Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

Abstract

Background The optimal timing of elective surgery in diverticulitis remains unclear. We attempted to investigate early elective versus late elective laparoscopic surgery in acute recurrent diverticulitis in a retrospective study. Method Data of patients undergoing elective laparoscopic surgery for diverticulitis were retrospectively gathered, including Hinchey stages I-II a/b. The primary endpoint was in-hospital complications according to the ClavienDindo classification. Secondary endpoints were surgical complications, operative time, conversion rate, and length of hospital stay. Results Of 237 patients, 81 (34%) underwent early elective operation (group A) and 156 (66%) underwent late elective operation (group B). In-hospital complications developed in 32% in group A and in 34% in group B (risk difference 2%, 95% Confidence Interval (95% CI): -11%, 14%). Higher age (p = 0.048) and borderline higher American Society of Anesthesiologists score (p = 0.056) were risk factors for in-hospital complications. Severe surgical complications occurred in 9% of patients in group A and 10% in group B (risk difference 2%, 95% CI: -6%, 9%). Conversion rate was 9% in group A and 3% in group B (p = 0.070). Severity of disease did not seem to have an impact on complications or length of hospital stay. The median postoperative hospital stay was 8 days in both groups (interquartile range 6-10). Mean operative time was 220 min (SD 64) in group A and 202 min (SD 48) in group B. Conclusions This is the first study comparing early versus late elective surgery for diverticulitis in terms of the postoperative outcome using a validated classification. Although the retrospective setting and large confidence intervals don't allow definitive recommendations, these results are of utmost importance for the design of future prospective, randomized controlled trials.

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

“…Early elective surgery was initially considered to be at lower risk [145]. However, Natarjan [146] and Hoffman [147] found no outcome difference in their retrospective case control studies. A prospective comparison of early and late laparoscopic resection showed a significantly higher rate of anastomotic leak, abdominal abscess, hospital stay and conversion rate during early elective surgery [148].…”

Impact of tutorial assistance in laparoscopic sigmoidectomy for acute recurrent diverticulitis

“…The data from 237 patients who underwent laparoscopic colonic resection for acute recurrent diverticulitis were retrospectively gathered from January 1, 2005 to December 31, 2009. This study is a secondary analysis of a recently published analysis comparing early versus late surgery in patients with acute recurrent diverticulitis [24] and was approved by the local ethics committee as required for retrospective studies (EKBB, Ref-no. 101/10).…”

“…All patients initially received antibiotic treatment with either amoxicillin/clavulanic acid, tazobactam/piperacillin or ciprofloxacin/metronidazole. Depending on the patients' condition and the results of the clinical examination, the patients where surgically treated via early elective versus late surgery, as reported previously [24].…”

Changes in the Surgical Approach to Colonic Emergencies during a 15-Year Period

“…Although considerable progress has been made with regard to surgical techniques and in pre- and postoperative patient care, morbidity and mortality rates for emergency colon surgery continue to range between 11-35% and 9-22%, respectively [14,15,16,17,18,19,20,21,22,23,24]. …”