The diminishing role of surgery for acute diverticulitis

Biondo, Sebastiano

doi:10.1002/bjs.11133

Cited by 17 publications

(18 citation statements)

References 13 publications

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“…If an emergency operation is required at the start or following the failure of conservative management, surgical options include a Hartmann's operation with the formation of a colostomy or a sigmoidectomy with anastomosis, with or without defunctioning ileostomy. 22 Second, in the subgroup that are suitable for trialing conservative management, it must be recognized that this approach is likely to be successful in approximately 85% of patients, as observed in our review. However, the clinical behavior of a patient with persistent perforation that can occur in up to 15% of patients who are conservatively managed needs to be recognized early to reduce the morbidity and mortality.…”

Section: Discussionmentioning

confidence: 85%

“…Therefore, every effort should be made to distinguish patients with acute perforated diverticulitis who have generalized peritonitis requiring an emergency operation and those who do not have generalized peritonitis, and may be managed conservatively. If an emergency operation is required at the start or following the failure of conservative management, surgical options include a Hartmann's operation with the formation of a colostomy or a sigmoidectomy with anastomosis, with or without defunctioning ileostomy . Second, in the subgroup that are suitable for trialing conservative management, it must be recognized that this approach is likely to be successful in approximately 85% of patients, as observed in our review.…”

Section: Discussionmentioning

confidence: 93%

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Conservative management of acute perforated diverticulitis: A systematic review

Chua

Jeyakumar

et al. 2020

J of Digest Diseases

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Objective Acute perforated diverticulitis is frequently observed and spans a spectrum in the severity of its presentation. Emergency surgery is required in patients with generalized peritonitis; however, a large proportion of patients are clinically stable with localized peritonitis. This article aimed to examine this specific group of patients by reviewing the outcomes of their conservative management. Methods A systematic literature search was performed on the MEDLINE and PubMed databases. The management outcomes of patients undergoing non‐operative treatment for acute perforated diverticulitis were synthesized and tabulated. Results Of 479 patients, 407 (85%) were successfully managed non‐operatively. In total 70 (14.6%) patients failed non‐operative treatment and underwent operative surgical management, and two (0.4%) died. Emergency surgery includes a Hartmann's operation (40%) and resection with anastomosis with or without stoma (24%), laparoscopic lavage (16%) and surgical drainage (20%). The success rate of conservative management was 94.0% and 71.4% for patients with pericolic and distant free air, respectively. Treatment failure was associated with a high volume of free air, distant free air and the presence of abscess. Conclusions Conservative management is safe and successful in patients with acute perforated diverticulitis without generalized peritonitis. The early recognition of patients who show clinical signs of persistent perforation is important to ensure the success of this strategy.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 93%

Conservative management of acute perforated diverticulitis: A systematic review

Chua

Jeyakumar

et al. 2020

J of Digest Diseases

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“…Recent epidemiological studies report a significantly increasing trend in overall hospital admissions for diverticulitis [1] and admissions for complicated diverticulitis [2], especially in younger patients, the most frequent (35%) complication being peritonitis. These data, together with the decreasing role of surgery in diverticular disease [3], underline the growing need to optimize the surgical strategy to improve the outcomes and avoid permanent stomas, especially in diffuse peritonitis which is the main indication for surgery.…”

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confidence: 99%

Management of acute perforated diverticulitis with generalized peritonitis: is this the end of the Hartmann’s era?

Binda¹

2020

Tech Coloproctol

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“…In response to Sebastiano Biondo's leader on the diminishing role of surgery for acute diverticulitis, @Beccajfish asked how surgeons on Twitter approached cases of widespread purulent peritonitis with multiple interloop abscesses, reopening an old discussion and receiving many interesting responses.…”

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confidence: 99%

This month on Twitter

Grossman

2019

British Journal of Surgery

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In March, @bjsurgery generated 220 900 impressions, 522 retweets and 643 likes.One of the most popular papers this month was by Kirkegård et al. who studied multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation 1 . Catherine Teh (@hpbsurgeon1) opined that the core members 'make or break' an MDT. @ewanharrison made the point that a lot of the variation arises from uncertainty about best practice in pancreatic cancer.In response to Sebastiano Biondo's leader on the diminishing role of surgery for acute diverticulitis 2 , @Beccajfish asked how surgeons on Twitter approached cases of widespread purulent peritonitis with multiple interloop abscesses, reopening an old discussion and receiving many interesting responses. @haileybanack wrote a thought-provoking tweet about unkind comments from reviewers. This sparked a debate about the roles of reviewers and editors. BJS Council member @ProfDemartines stated that 'the way you say no is important' and while he encouraged constructive criticism, he stated that unkind, anonymous reviewers were 'a disaster, a shame and cowards'. @JohnRTMonsonMD and @SJ_Chapman felt that this was 'pretty harsh', as reviews are 'time-consuming and hard work', but also a 'privilege and a learning experience'. BJS Editor @des_winter stated that editors filter out rude comments and asked if more should be done. Chair of BJS Council, Prof James Garden (@ProfG_Edinsurg) confirmed that editors should modify reviewer comments to ensure they are more constructive. @cchildersmd posted a Twitter poll which showed that 62 per cent of the 26 respondents favoured video-based documentation of items and techniques used in the operating theatre versus 31 per cent favouring the operative report. This prompted a thought-provoking thread by Dan Hashimoto (@Laparoscopes) about the benefits of video recordings in the era of technological advancements and cheap data storage, citing Wauben et al.'s BJS paper from 2011 on the accuracy of operating notes in laparoscopic cholecystectomy 3 .BJS held the popular How To Write A Clinical Paper workshop at the ASiT annual conference in Belfast. It was standing room only and many delegates tweeted kind feedback after the course. Gerardo Perrotta (@dr_perrotta) was the winner of the competition to design a visual abstract for a BJS RCT on skin closure 4 . References1 Kirkegård J, Aahlin EK, Al-Saiddi M, Bratlie SO, Coolsen M, de Haas RJ et al. Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. Br J Surg 2019; 106: 756-764. 2 Biondo S. The diminishing role of surgery for acute diverticulitis. Br J Surg 2019; 106: 308-309. 3 Wauben LSGL, van Grevenstein WMU, Goossens RHM, van der Meulen FH, Lange JF. Operative notes do not reflect reality in laparoscopic cholecystectomy. Br J Surg 2011; 98: 1431-1436. 4 Kobayashi S, Ito M, Yamamoto S, Kinugasa Y, Kotake M, Saida Y et al. Randomized clinical trial of skin closure by subcuticular suture or skin stapling after elective colorect...

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The diminishing role of surgery for acute diverticulitis

Abstract: Tailored treatment

Cited by 17 publications

References 13 publications

Conservative management of acute perforated diverticulitis: A systematic review

Conservative management of acute perforated diverticulitis: A systematic review

Management of acute perforated diverticulitis with generalized peritonitis: is this the end of the Hartmann’s era?

This month on Twitter

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