

confidence: 99%

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

Vaghiri

Prassas

Knoefel

et al. 2022

Langenbecks Arch Surg

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“…30 Regarding the classification of acute diverticulitis, in 1978, Hinchey et al 31 proposed classifying perforated diverticulitis from stages I (pericolic abscess) to IV (generalized fecal peritonitis) (►Table 2). Since then, with the introduction of CT to daily clinical practice, Wasvary et al, 32 in 1999, modified the original classification by adding non-complicated diverticulitis as stage 0, and subdivided stage I into two: stage Ia, with phlegmon or pericolic inflammation, and stage Ib, with pericolic or mesocolic abscess (►Table 3).…”

Section: Discussionmentioning

confidence: 99%

Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Sobrado

Caldas

Facanali

et al. 2022

Journal of Coloproctology

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Introduction Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy. Objective To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment. Methods A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed. Results In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period. Conclusion Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease.

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“…Radiologists with at least 5 years of experience evaluated the CTs. The modified Hinchey classification (Wasvary [ 16 ] ) was used for the Hinchey classification in CT.…”

Section: Methodsmentioning

confidence: 99%

“…However, with the widespread use of computerized tomography (CT), which is preferred as the most sensitive tool in diagnosis, the modified Hinchey classification, which includes radiologic findings, is more commonly used ( Table 1 ). [ 14 - 16 ]…”

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confidence: 99%

Management of Acute Uncomplicated Diverticulitis: Inpatient or Outpatient

et al. 2022

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Objectives: Diverticular disease is a highly frequent condition and affects 50% of the population in the 9th decade in Western society. Acute diverticulitis is the most prevalent complication. The patients who are clinically stable and tolerate fluid should be hospitalized if fluid intake tolerance worsens, fever occurs, or pain increases. Bowel rest, intravenous fluid therapy, and empiric antibiotic therapy are the traditional treatments for patients admitted to the hospital. This retrospective study aimed to determine the parameters that will affect the outpatient or inpatient treatment of patients diagnosed with uncomplicated acute diverticulitis. Methods: Patients who presented to the emergency department with abdominal pain between January 2018 and December 2020 and were diagnosed with uncomplicated diverticulitis (modified Hinchey 1a) on computed tomography (CT) taken after intravenous contrast material shoot up were included in the study. Patient records were recorded retrospectively in the Excel file. After being seen in the emergency department, a comparison was performed between the inpatient group (Group 1) and the outpatient follow-up group (Group 2). Results: The study comprised 172 patients with acute uncomplicated diverticulitis (modified Hinchey 1a). While 110 (64.0%) patients were followed up and treated as inpatients (Group 1), 62 (36.0%) patients were followed up as outpatients (Group 2). There was no statistically significant difference between the two groups in terms of patients readmitted to the hospital in the first 30 days after discharge (both for outpatient follow-up in the emergency department and after treatment in the inpatient group). Conclusion: In this retrospective study, in which we evaluated the hospitalization criteria in uncomplicated Modified Hinchey 1a patients, it was found that patients can be safely treated as an outpatient if they have poor physical examination findings. Although there was no difference between the two groups in terms of hospital readmission after discharge and it was thought that follow-up of patients with Modified Hinchey 1a diverticulitis with outpatient oral antibiotic therapy might be reliable, prospective studies with larger numbers of patients are needed.

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Same Hospitalization Resection for Acute Diverticulitis

Cited by 227 publications

References 6 publications

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?

Management of Acute Uncomplicated Diverticulitis: Inpatient or Outpatient

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