WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting

Sartelli, Massimo; Catena, Fausto; Ansaloni, Luca; Catena, Fausto; Griffiths, Ewen A.; Abu‐Zidan, Fikri M.; Saverio, Salomone Di; Ulrych, Jan; Kluger, Yoram; Ben-Ishay, Ofir; Moore, Frederick A.; Ivatury, Rao R.; Coimbra, Raúl; Peitzman, Andrew B.; Leppäniemi, Ari; Fraga, Gustavo Pereira; Maier, Ronald V.; Chiara, Osvaldo; Kashuk, Jeffry L.; Sakakushev, Boris; Weber, Dieter; Latifi, Rifat; Biffl, Walter L.; Bala, Miklosh; Karamarković, Aleksandar; Inaba, Kenji; Ordóñez, Carlos A.; Hecker, Andreas; Augustin, Goran; Demetrashvili, Zaza; Melo, Renato Bessa; Marwah, Sanjay; Zachariah, Sanoop Koshy; Shelat, Vishal G; McFarlane, Michael; Rems, Miran; Gomes, Carlos Augusto; Faro, Mário Paulo; Júnior, Gerson Alves Pereira; Negoi, Ionuț; Y, Cui; Sato, Norio; Vereczkei, András; Bellanova, Giovanni; Birindelli, Arianna; Carlo, Isidoro Di; Kok, Kenneth Y.Y.; Gachabayov, Mahir; Gkiokas, Georgios; Bouliaris, Konstantinos; Çolak, Elif; Işık, Arda; Ríos-Cruz, Daniel; Soto, Rodolfo; Moore, Ernest E.

doi:10.1186/s13017-016-0095-0

Cited by 170 publications

(198 citation statements)

References 92 publications

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“…As suggested by the last guidelines on acute left-sided diverticulitis [3], the best treatment option still remains sigmoid resection until new available evidences will help in better clarifying the role of laparoscopic lavage.…”

Section: Dear Editormentioning

confidence: 99%

Laparoscopic lavage in perforated purulent diverticulitis—is it time for definitive conclusions?

Ceresoli

Catena

Montori

et al. 2016

Int J Colorectal Dis

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Dear Editor:We read with great interest the recent meta-analysis published about laparoscopic lavage in perforated purulent diverticulitis by Angenete and colleagues [1]. A minimally invasive approach to acute diverticulitis is an issue of great interest with an animated debate among surgeons; randomized trials were conducted to clarify the real benefit of lavage in purulent peritonitis from diverticulitis. The authors of the metaanalysis demonstrated that laparoscopic lavage was associated with a reduced rate of reoperations within 12 months with comparable morbidity and mortality.We would like to comment on these results at the light of another meta-analysis simultaneously published by our group in the World Journal of Emergency Surgery [2]. Our results were unanimous in defining no difference in morbidity and mortality at 3 and 12 months between laparoscopic lavage and sigmoid resection and also showed an augmented rate of reoperations in the resection group, due above all to stoma closures. However laparoscopic lavage was associated with a significantly higher incidence rate of intra-abdominal abscesses and higher reoperation rate during the index admission.As highlighted by both meta-analysis' results, these conclusions should be interpreted cautiously: at the moment, only three randomized trials are available but with contrasting results and different study's designs. The major part of pooled results of these meta-analysis were based only on the result of two out of three studies with a relatively small number of patients included [2]. Moreover, another randomized trial is still ongoing, the LapLAND trial (NCT01019239).At the light of all these considerations, we would like to suggest great caution in interpreting results of the metaanalysis by Angenete and colleagues [1]: laparoscopic lavage could not even be considered a valid alternative treatment to sigmoid resection for purulent perforated diverticulitis. As suggested by the last guidelines on acute left-sided diverticulitis [3], the best treatment option still remains sigmoid resection until new available evidences will help in better clarifying the role of laparoscopic lavage.

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Section: Dear Editormentioning

confidence: 99%

Laparoscopic lavage in perforated purulent diverticulitis—is it time for definitive conclusions?

Ceresoli

Catena

Montori

et al. 2016

Int J Colorectal Dis

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“…No clear consensus exists on follow-up after the nonoperative treatment of diverticular abscesses, although the WSES guideline advises early colonoscopic evaluation (4–6 weeks) [28]. More importantly, the role and necessity of elective surgery is still debated.…”

Section: Introductionmentioning

confidence: 99%

“…At present, no definite consensus has been reached on the optimal approach for this patient group, due to the lack of high-quality research [1]. Definitions of a large abscess vary from 2 to 5 cm throughout the literature, but the cutoff value of > 4–5 cm is generally used in publications and guidelines [1, 5, 28, 32]. However, as supported by several international guidelines, small mesocolic abscesses can be treated with antibiotics alone, whereas larger mesocolic or pelvic abscesses require PCD [5].…”

Section: Introductionmentioning

confidence: 99%

“…Sallinen et al [27] reported a 62% success rate in patients with distant intraperitoneal air, although this rate increased to 86% when patients with abundant distant intraperitoneal air or fluid in the recto-vesical or recto-uterine pouch were excluded. In the World Society of Emergency Surgery (WSES) guidelines [28] it is stated that patients with CT findings of pericolic air or small fluid collection should be managed by antimicrobial therapy. Furthermore, it is articulated that nonoperative treatment might be an option in selected patients with distant air, but without diffuse fluid on CT.…”

Section: Introductionmentioning

confidence: 99%

“…The timing of catheter removal can be based on clinical and imaging criteria [35]. If resolution of the abscess is not reached and the patient has no clinical improvement, repeated CT and further drainage or catheter repositioning might be indicated, and eventually necessitate surgery [28, 35, 41]. Laparoscopic drainage has a limited role in the treatment of diverticular abscesses, but may be considered in case of a large abscess that is not amenable for PCD [42].…”

Section: Introductionmentioning

confidence: 99%

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The Multidisciplinary Management of Acute Complicated Diverticulitis

et al. 2018

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Background: Acute complicated diverticulitis (ACD) is an important and increasing issue in Western countries that leads to a significant impact and burden for patients, but also for the society due to its effects on hospital costs. In recent years, essential progression has been made regarding the research and implementation of novel or improved treatment strategies for the various disease entities of ACD. Much debated topics in the multidisciplinary approach of patients with ACD, such as the choice for nonoperative treatment options, the role of percutaneous drainage for diverticular abscesses, the role of laparoscopic lavage for perforated diverticulitis with purulent peritonitis, and the role of sigmoidectomy with primary anastomosis for patients with perforated diverticulitis, require clinicians to attentively follow and participate in these discussions. Summary: The aim of this review article is to provide clinicians with a structured overview of the recent literature on the multidisciplinary management of complicated diverticulitis by a panel of experts on the topic. By performing an extensive literature search in the online medical databases MEDLINE (Ovid) and Embase, insights into nonoperative treatment, percutaneous drainage, minimally invasive and open surgical treatment of ACD are provided. Furthermore, a comprehensive algorithm for the treatment of ACD has been developed. Key Messages: Accurate patient evaluation and selection based on patient and disease characteristics is of paramount importance to determine the appropriate treatment strategy for patients with complicated diverticulitis. The presence of an experienced surgeon with advanced skills in laparoscopic emergency colorectal surgery is crucial for the treatment of patients with perforated diverticulitis in order to properly evaluate, select and treat patients suitable for nonoperative or operative treatment with an open or laparoscopic approach.

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Comparing Laparoscopic Elective Sigmoid Resection With Conservative Treatment in Improving Quality of Life of Patients With Diverticulitis

et al. 2021

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IMPORTANCE Diverticulitis has a tendency to recur and affect quality of life.OBJECTIVE To assess whether sigmoid resection is superior to conservative treatment in improving quality of life of patients with recurrent, complicated, or persistent painful diverticulitis. DESIGN, SETTING, AND PARTICIPANTSThis open-label randomized clinical trial assessed for eligibility 128 patients with recurrent, complicated, or persistent painful diverticulitis in 6 Finnish hospitals from September 29, 2014, to October 10, 2018. Exclusion criteria included age younger than 18 years or older than 75 years; lack of (virtual) colonoscopy or sigmoidoscopy data within 2 years, or presence of cancer, contraindication to laparoscopy, or fistula. Outcomes were assessed using intention-to-treat analysis. A prespecified interim analysis was undertaken when 66 patients had been randomized and their 6-month follow-up was assessable. Data were analyzed from June 2018 to May 2020. INTERVENTIONS Laparoscopic sigmoid resection or conservative treatment.MAIN OUTCOMES AND MEASURES The primary outcome was difference in Gastrointestinal Quality of Life Index (GIQLI) score between randomization and 6 months. RESULTSOf 128 patients assessed for eligibility, 90 were randomized (28 male [31%]; mean [SD] age, 54.11 [11.9] years; 62 female [69%]; mean [SD] age, 57.13 [7.6] years). A total of 72 patients were included in analyses for the primary outcome (37 in the surgery group and 35 in the conservative treatment group), and 85 were included in analyses for clinical outcomes (41 in the surgery group and 44 in the conservative treatment group). The difference between GIQLI score at randomization and 6 months was a mean of 11.96 points higher in the surgery group than in the conservative treatment group (mean [SD] of 11.76 [15.89] points vs −0.2 [19.07] points; difference, 11.96; 95% CI, 3.72-20.19; P = .005). Four patients (10%) in the surgery group and no patients in the conservative treatment group experienced major complications (Clavien-Dindo grade III or higher). There were 2 patients (5%) in the surgery group and 12 patients (31%) in the conservative treatment group who had new episodes of diverticulitis within 6 months. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, elective laparoscopic sigmoid resection improved quality of life in patients with recurrent, complicated, or persistent painful diverticulitis but carried a 10% risk of major complications.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02174926.

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WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting

Cited by 170 publications

References 92 publications

Laparoscopic lavage in perforated purulent diverticulitis—is it time for definitive conclusions?

Laparoscopic lavage in perforated purulent diverticulitis—is it time for definitive conclusions?

The Multidisciplinary Management of Acute Complicated Diverticulitis

Comparing Laparoscopic Elective Sigmoid Resection With Conservative Treatment in Improving Quality of Life of Patients With Diverticulitis

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