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Presl J, Ehgartner M, Schabl L, Singhartinger F, Gantschnigg A, Wallner E, Jäger T, Emmanuel K, Kessler H, Koch OO. Robotic surgery versus conventional laparoscopy in sigmoid colectomy for diverticular disease-a comparison of operative trauma and cost-effectiveness: retrospective, single-center analysis. Langenbecks Arch Surg 2024; 409:200. [PMID: 38935194 PMCID: PMC11211106 DOI: 10.1007/s00423-024-03382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Robotic assisted surgery is an alternative, fast evolving technique for performing colorectal surgery. The primary aim of this single center analysis is to compare elective laparoscopic and robotic sigmoid colectomies for diverticular disease on the extent of operative trauma and the costs. METHODS Retrospective analysis from our prospective clinical database to identify all consecutive patients aged ≥ 18 years who underwent elective minimally invasive left sided colectomy for diverticular disease from January 2016 until December 2020 at our tertiary referral institution. RESULTS In total, 83 patients (31 female and 52 male) with sigmoid diverticulitis underwent elective minimally invasive sigmoid colectomy, of which 42 underwent conventional laparoscopic surgery (LS) and 41 robotic assisted surgery (RS). The mean C-reactive protein difference between the preoperative and postoperative value was significantly lower in the robotic assisted group (4,03 mg/dL) than in the laparoscopic group (7.32 mg/dL) (p = 0.030). Similarly, the robotic´s hemoglobin difference was significantly lower (p = 0.039). The first postoperative bowel movement in the LS group occurred after a mean of 2.19 days, later than after a mean of 1.63 days in the RS group (p = 0.011). An overview of overall charge revealed significantly lower total costs per operation and postoperative hospital stay for the robotic approach, 6058 € vs. 6142 € (p = 0,014) not including the acquisition and maintenance costs for both systems. CONCLUSION Robotic colon resection for diverticular disease is cost-effective and delivers reduced intraoperative trauma with significantly lower postoperative C-reactive protein and hemoglobin drift compared to conventional laparoscopy.
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Affiliation(s)
- Jaroslav Presl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria.
| | - M Ehgartner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - L Schabl
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - F Singhartinger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - A Gantschnigg
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - E Wallner
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - T Jäger
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - K Emmanuel
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
| | - H Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - O O Koch
- Department of Visceral and Thoracic Surgery, Paracelsus Medical University, Salzburg, Austria
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Podda M, Ceresoli M, Di Martino M, Ortenzi M, Pellino G, Pata F, Ielpo B, Murzi V, Balla A, Lepiane P, Tamini N, De Carlo G, Davolio A, Di Saverio S, Cardinali L, Botteri E, Vettoretto N, Gelera PP, De Simone B, Grasso A, Clementi M, Meloni D, Poillucci G, Favi F, Rizzo R, Montori G, Procida G, Recchia I, Agresta F, Virdis F, Cioffi SPB, Pellegrini M, Sartelli M, Coccolini F, Catena F, Pisanu A. Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study. Surg Endosc 2024; 38:3180-3194. [PMID: 38632117 PMCID: PMC11133057 DOI: 10.1007/s00464-024-10793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND This multicentre case-control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses. METHODS This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed. RESULTS Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23). CONCLUSIONS Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.
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Affiliation(s)
- Mauro Podda
- Emergency Surgery Unit, Department of Surgical Science, University of Cagliari, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Km 4,500, 09042, Monserrato, Italy.
| | - Marco Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Marcello Di Martino
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Benedetto Ielpo
- Hepatobiliary Surgery Unit, Hospital del Mar, Barcelona, Spain
| | - Valentina Murzi
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy
| | - Pasquale Lepiane
- General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy
| | - Nicolo' Tamini
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Giulia De Carlo
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Alessia Davolio
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Luca Cardinali
- Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Pier Paolo Gelera
- General Surgery Unit, ASST Spedali Civili, Montichiari, Brescia, Italy
| | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint-Germain-en-Laye Hospitals, Poissy, France
| | - Antonella Grasso
- General Surgery Unit, San Salvatore Hospital, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Clementi
- General Surgery Unit, San Salvatore Hospital, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Danilo Meloni
- General Surgery Unit, San Salvatore Hospital, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gaetano Poillucci
- Department of General, Minimally Invasive and Robotic Surgery, S. Matteo Degli Infermi Hospital, Spoleto, Perugia, Italy
| | - Francesco Favi
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Roberta Rizzo
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Giulia Montori
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Giuseppa Procida
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Irene Recchia
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Ferdinando Agresta
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Francesco Virdis
- Trauma and Acute Care Surgery Unit, "Niguarda Ca Granda" Hospital, Milan, Italy
| | | | - Martina Pellegrini
- Trauma and Acute Care Surgery Unit, "Niguarda Ca Granda" Hospital, Milan, Italy
| | | | - Federico Coccolini
- General, Emergency, and Trauma Surgery Unit, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Department of General Surgery, ULSS2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Adolfo Pisanu
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
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Schmidbauer M, Levers A, Wacker FK, Ringe KI. Classification of Diverticular Disease (CDD) - assessment of the intra- and interobserver agreement in abdominal CT scans. ROFO-FORTSCHR RONTG 2024; 196:591-599. [PMID: 38065539 DOI: 10.1055/a-2203-3144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
PURPOSE Along with ultrasound, computed tomography (CT) is one of the imaging modalities of choice in patients with suspected diverticular disease (DD). Recently, a newer Classification of Diverticular Disease (CDD) has been proposed. However, its reliability in daily radiological practice has never been proven. Therefore, our aim was to evaluate the intra- and interobserver agreement of the CDD in abdominal CT scans. METHODS In this retrospective study, 481 CT scans of patients with suspected DD were included. Two readers (one board-certified radiologist with 6 years of experience, one 3 rd year radiology resident) individually evaluated all CTs in two reading sessions using the CDD. A composite endpoint of a prior consensus reading, follow-up, and intraoperative findings served as the reference. Intra- and interobserver agreement were calculated using Cohen-k statistic. RESULTS DD was present in 317 cases (66 %), mostly classified as CDD stage 0, 1b, and 2a (28 %, 30 %, und 14 %). Intraobserver agreement was almost perfect for both readers (kappa 0.93 and 0.88). Interobserver agreement was high and improved from substantial (kappa 0.77) in the first reading session to almost perfect (kappa 0.84) in the second reading session. The interobserver agreement was best for CDD types 0 (diverticulosis) and 2c (free perforated diverticulitis) (mean kappa 0.83 and 0.86) and poorest for CDD types 1a (diverticulitis without phlegmon) and 2b (covered diverticulitis with macroabscess) (mean kappa 0.17 and 0.38). Intra- and interobserver agreement of acute uncomplicated (CDD type 1) and acute complicated diverticulitis (CDD type 2) were substantial to almost perfect (mean kappa 0.63-0.86). Agreement with the reference was almost perfect for both observers (mean kappa 0.86 and 0.82). Administration of rectal contrast did not significantly improve the diagnosis. CONCLUSION The CDD is a classification based on relatively clear imaging characteristics, which can be readily applied by radiologists with different expertise. In our study, the CDD had a high intra- and interobserver agreement, enabling a reliable therapy-related categorization of DD. KEY POINTS · The Classification of Diverticular Disease (CDD) is an easy-to-use classification for diverticular disease based on relatively clear image features.. · The CDD can be applied equally by radiologists with different levels of experience in the clinical routine.. · The high intra- and interobserver agreement indicates high reliability in the therapy-relevant classification of diverticulitis on CT.. CITATION FORMAT · Schmidbauer M, Levers A, Wacker FK et al. Classification of Diverticular Disease (CDD) - assessment of the intra- and interobserver agreement in abdominal CT scans. Fortschr Röntgenstr 2024; 196: 591 - 599.
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Affiliation(s)
- Martina Schmidbauer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Alena Levers
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Kristina Imeen Ringe
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Agresta F, Montori G, Podda M, Ortenzi M, Giordano A, Bergamini C, Mazzarolo G, Licitra E, Gobbi T, Procida G, Borgo AD, Botteri E, Ansaloni L, Fugazzola P, Savino G, Guerrieri M, Campanile FC, Sartori A, Petz W, Silecchia G, di Saverio S, Catena F, Agrusa A, Salemi M, Morales-Conde S, Arezzo A. Diverticulitis, surgery, evidence-based medicine, and the Steve Jobs' dots: a narrative review. Eur J Trauma Emerg Surg 2024; 50:81-91. [PMID: 37747500 DOI: 10.1007/s00068-023-02362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Emergency treatment of acute diverticulitis remains a hazy field. Despite a number of clinical studies, randomized controlled trials (RCTs), guidelines and surgical societies recommendations, the most critical hot topics have yet to be addressed. METHODS Literature research from 1963 until today was performed. Data regarding the principal RCTs and observational studies were summarized in descriptive tables. In particular we aimed to focus on the following topics: the role of laparoscopy, the acute care setting, the RCTs, guidelines, observational studies and classifications proposed by literature, the problem in case of a pandemic, and the importance of adapting treatment /place/surgeon conditions. RESULTS In the evaluation of these points we did not try to find any prospective evolution of the concepts achievements. On the contrary we simply report the individuals strands of research from a retrospective point of view, similarly to what Steve Jobes said: "you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future". We have finally obtained what can be defined "a narrative review of the literature on diverticulitis". CONCLUSIONS Not only evidence-based medicine but also the contextualization, as also the role of 'competent' surgeons, should guide to novel approach in acute diverticulitis management.
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Affiliation(s)
- Ferdinando Agresta
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy.
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Monica Ortenzi
- Clinica di Chirurgia Generale e d'Urgenza, Università Politecnica delle Marche, Ancona, Italy
| | - Alessio Giordano
- Surgery Department, Emergency Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Bergamini
- Surgery Department, Emergency Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Giorgio Mazzarolo
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Edelweiss Licitra
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Tobia Gobbi
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Giuseppa Procida
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Andrea Dal Borgo
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | | | - Luca Ansaloni
- Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Grazia Savino
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Mario Guerrieri
- Clinica di Chirurgia Generale e d'Urgenza, Università Politecnica delle Marche, Ancona, Italy
| | | | - Alberto Sartori
- Department of General Surgery, Ospedale di Montebelluna, Montebelluna, Italy
| | - Wanda Petz
- Division of Digestive Surgery, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy
| | - Salomone di Saverio
- Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, Cesena, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Michelangelo Salemi
- Medical Director of ULSS 2Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto, TV, Italy
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
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5
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Agnes AL, Agnes A, Di Grezia M, Giambusso M, Savia E, Grieco M, Cozza V, Magalini S, Sganga G. Management of acute diverticulitis in Stage 0-IIb: indications and risk factors for failure of conservative treatment in a series of 187 patients. Sci Rep 2024; 14:1501. [PMID: 38233497 PMCID: PMC10794215 DOI: 10.1038/s41598-024-51526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
Left-sided acute diverticulitis in WSES Stage 0-IIb preferentially undergoes conservative management. However, there is limited understanding of the risk factors for failure of this approach. The aim of this study was to investigate the factors associated with the decision to perform conservative treatment as well as the predictors of its failure. We included patients with a diagnosis of WSES diverticulitis CT-driven classification Stage 0-IIb treated in the Emergency Surgery Unit of the Agostino Gemelli University Hospital Foundation between 2014 and 2020. The endpoints were the comparison between the characteristics and clinical outcomes of acute diverticulitis patients undergoing conservative versus operative treatment. We also identified predictors of conservative treatment failure. A set of multivariable backward logistic analyses were conducted for this purpose. The study included 187 patients. The choice for operative versus conservative treatment was associated with clinical presentation, older age, higher WSES grade, and previous conservative treatment. There were 21% who failed conservative treatment. Of those, major morbidity and mortality rates were 17.9% and 7.1%, respectively. A previously failed conservative treatment as well as a greater WSES grade and a lower hemoglobin value were significantly associated with failure of conservative treatment. WSES classification and hemoglobin value at admission were the best predictors of failure of conservative treatment. Patients failing conservative treatment had non-negligible morbidity and mortality. These results promote the consideration of a combined approach including baseline patients' characteristics, radiologic features, and laboratory biomarkers to predict conservative treatment failure and therefore optimize treatment of acute diverticulitis.
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Affiliation(s)
- Amedea L Agnes
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
| | - Annamaria Agnes
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy.
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Marta Di Grezia
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Mauro Giambusso
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
| | - Eleonora Savia
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
| | - Michele Grieco
- S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Valerio Cozza
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Sabina Magalini
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gabriele Sganga
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
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6
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Gil C, Beyer-Bergeot L, Sabbagh C, Zerbib P, Bridoux V, Manceau G, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiori L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Alves A, Ouaissi M. Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study. Int J Colorectal Dis 2023; 38:276. [PMID: 38040936 DOI: 10.1007/s00384-023-04564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. METHODS From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21). RESULTS A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. CONCLUSION This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.
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Affiliation(s)
- Camille Gil
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France
| | - Laura Beyer-Bergeot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - Charles Sabbagh
- Department of Surgery Department, Amiens University Hospital, Amiens, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - Valérie Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - Gilles Manceau
- Department of digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, univeristy Paris Cité, Paris, France
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Aurélien Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - Benjamin Menahem
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bodgan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Camille Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Yassine Eid
- Department of Digestive Surgery, Polyclinique de Lisieux, Lisieux, France
| | - Emilie Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - Anais Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | | | - François Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Sorbonne Paris Nord University, Paris, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Martin Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Urs Giger
- Fliedner Fachhochschule, University of Applied Sciences, Düsseldorf, Germany
| | - Arnaud Alves
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France.
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7
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Ore AS, Allar BG, Fabrizio A, Cataldo TE, Messaris E. Trends in the Management of Non-emergent Surgery for Diverticular Disease and the Impact of Practice Parameters. Am Surg 2023; 89:4590-4597. [PMID: 36044675 DOI: 10.1177/00031348221124319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the rise in diverticular disease, the ASCRS developed practice parameters to ensure high-quality patient care. Our study aims to evaluate the impact of the 2014 practice parameters on the treatment of non-emergent left-sided diverticular disease. METHODS This is a retrospective cohort study using the ACS-National Surgical Quality Improvement Project (ACS-NSQIP). Elective sigmoid resections performed by year were evaluated and compared before and after practice parameters were published. RESULTS Overall, 46,950 patients met inclusion criteria. There was a significant decrease in the number of non-emergent operations when evaluating before and after guideline implementation (P < .001). There was a significant decrease in the number of patients younger than 50 years of age operated electively for diverticular disease (25.8% vs. 23.9%, P = .005). Adoption of minimally invasive surgery continued to increase significantly throughout the study period. CONCLUSIONS Publication of the 2014 ASCRS practice parameters is associated with a change in management of diverticular disease in the non-emergent setting.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Benjamin G Allar
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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8
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Ocaña J, García-Pérez JC, Fernández-Martínez D, Aguirre I, Pascual I, Lora P, Espin E, Labalde-Martínez M, León C, Pastor-Peinado P, López-Domínguez C, Muñoz-Plaza N, Valle A, Dujovne P, Alías D, Pérez-Santiago L, Correa A, Carmona M, Díez MM, Timoteo A, Salvans S, Medina RE, Gómez T, Fernández-Vega L, Peña E, García-González JM, Blanco-Antona F, Fábregues AI, Sagarra E, Viejo E, Moreno A, Fernández-Cebrián JM, Die J. Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group. Surgery 2023; 174:492-501. [PMID: 37385866 DOI: 10.1016/j.surg.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery. METHODS This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed. RESULTS Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85). CONCLUSION Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.
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Affiliation(s)
- Juan Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Juan Carlos García-Pérez
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Ignacio Aguirre
- Colorectal Surgery Unit, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Isabel Pascual
- Colorectal Division, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Lora
- Colorectal Division, Hospital Univseristario Cabueñes, Gijón, Spain
| | - Eloy Espin
- Department of Colorectal Surgery, Hospital Universitari Vall d´Hebron, Universitat Autonoma de Barcelona, Spain
| | | | - Carmen León
- Division of Coloproctology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Paula Pastor-Peinado
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Ainhoa Valle
- Division of Coloproctology, Hospital Universitario de Getafe, Spain
| | - Paula Dujovne
- Division of Coloproctology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - David Alías
- Unit of Coloproctology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Alba Correa
- Unit of Coloproctology, Hospital Universitario La Princesa, Madrid, Spain
| | - María Carmona
- Division of Coloproctology, Hospital Universitario de Badajoz, Spain
| | - Manuel Mariano Díez
- Division of Coloproctology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Ander Timoteo
- Division of Coloproctology, Hospital Universitari Dr Josep Trueta, Gerona, Spain
| | - Silvia Salvans
- Division of Coloproctology, Hospital del Mar, Barcelona, Spain
| | - Rita Esther Medina
- Division of Coloproctology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Tatiana Gómez
- Division of Coloproctology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Emilio Peña
- Division of Coloproctology, Hospital Universitario Reina Sofía, Murcia, Spain
| | | | | | | | - Elena Sagarra
- Division of Coloproctology, Hospital Universitario Infanta Cristina, Parla, Spain
| | - Elena Viejo
- Division of Coloproctology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Araceli Moreno
- Division of Coloproctology, Hospital Reina Sofía, Córdoba, Spain
| | - José María Fernández-Cebrián
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Die
- Division of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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9
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Nocera F, Haak F, Posabella A, Angehrn FV, Peterli R, Müller-Stich BP, Steinemann DC. Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients. Langenbecks Arch Surg 2023; 408:295. [PMID: 37535118 PMCID: PMC10400669 DOI: 10.1007/s00423-023-03034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication. METHODS All patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed. RESULTS 585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001). CONCLUSION The lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.
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Affiliation(s)
- Fabio Nocera
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
- Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland
| | - Fabian Haak
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
- Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland
| | - Alberto Posabella
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Fiorenzo Valente Angehrn
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Beat P Müller-Stich
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Daniel C Steinemann
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
- Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
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10
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Pietryga S, Lock JF, Diers J, Baum P, Uttinger KL, Baumann N, Flemming S, Wagner JC, Germer CT, Wiegering A. Nationwide volume-outcome relationship concerning in-hospital mortality and failure-to-rescue in surgery of sigmoid diverticulitis. Int J Colorectal Dis 2023; 38:203. [PMID: 37522984 DOI: 10.1007/s00384-023-04495-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE A correlation between the hospital volume and outcome is described for multiple entities of oncological surgery. To date, this has not been analyzed for the surgical treatment of sigmoid diverticulitis. The aim of this study was to explore the impact of the annual caseload per hospital of colon resection on the postoperative incidence of complications, failure to rescue, and mortality in patients with diverticulitis. METHODS Patients receiving colorectal resection independent from the diagnosis from 2012 to 2017 were selected from a German nationwide administrative dataset. The hospitals were grouped into five equal caseload quintiles (Q1-Q5 in ascending caseload order). The outcome analysis was focused on patients receiving surgery for sigmoid diverticulitis. RESULTS In total, 662,706 left-sided colon resections were recorded between 2012 and 2017. Of these, 156,462 resections were performed due to sigmoid diverticulitis and were included in the analysis. The overall in-house mortality rate was 3.5%, ranging from 3.8% in Q1 (mean of 9.5 procedures per year) to 3.1% in Q5 (mean 62.8 procedures per year; p < 0.001). Q5 hospitals revealed a risk-adjusted odds ratio of 0.85 (95% CI 0.78-0.94; p < 0.001) for in-hospital mortality compared to Q1 during multivariable logistic regression analysis. High-volume centers showed overall lower complication rates, whereas the failure-to-rescue did not differ significantly. CONCLUSION Surgical treatment of sigmoid diverticulitis in high-volume colorectal centers shows lower postoperative mortality rates and fewer postoperative complications.
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Affiliation(s)
- Sebastian Pietryga
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Johannes Diers
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Philip Baum
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Konstantin L Uttinger
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Nikolas Baumann
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Johanna C Wagner
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany.
- Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, Würzburg, Germany.
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany.
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, Medical Center Julius Maximilians, University of Würzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany.
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11
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Drapkina OM, Lazebnik LB, Bakulin IG, Skazyvaeva EV, Bakulina NV, Sitkin SI, Skalinskaya MI, Zhuravleva MS, Avalueva EB, Livzan MA, Bordin DS, Khavkin AI. Colonic diverticular disease: clinical presentation, diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:33-69. [DOI: 10.31146/1682-8658-ecg-210-2-33-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Clinical guidelines are intended for gastroenterologists, internists, and general practitioners and focus primarily on the management of patients with symptomatic uncomplicated diverticular disease, as well as on the primary and secondary prevention of acute diverticulitis and other complications of diverticular disease. Clinical guidelines were developed by the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientifi c Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists. One of the reasons for creating new clinical guidelines is that the current guidelines on diverticular disease (2021) pay much more attention to complications of diverticular disease and surgical treatment of acute and chronic complications of the disease.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine Russian Federation
| | - L. B. Lazebnik
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry Russian Federation
| | - I. G. Bakulin
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - E. V. Skazyvaeva
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - N. V. Bakulina
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - S. I. Sitkin
- North-Western state medical University named after I. I. Mechnikov; Almazov National Medical Research Centre
| | - M. I. Skalinskaya
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - M. S. Zhuravleva
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - E. B. Avalueva
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | | | - D. S. Bordin
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry Russian Federation; Moscow Clinical Scientific Center named after Loginov
| | - A. I. Khavkin
- Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University
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12
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Drapkina OM, Lazebnik LB, Bakulin IG, Skazyvaeva EV, Bakulina NV, Sitkin SI, Skalinskaya MI, Zhuravleva MS, Avalueva EB, Livzan MA, Bordin DS, Khavkin AI. Colonic diverticular disease: clinical presentation, diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2023:33-69. [DOI: https:/doi.org/10.31146/1682-8658-ecg-210-2-33-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Clinical guidelines are intended for gastroenterologists, internists, and general practitioners and focus primarily on the management of patients with symptomatic uncomplicated diverticular disease, as well as on the primary and secondary prevention of acute diverticulitis and other complications of diverticular disease. Clinical guidelines were developed by the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientifi c Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists. One of the reasons for creating new clinical guidelines is that the current guidelines on diverticular disease (2021) pay much more attention to complications of diverticular disease and surgical treatment of acute and chronic complications of the disease.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine Russian Federation
| | - L. B. Lazebnik
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry Russian Federation
| | - I. G. Bakulin
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - E. V. Skazyvaeva
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - N. V. Bakulina
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - S. I. Sitkin
- North-Western state medical University named after I. I. Mechnikov; Almazov National Medical Research Centre
| | - M. I. Skalinskaya
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - M. S. Zhuravleva
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | - E. B. Avalueva
- North-Western state medical University named after I. I. Mechnikov Russian Federation
| | | | - D. S. Bordin
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry Russian Federation; Moscow Clinical Scientific Center named after Loginov
| | - A. I. Khavkin
- Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University
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13
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Weykamp M, Bingham J. Generation Learning Differences in Surgery: Why They Exist, Implication, and Future Directions. Surg Clin North Am 2023; 103:287-298. [PMID: 36948719 DOI: 10.1016/j.suc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The evolution of the knowledge economy and technology industry have fundamentally changed the learning environments occupied by contemporary surgical trainees and created pressures that will force the surgical community to consider. Although some learning differences are intrinsic to the generations themselves, these differences are primarily a function of the environments in which surgeons of different generations trained. Acknowledgment of the principles of connectivism and thoughtful integration of artificial intelligence and computerized decision support tools must play a central role in charting the future course of surgical education.
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Affiliation(s)
- Mike Weykamp
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jason Bingham
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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14
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When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach. J Pers Med 2022; 12:jpm12101713. [PMID: 36294852 PMCID: PMC9605603 DOI: 10.3390/jpm12101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Colonoscopy is a crucial diagnostic tool in managing diverticular disease (DD). Diverticulosis can often be an unexpected diagnosis when colonoscopy is performed in asymptomatic subjects, generally for colorectal cancer screening, or it could reveal an endoscopic picture compatible with DD, including acute diverticulitis, in patients suffering from abdominal pain or rectal bleeding. However, alongside its role in the differential diagnosis of colonic diseases, particularly with colon cancer after an episode of acute diverticulitis or segmental colitis associated with diverticulosis, the most promising use of colonoscopy in patients with DD is represented by its prognostic role when the DICA (Diverticular Inflammation and Complication Assessment) classification is applied. Finally, colonoscopy plays a crucial role in managing diverticular bleeding, and it could sometimes be used to resolve other complications, particularly as a bridge to surgery. This article aims to summarize “when” to safely perform a colonoscopy in the different DD settings and “why”.
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15
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Vaghiri S, Prassas D, Knoefel WT, Krieg A. The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis. Langenbecks Arch Surg 2022; 407:3259-3274. [PMID: 36214867 DOI: 10.1007/s00423-022-02698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/23/2022] [Indexed: 01/14/2023]
Abstract
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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Affiliation(s)
- Sascha Vaghiri
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Dimitrios Prassas
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany.
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16
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Larkins K, Mohan H, Apte SS, Chen V, Rajkomar A, Larach JT, Smart P, Heriot A, Warrier S. A systematic review and meta-analysis of robotic resections for diverticular disease. Colorectal Dis 2022; 24:1105-1116. [PMID: 35723895 DOI: 10.1111/codi.16227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023]
Abstract
AIM Resection of diverticular disease can be technically challenging. Tissue planes can be difficult to identify intraoperatively due to inflammation or fibrosis. Robotic surgery may improve identification of tissue planes and dissection which can facilitate difficult minimally invasive resections. This systematic review and meta-analysis evaluates the role of robotic surgery compared to laparoscopic surgery in diverticular resection. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA statement. The search was completed using PubMed, OVID MEDLINE and EMBASE. A total of 490 articles were retrieved, and studies reporting primary outcomes for robotic diverticular resection were included in the final analysis. A meta-analysis of studies comparing robotic and laparoscopic surgery was performed on rate of conversion to open surgery and complications. RESULTS Fifteen articles (8 cohort studies and 7 case series) reporting 3711 robotic diverticular resections were analysed. In comparison to laparoscopic, robotic surgery for diverticular disease was associated with a reduced conversion to open and a longer operating time. Meta-analysis showed robotic resection was associated with a lower conversion rate compared to laparoscopic surgery (OR: 0.57; 95% CI: 0.49-0.66, p < 0.001). There was no significant difference in grade III and above complications (OR: 0.74; 95% CI: 0.49-1.13, p = 0.17). Operating time was longer with a robotic approach (Hedge's G: 0.43; 95% CI: 0.04-0.81, p = 0.03). CONCLUSION Robotic resection is a feasible and safe option in diverticular disease. Although associated with a longer operating time, robotic surgery may render diverticular disease resectable with a minimally invasive approach that would have otherwise necessitated a laparotomy. Randomised controlled data is required to better define the role of robotic surgery for diverticular disease resections.
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Affiliation(s)
- Kirsten Larkins
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Vicky Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amrish Rajkomar
- Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Colorectal Surgery, Epworth HealthCare, East Melbourne, Victoria, Australia
| | - Philip Smart
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Satish Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, The Surgery Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Colorectal Surgery, Alfred Health, Prahran, Victoria, Australia
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17
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Diverticulitis does not increase the long-term risk of developing colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:1945-1952. [PMID: 36042030 DOI: 10.1007/s00384-022-04246-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this review was to examine if diverticulitis increases the long-term risk (> 6 months) of developing colon cancer. METHODS A systematic search was conducted in PubMed, Embase, and Cochrane CENTRAL. Google Scholar was also searched. We included studies with human adults of 18 years of age and above. Studies that included only patients with diverticulitis as well as studies comparing groups with and without diverticulitis were included. The primary outcome was the incidence of colon cancer 6 months or more after an episode of diverticulitis. RESULTS Twelve records were included with 38,621 patients with diverticulitis. The crude rate of colon cancer among the prospectively followed populations with diverticulitis was by meta-analysis found to be 0.6% (95% CI 0.5-0.6%). The limitations of this review include heterogeneous reporting of outcomes across studies, specifically regarding population and outcome as well as variations in the design and reporting of the studies. CONCLUSION We found that the long-term risk of colon cancer after diverticulitis is not increased. The results of our review support current practice on follow-up after an episode of diverticulitis with short-term follow-up being the primary focus.
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18
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De Waele JJ, Boelens J, Van De Putte D, Huis In ‘t Veld D, Coenye T. The Role of Abdominal Drain Cultures in Managing Abdominal Infections. Antibiotics (Basel) 2022; 11:antibiotics11050697. [PMID: 35625341 PMCID: PMC9137968 DOI: 10.3390/antibiotics11050697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
Intra-abdominal infections (IAI) are common in hospitalized patients, both in and outside of the intensive care unit. Management principles include antimicrobial therapy and source control. Typically, these infections are polymicrobial, and intra-operative samples will guide the targeted antimicrobial therapy. Although the use of prophylactic abdominal drains in patients undergoing abdominal surgery is decreasing, the use of drains to treat IAI, both in surgical and non-surgical strategies for abdominal infection, is increasing. In this context, samples from abdominal drains are often used to assist in antimicrobial decision making. In this narrative review, we provide an overview of the current role of abdominal drains in surgery, discuss the importance of biofilm formation in abdominal drains and the mechanisms involved, and review the clinical data on the use of sampling these drains for diagnostic purposes. We conclude that biofilm formation and the colonization of abdominal drains is common, which precludes the use of abdominal fluid to reliably diagnose IAI and identify the pathogens involved. We recommend limiting the use of drains and, when present, avoiding routine microbiological sampling.
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Affiliation(s)
- Jan J. De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
- Correspondence: ; Tel.: +32-93-32-62-19; Fax: +32-93-32-49-95
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Dirk Van De Putte
- Department of Gastrointestinal Surgery, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Diana Huis In ‘t Veld
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, 9000 Ghent, Belgium;
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Leifeld L, Germer CT, Böhm S, Dumoulin FL, Frieling T, Kreis M, Meining A, Labenz J, Lock JF, Ritz JP, Schreyer A, Kruis W. S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:613-688. [PMID: 35388437 DOI: 10.1055/a-1741-5724] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ludger Leifeld
- Medizinische Klinik 3 - Gastroenterologie und Allgemeine Innere Medizin, St. Bernward Krankenhaus, Hildesheim, apl. Professur an der Medizinischen Hochschule Hannover
| | - Christoph-Thomas Germer
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Würzburg
| | - Stephan Böhm
- Spital Bülach, Spitalstrasse 24, 8180 Bülach, Schweiz
| | | | - Thomas Frieling
- Medizinische Klinik II, Klinik für Gastroenterologie, Hepatologie, Infektiologie, Neurogastroenterologie, Hämatologie, Onkologie und Palliativmedizin HELIOS Klinikum Krefeld
| | - Martin Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Meining
- Medizinische Klinik und Poliklinik 2, Zentrum für Innere Medizin (ZIM), Universitätsklinikum Würzburg, Würzburg
| | - Joachim Labenz
- Abteilung für Innere Medizin, Evang. Jung-Stilling-Krankenhaus, Siegen
| | - Johan Friso Lock
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Würzburg
| | - Jörg-Peter Ritz
- Klinik für Allgemein- und Viszeralchirurgie, Helios Klinikum Schwerin
| | - Andreas Schreyer
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Brandenburg Theodor Fontane Klinikum Brandenburg, Brandenburg, Deutschland
| | - Wolfgang Kruis
- Medizinische Fakultät, Universität Köln, Köln, Deutschland
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20
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Turner GA, O'Grady MJ, Purcell RV, Frizelle FA. Acute Diverticulitis in Young Patients: A Review of the Changing Epidemiology and Etiology. Dig Dis Sci 2022; 67:1156-1162. [PMID: 33786702 DOI: 10.1007/s10620-021-06956-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Acute diverticulitis is one of the leading gastrointestinal causes for hospitalization. The incidence of acute diverticulitis has been increasing in recent years, especially in patients under 50 years old. Historically, acute diverticulitis in younger patients was felt to represent a separate entity, being more virulent and associated with a higher rate of recurrence. Accordingly, young patients were often managed differently to older counterparts. Our understanding of the natural history of this condition has evolved, and current clinical practice guidelines suggest age should not alter management. The purpose of this review is to evaluate the changing epidemiology of acute diverticulitis, consider potential explanations for the observed increased incidence in younger patients, as well as review the natural history of acute diverticulitis in the younger population.
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Affiliation(s)
- Greg A Turner
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Michael J O'Grady
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Rachel V Purcell
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Frank A Frizelle
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Department of Surgery, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
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21
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Lurz M, Gazis A, Hanschke S, Weimann A, Schäfer AO. Value of high-field magnetic resonance imaging for diagnosis and classification of acute colonic diverticulitis. Int J Colorectal Dis 2022; 37:201-207. [PMID: 34633499 DOI: 10.1007/s00384-021-04045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Due to limited and outdated literature, the role of magnetic resonance imaging (MRI) in the diagnostic work-up of acute colonic diverticulitis (ACD) is still under debate. The purpose of this study was to compare the performance of modern high-field MRI and multidetector computed tomography (MDCT) in the diagnosis and classification of ACD. METHODS In our prospective study 24 emergency patients with the clinical diagnosis of ACD received MDCT and high-field MRI. Imaging features of ACD were assessed and categorized according to the classification of diverticular disease (CDD) by three independent readers. Results were matched with the final clinical report. RESULTS MRI with a specialized examination protocol clearly depicted all relevant findings of ACD. Statistical analysis resulted in an almost perfect strength of agreement between CT and MRI across all readers for the final CDD category (κ = 0.94) and the stage-related image features (κ = 0.98). Moderate agreement was seen for the detection of micro-abscesses (κ = 0.78), with a slight advantage for MRI. CONCLUSION Modern high-field MRI is fully comparable to MDCT in the assessment of ACD and has the potential to serve as a first-line imaging tool.
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Affiliation(s)
- Markus Lurz
- Department of Radiology, Klinikum St. Georg Leipzig, Leipzig, Germany.
| | - Angelos Gazis
- Department of Radiology, Klinikum St. Georg Leipzig, Leipzig, Germany
| | - Stefanie Hanschke
- Department of Emergency Medicine, Klinikum St. Georg Leipzig, Leipzig, Germany
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg Leipzig, Leipzig, Germany
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22
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Segna D, Jaklin PJ, Schnüriger B, Misselwitz B. Health-related quality of life and functional disorders after diverticular surgery. Therap Adv Gastroenterol 2021; 14:17562848211066437. [PMID: 34987613 PMCID: PMC8721402 DOI: 10.1177/17562848211066437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/24/2021] [Indexed: 02/04/2023] Open
Abstract
Diverticulosis and diverticulitis are leading indications for colorectal surgery in Western countries. Abdominal pain, functional disorders, and low health-related quality of life (HRQoL) can limit the outcome of abdominal surgery even in the absence of complications. Therefore, we aimed to review current evidence on postoperative long-term outcomes including HRQoL, functional disorders, abdominal pain, and patients' satisfaction after diverticular surgery for diverticulosis/diverticulitis. We performed a PubMed database search (inception: 17 December 2020). Identified publications were screened and outcome parameters extracted. In summary, HRQoL increased after diverticular surgery in 9 out of 10 longitudinal cohort studies. Similarly, patients' satisfaction with treatment and their choice to undergo surgery was commonly reported as high or very good, as reported in eight studies. In a randomized control trial and retrospective cohort, elective diverticular surgery was superior to conservative treatment regarding HRQoL. In cross-sectional analyses, chronic abdominal pain and functional disorders including defaecation disorders or diarrhoea/obstipation were found in a relevant fraction of patients. Incontinence ranged from 5% to 25% with insufficient data for comparison before and after surgery. However, functional disorders did not result in decreased HRQoL in most studies, and no increase in functional disorders was observed after elective diverticular surgery in longitudinal analyses. We conclude that HRQoL among operated patients with diverticular disease improved in most studies after surgery. Functional disorders and postoperative abdominal pain can be present after elective diverticular surgery; however, no increase in functional disorders was observed in longitudinal studies. Functional disorders after diverticular surgery need to be carefully discussed with the patient before surgery and a careful clinical assessment before surgery including incontinence scoring should be considered.
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Affiliation(s)
| | - Paul J. Jaklin
- Faculty of Medicine, University of Zurich,
Zurich, Switzerland
| | - Beat Schnüriger
- Department of Visceral Surgery and Medicine,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
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23
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Gray PJ, Goldwag JL, Eid MA, Trooboff SW, Wilson MZ, Ivatury SJ. What Are the Long-Term Changes to Bowel Function Patient-reported Outcomes After Elective Sigmoidectomy for Diverticular Disease?: Observational Study of Patients Undergoing Elective Sigmoidectomy for Diverticular Disease. ANNALS OF SURGERY OPEN 2021; 2:e110. [PMID: 37637876 PMCID: PMC10455065 DOI: 10.1097/as9.0000000000000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease. Background For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited. Methods This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores. Results Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13-34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains. Conclusions In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection.Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.
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Affiliation(s)
| | | | - Mark A. Eid
- From the Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Matthew Z. Wilson
- From the Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine, Hanover, NH
| | - Srinivas J. Ivatury
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, TX
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Nazerian P, Gigli C, Donnarumma E, de Curtis E, Bribani A, Lanzi S, Rovida S, Magazzini S, Grifoni S, Perani C. Diagnostic Accuracy of Point-of-Care Ultrasound Integrated into Clinical Examination for Acute Diverticulitis: A Prospective Multicenter Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:614-622. [PMID: 32688404 DOI: 10.1055/a-1161-0780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Diverticulitis is a common cause of abdominal pain and CT scan is commonly used for its diagnosis in the emergency department (ED). The diagnostic performance of point-of-care ultrasound (POCUS) integrated into a clinical exam for diverticulitis is still not established. We evaluate the accuracy of clinical-sonographic assessment for the diagnosis of diverticulitis and whether POCUS could improve the selection of patients needing CT scan for complicated diverticulitis. MATERIALS AND METHODS This is a multicentric observational study involving adult patients suspected of having diverticulitis presenting at 4 EDs. 21 sonographer physicians were asked to diagnose diverticulitis and complicated diverticulitis based on clinical-sonographic assessment. The final diagnosis was established by two reviewers, blinded to POCUS, based on data collected during the one-month follow-up comprehensive CT scan. RESULTS Among 393 enrolled patients, 218 (55.5 %) were diagnosed with diverticulitis and 33 (8 %) had complicated diverticulitis. The time to diagnosis by the sonographer physicians was shorter compared to standard care (97 ± 102 vs. 330 ± 319 minutes, p < 0.001). Clinical-sonographic assessment showed optimal sensitivity (92.7 %) and specificity (90.9 %) for diverticulitis. However, the sensitivity (50 %) for complicated diverticulitis was low. The sonographer physician would have proceeded to CT scan in 194 (49.4 %) patients and the CT scan request compared to the final diagnosis of complicated diverticulitis demonstrated 94 % sensitivity. CONCLUSION Clinical-sonographic assessment is rapid and accurate for the diagnosis of diverticulitis. Even if POCUS has low sensitivity for complicated diverticulitis, it can be used to safely select patients needing CT.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, University Hospital Careggi, Firenze, Italy
| | - Chiara Gigli
- Department of Emergency Medicine, University Hospital Careggi, Firenze, Italy
| | - Emilia Donnarumma
- Department of Emergency Medicine, University Hospital Careggi, Firenze, Italy
| | | | - Andrea Bribani
- Department of Internal Medicine and Emergency Medicine, Serristori Hospital, Figline Valdarno, Italy
| | - Sabina Lanzi
- Department of Emergency Medicine, Brescia Community Hospital, Brescia, Italy
| | - Serena Rovida
- Department of Emergency Medicine and Trauma Center, Linköping University Hospital, Linköping, Sweden
| | - Simone Magazzini
- Department of Emergency Medicine, Prato New Hospital, Prato, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, University Hospital Careggi, Firenze, Italy
| | - Cristiano Perani
- Department of Emergency Medicine, Brescia Community Hospital, Brescia, Italy
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Donatelli G, Cereatti F, Fazi M, Ceci V, Dhumane P. Endoscopic ultrasound-guided drainage of intra-abdominal diverticular abscess. A case series. J Minim Access Surg 2021; 17:513-518. [PMID: 34558427 PMCID: PMC8486052 DOI: 10.4103/jmas.jmas_184_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
AIM Diverticular disease is widespread worldwide. Mainstay approach is non-operative treatment with bowel rest and broad-spectrum intravenous antibiotics. However, extra-colic abscess larger than 4 cm may require percutaneous trans-abdominal drainage. We report a single centre case series of patients underwent to trans-luminal endoscopic ultrasound (EUS)-guided drainage of pelvic abscess in diverticular disease with temporary placement of lumen apposing metal stent (LAMS). METHODS All patients referred to our tertiary centre from January 2019 to July 2020 were enrolled in a prospective data base that was retrospectively analysed. Procedural steps were as follows: pre-operative computed tomography scan, broad-spectrum antibiotic therapy, EUS-guided deployment of LAMS for 15 days, LAMS removal and deployment of pigtail stent in case of pseudo-cavity persistence. RESULTS Ten patients (6F) with an average of 59.6 years were enrolled with deployment of 10 LAMS. One patient was excluded after EUS evaluation and 1 patient had 2 LAMS for 2 separate abscesses. Technical and clinical success was achieved in 88.8% (8/9). CONCLUSIONS Management of diverticulitis has shifted from primary surgical intervention towards a non-operative approach of bowel rest and broad-spectrum intravenous antibiotics in conjunction with interventional procedures to drain abscesses whenever necessary. EUS-guided drainage with LAMS for the management of diverticular abscesses seems an efficient treatment modality for encapsulated abscesses more than 4 cm in size and close to colonic wall. In expert centres, it may avoid radiologic intervention and/or surgery in a relevant percentage of cases.
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Affiliation(s)
- Gianfranco Donatelli
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Fabrizio Cereatti
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
- Department of Medical, Gastroenterology and Endoscopy Unit, ASST Cremona, Cremona, Italy
| | - Maurizio Fazi
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Vincenzo Ceci
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Parag Dhumane
- Department of Surgical, General and Laparoscopic Surgery Unit, Lilavati Hospital and Research Center, Mumbai, India
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Is There an Impact of the Duration of Antibiotic Therapy on the Outcome of Nonsurgical Treatment of Complicated Diverticulitis? SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:84-88. [PMID: 34570071 DOI: 10.1097/sle.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients treated nonsurgically for complicated diverticulitis are managed by antibiotics. However, there are no recommendations concerning their duration. We aimed to determine the impact of the duration of antibiotic therapy on the risk of failure of nonsurgical treatment of complicated acute diverticulitis. PATIENTS AND METHODS This was a single-center retrospective study of patients with computer tomography (CT)-diagnosed complicated diverticulitis between January 2015 and April 2020. Treatment failure was defined as early recurrence and/or a persistent abscess by control CT. RESULTS In total, 148 patients fulfilled the inclusion criteria [87 men (58.8%), mean age 55±15 y]. The diverticulitis was classified as Hinchey I in 41.9%, Hinchey II in 9.5%, and pericolic free air in 48.6% of cases. The median abscess size was 2.9±1.7 cm. The median duration of antibiotic treatment was 10±4.2 days. The median follow-up was 64±60 months. The rate of failure was 12.8%. In univariate analysis, treatment >10 days (P=0.015) and an abscess >3 cm (P=0.032) were associated with a risk of treatment failure. In multivariate analysis, only the diameter of the abscess remained associated with a risk of failure (odds ratio: 1.6, 95% confidence interval: 1.09-2.4, P=0.01). CONCLUSION This study suggests that there is no need to extend the duration of antibiotic treatment beyond 10 days in nonsurgically treated complicated acute diverticulitis.
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Origi M, Achilli P, Calini G, Costanzi A, Monteleone M, Montroni I, Maggioni D, Cocozza E, Megna S, Totis M, Tamini N, Ziccarelli A, Filippone G, Ferrari G, Crippa J, Spinelli A, Mari GM. The Diverticular Disease Registry (DDR Trial) by the Advanced International Mini-Invasive Surgery Academy Clinical Research Network: Protocol for a Multicenter, Prospective Observational Study. Int J Surg Protoc 2021; 25:194-200. [PMID: 34541429 PMCID: PMC8415185 DOI: 10.29337/ijsp.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 01/16/2023] Open
Abstract
Diverticular disease is an increasingly common issue, with a variety of clinical presentations and treatment options. However, very few prospective cohort studies explore outcomes between the different presentations and treatments. The Diverticular Disease Registry (DDR Trial) is a multicenter, prospective, observational cohort study on behalf of the Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network. The DDR Trial aims to investigate the short-term postoperative and long-term quality of life outcomes in patients undergoing surgery or medical treatments for diverticular disease. DDR Trial is open to participation by all tertiary-care hospitals. DDR Trial has been registered at ClinicalTrials.gov (NCT04907383). Data collection will be recorded on Research Electronic Data Capture (REDCap) starting on June 1st, 2021 and will end after 5 years of recruitment. All adult patients with imaging-proven colonic diverticular disease (i.e., symptomatic colonic diverticulosis including diverticular bleeding, diverticulitis, and Symptomatic Uncomplicated Diverticular Disease) will be included. The primary outcome of DDR Trial is quality of life assessment at 12-month according to the Gastrointestinal Quality of Life Index (GIQLI). The secondary outcome is 30-day postoperative outcomes according to the Clavien-Dindo classification. DDR Trial will significantly advance in identifying the optimal care for patients with diverticular disease by exploring outcomes of different presentations and treatments. Highlights Diverticular disease (i.e., diverticulitis, bleeding) has different treatments.This is a clinical protocol for the Diverticular Disease Registry (DDR Trial).DDR Trial is a multicenter, prospective, observational cohort study open to participation.DDR Trial will study short-term postoperative and long-term quality of life outcomes.Medical treatments, interventional radiology and surgery will be explored.
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Affiliation(s)
- Matteo Origi
- General Surgery Department, Niguarda Hospital, Milano, Italy
| | - Pietro Achilli
- General Surgery Department, Niguarda Hospital, Milano, Italy
| | - Giacomo Calini
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Andrea Costanzi
- General Surgery Department, Merate Hospital, ASST Lecco, Italy
| | | | - Isacco Montroni
- General Surgery Department, Ospedale degli Infermi, Faenza, Italy
| | - Dario Maggioni
- General Surgery Department, Desio Hospital, ASST Brianza, Italy
| | | | | | - Mauro Totis
- General Surgery Department, ASST Monza, Italy
| | | | | | | | | | - Jacopo Crippa
- Humanitas Research Hospital, IRCCS, Rozzano - Milano, Italy
| | - Antonino Spinelli
- Humanitas Research Hospital, IRCCS, Rozzano - Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milano, Italy
| | - Giulio M Mari
- General Surgery Department, Desio Hospital, ASST Brianza, Italy
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Fowler H, Gachabayov M, Vimalachandran D, Clifford R, Orangio GR, Bergamaschi R. Failure of nonoperative management in patients with acute diverticulitis complicated by abscess: a systematic review. Int J Colorectal Dis 2021; 36:1367-1383. [PMID: 33677750 DOI: 10.1007/s00384-021-03899-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to assess failure rates following nonoperative management of acute diverticulitis complicated by abscess and trends thereof. METHOD Pubmed, MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science were systematically searched. Nonoperative management was defined as a combination of nil per os, IV fluids, IV antibiotics, CT scan-guided percutaneous drainage, and total parenteral nutrition. The primary endpoint was failure of nonoperative management defined as persistent or worsening abscess and/or sepsis, development of new complications, such as peritonitis, ileus, or colocutaneous fistula, and urgent surgery within 30-90 days of index admission. Data were stratified by three arbitrary time intervals: 1986-2000, 2000-2010, and after 2010. The primary outcome was calculated for those groups and compared. RESULTS Thirty-eight of forty-four eligible studies published between 1986 and 2019 were included in the quantitative synthesis of data (n = 2598). The pooled rate of failed nonoperative management was 16.4% (12.6%, 20.2%) at 90 days. In studies published in 2000-2010 (n = 405), the pooled failure rate was 18.6% (10.5%, 26.7%). After 2000 (n = 2140), the pooled failure rate was 15.3% (10.7%, 20%). The difference was not statistically significant (p = 0.725). After controlling for heterogeneity in the definition of failure of nonoperative management, subgroup analysis yielded the pooled rate of failure of 21.8% (16.1%, 27.4%). CONCLUSION This meta-analysis found that failure rates following nonoperative management of acute diverticulitis complicated by abscess did not significantly decrease over the past three decades. The general quality of published data and the level and certainty of evidence produced were low.
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Affiliation(s)
| | - Mahir Gachabayov
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Suite D-361, Taylor Pavilion, 100 Woods Rd, Valhalla, NY, 10595, USA
| | | | | | - Guy R Orangio
- Section of Colon and Rectal Surgery, Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Roberto Bergamaschi
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Suite D-361, Taylor Pavilion, 100 Woods Rd, Valhalla, NY, 10595, USA.
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Gavriilidis P, Askari A, Gavriilidis E, de’Angelis N, Di Saverio S, Wheeler J, Davies RJ. Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. Ann R Coll Surg Engl 2021; 103:471-477. [PMID: 33851878 PMCID: PMC9774019 DOI: 10.1308/rcsann.2021.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. METHODS PubMed, Embase, Cochrane Library and Google Scholar databases were searched systematically. The methodological quality of the guidelines was appraised independently by five appraisers using the AGREE II instrument. FINDINGS A systematic search of the literature identified 12 guidelines. The median overall score of all guidelines was 68%. Across all guidelines, the highest score of 85% was demonstrated in the domain 'Scope and purpose'. The domains 'Clarity and presentation' and 'Editorial independence' both scored a median of 72%. The lowest scores were demonstrated in the domains 'Stakeholder involvement' and 'Applicability' at 46% and 40%, respectively. Overall, the National Institute for Health and Care Excellence (NICE) guidelines performed consistently well, scoring 100% in five of six domains; NICE was one of the few guidelines that specifically reported stakeholder involvement, scoring 97%. Generally, the domain of 'Stakeholder involvement' ranked poorly with seven of twelve guidelines scoring below 50%, with the worst score in this domain demonstrated by Danish guidelines at 25%. CONCLUSION Six of twelve guidelines (NICE, American Society of Colon & Rectal Surgeons (ASCRS), European Society of Coloproctology (ESCP), American Gastroenterological Association, German Society of Gastroenterology/German Society for General and Visceral Surgery (German), Netherlands Society of Surgery) scored above 70%. Only three, NICE, ASCRS and ESCP, scored above 75% and were voted unanimously by the appraisers for use as they are. Therefore, use of AGREE II may help improve the methodological quality of guidelines and their future updates.
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Affiliation(s)
- P Gavriilidis
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, UK
| | - A Askari
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - E Gavriilidis
- University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - J Wheeler
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - RJ Davies
- Cambridge University Hospitals NHS Foundation Trust, UK
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Lock J, Wiegering A, Germer CT. [Indications for surgical treatment of diverticular disease]. Chirurg 2021; 92:694-701. [PMID: 34100113 DOI: 10.1007/s00104-021-01432-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality. OBJECTIVE Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence. MATERIAL AND METHODS The narrative review is based on current national and international guidelines and a selective literature search. RESULTS There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1-3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment. CONCLUSION The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks.
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Affiliation(s)
- Johan Lock
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - A Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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Rausch VH, Weinrich JM, Schön G, Sabour L, Özden C, Kaul MG, Adam G, Bannas P, Henes FO. Accuracy of preoperative CT staging of acute colonic diverticulitis using the classification of diverticular disease (CDD) - Is there a beneficial impact of water enema and visceral obesity? Eur J Radiol 2021; 141:109813. [PMID: 34116453 DOI: 10.1016/j.ejrad.2021.109813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE We evaluated the accuracy of preoperative CT in staging colonic diverticulitis (ACD) by using the classification of diverticular disease (CDD) and investigated the diagnostic impact of water enema (WE) and visceral obesity. METHODS In this retrospective study, the radiological and hospital information system was searched for patients who underwent CT for clinically suspected ACD prior to surgery between 2009 and 2019. From the initial population (n = 164), we included 155 patients (94.5 %) (85 women; mean age: 58 ± 13 years) matching the following inclusion criteria: i.) clinically suspected ACD, ii.) i.v. contrast-enhanced CT, iii.) surgery for ACD within 1 week after CT, iv.) histopathological report that proved ACD. The remaining 9 patients (5.5 %) were excluded because histopathological reports were lacking (n = 3) or CT was performed without intravenous contrast agent (n = 6). WE (+ butylscopolamine i.v.) was performed in 93 patients (group A, 60 %). 62 patients (group B, 40 %) had no WE. Visceral-to-subcutaneous fat ratio (V/S) was determined for each patient. Two radiologists blinded for final diagnosis independently staged ACD according to CDD and assessed prevalence and confidence ratings of ACD-related CT-findings: pericolonic fat stranding, covered- and free-perforation, local and generalized peritonitis, abscess. Interobserver-agreement of CT-findings were assessed and effects of WE and V/S ratio on the diagnostic accuracy of CT with surgical and histopathological findings as reference were determined by calculating a logistic regression model. RESULTS CT-staging showed high accuracy (94 %) and excellent interrater-correlation (ICC 0.96) for staging ACD. WE had no positive impact neither on diagnostic accuracy of staging, nor on confidence ratings of ACD-related CT-findings (all p > 0.5). Confidence ratings were significantly higher in examinations without WE for perforation, peritonitis as well as abscesses (all p < 0.5). Confidence ratings for the assessment of local peritonitis improved significantly with higher V/S (p = 0.049). The increase of V/S significantly correlated with the probability for correct CDD staging of ACD in CT (p = 0.023). CONCLUSION Increase of visceral obesity significantly improves accuracy of CT in preoperative staging acute colonic diverticulitis. However, independently of the degree of visceral obesity, water enema has no diagnostic benefit and may therefore be omitted. Overall, CT proves high accuracy in preoperative staging ACD using the classification of diverticular disease. LEVEL OF EVIDENCE Retrospective study, observational study.
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Affiliation(s)
- Vanessa Hanna Rausch
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D 20246, Hamburg, Germany.
| | - Layal Sabour
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Michael Gerhard Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Abstract
BACKGROUND Diverticular disease frequently leads to emergency admissions. Clinical parameters are not sufficiently accurate to determine the extent of acute colonic diverticulitis, thus a quick, reproducible and valid diagnostic imaging procedure is required. OBJECTIVE In the following, the imaging methods commonly used for the diagnostic work-up and staging of diverticulitis are presented and classified in the context of the data situation and clinical reality. RESULTS Multidetector computed tomography (MDCT) is the current diagnostic gold standard for the imaging evaluation of diverticulitis and the basis for guideline-conform treatment decisions according to the classification of diverticular disease (CDD). DISCUSSION The role of magnetic resonance imaging (MRI) in the evaluation of diverticulitis will have to be investigated but a more profound integration of this method can already be predicted. Point-of-care ultrasound for initial diagnosis and follow-up assessment will become more important, analogous to FAST in trauma patients.
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Affiliation(s)
- Arnd-Oliver Schäfer
- Klinik für Radiologie, Städtisches Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland.
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Sohn M, Agha A, Iesalnieks I, Gundling F, Presl J, Hochrein A, Tartaglia D, Brillantino A, Perathoner A, Pratschke J, Aigner F, Ritschl P. Damage control strategy in perforated diverticulitis with generalized peritonitis. BMC Surg 2021; 21:135. [PMID: 33726727 PMCID: PMC7968247 DOI: 10.1186/s12893-021-01130-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann’s procedure (HP), laparoscopic lavage (LL) and damage control surgery (DCS). This review intends to systematically analyze the current literature on DCS. Methods DCS consists of two stages. Emergency surgery: limited resection of the diseased colon, oral and aboral closure, lavage, vacuum-assisted abdominal closure. Second look surgery after 24–48 h: definite reconstruction with colorectal anastomosis (−/ + DI) or HP after adequate resuscitation. The review was conducted in accordance to the PRISMA-P Statement. PubMed/MEDLINE, Cochrane central register of controlled trials (CENTRAL) and EMBASE were searched using the following term: (Damage control surgery) AND (Diverticulitis OR Diverticulum OR Peritonitis). Results Eight retrospective studies including 256 patients met the inclusion criteria. No randomized trial was available. 67% of the included patients had purulent, 30% feculent peritonitis. In 3% Hinchey stage II diverticulitis was found. In 49% the Mannheim peritonitis index (MPI) was greater than 26. Colorectal anastomosis was constructed during the course of the second surgery in 73%. In 15% of the latter DI was applied. The remaining 27% received HP. Postoperative mortality was 9%, morbidity 31% respectively. The anastomotic leak rate was 13%. 55% of patients were discharged without a stoma. Conclusion DCS is a safe technique for the treatment of acute perforated diverticulitis with generalized peritonitis, allowing a high rate of colorectal anastomosis and stoma-free hospital discharge in more than half of the patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01130-5.
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Affiliation(s)
- Maximilian Sohn
- Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Ayman Agha
- Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Igors Iesalnieks
- Department of General, Abdominal, Endocrine and Minimally Invasive Surgery, Munich Clinic Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Felix Gundling
- Department of Gastroenterology, Medizinische Klinik II, Sozialstiftung Bamberg, Bamberg Bamberg, Germany
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | - Dario Tartaglia
- Emergency Surgery Unit, Cisanello Hospital, University of Pisa, Pisa, Italy
| | | | - Alexander Perathoner
- Department of Abdominal, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, 10178, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Paul Ritschl
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, 10178, Berlin, Germany.
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Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su'a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol 2021; 19:503-510.e1. [PMID: 32240832 DOI: 10.1016/j.cgh.2020.03.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antibiotic treatment is the standard care for patients with uncomplicated acute diverticulitis. However, this practice is based on low-level evidence and has been challenged by findings from 2 randomized trials, which did not include a placebo group. We investigated the non-inferiority of placebo vs antibiotic treatment for the management of uncomplicated acute diverticulitis. METHODS In the selective treatment with antibiotics for non-complicated diverticulitis study, 180 patients hospitalized for uncomplicated acute diverticulitis (determined by computed tomography, Hinchey 1a grade) from New Zealand and Australia were randomly assigned to groups given antibiotics (n = 85) or placebo (n = 95) for 7 days. We collected demographic, clinical, and laboratory data and answers to questionnaires completed every 12 hrs for the first 48 hrs and then daily until hospital discharge. The primary endpoint was length of hospital stay; secondary endpoints included occurrence of adverse events, readmission to the hospital, procedural intervention, change in serum markers of inflammation, and patient-reported pain scores at 12 and 24 hrs. RESULTS There was no significant difference in median time of hospital stay between the antibiotic group (40.0 hrs; 95% CI, 24.4-57.6 hrs) and the placebo group (45.8 hrs; 95% CI, 26.5-60.2 hrs) (P = .2). There were no significant differences between groups in adverse events (12% for both groups; P = 1.0), readmission to the hospital within 1 week (1% for the placebo group vs 6% for the antibiotic group; P = .1), and readmission to the hospital within 30 days (11% for the placebo group vs 6% for the antibiotic group; P = .3). CONCLUSIONS Foregoing antibiotic treatment did not prolong length of hospital admission. This result provides strong evidence for omission of antibiotics for selected patients with uncomplicated acute diverticulitis. ACTRN 12615000249550.
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Affiliation(s)
- Rebekah Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sherry Nisbet
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Martijn Pieter Gosselink
- Department of Colorectal Surgery, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Angelina Di Re
- Department of Colorectal Surgery, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Celia Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Anthony Lin
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tony Milne
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Bruce Su'a
- South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Siraj Rajaratnam
- Colorectal Unit, Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Grahame Ctercteko
- Department of Colorectal Surgery, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Li Hsee
- Acute Surgical Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - David Rowbotham
- Department of Gastroenterology and Hepatology, Auckland City Hospital, Auckland, New Zealand South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Andrew Hill
- South Auckland Clinical School, University of Auckland, Auckland, New Zealand; Department of Surgery, Counties Manukau Health, Auckland New Zealand
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand; Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand.
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Zaborowski AM, Winter DC. Evidence-based treatment strategies for acute diverticulitis. Int J Colorectal Dis 2021; 36:467-475. [PMID: 33156365 DOI: 10.1007/s00384-020-03788-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Diverticular disease is a common acquired condition of the lower gastrointestinal tract that may be associated with significant morbidity. The term encompasses a spectrum of pathological processes with varying clinical manifestations. The purpose of this review was to update the reader on modern evidence-based treatment strategies for acute diverticulitis. METHODS A literature search of the PUBMED database was performed using the keywords 'diverticulosis', 'diverticular disease' and 'diverticulitis'. Only articles published in the English language were included. RESULTS Evidence-based treatment strategies for acute diverticulitis have evolved over time. Data have questioned the need for antibiotic therapy for Hinchey I disease and the role of percutaneous abscess drainage for Hinchey II. Clinical trials have demonstrated laparoscopic lavage is an appropriate option for select patients with Hinchey III disease and primary resection with anastomosis and defunctioning stoma may be considered in some cases of Hinchey IV disease. CONCLUSION Risk-adapted treatment strategies and operative decision-making for acute diverticulitis are increasingly based on a combination of patient and disease factors.
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Affiliation(s)
- Alexandra M Zaborowski
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Des C Winter
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Beresneva O, Donohue K, Kuhnen AH. Abscess management in left-sided diverticulitis. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2020.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lock JF, Galata C, Reißfelder C, Ritz JP, Schiedeck T, Germer CT. The Indications for and Timing of Surgery for Diverticular Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:591-596. [PMID: 33161943 DOI: 10.3238/arztebl.2020.0591] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/14/2019] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diverticular disease is one of the more common abdominal disorders. In 2016, approximately 130 000 patients received inpatient treatment for diverticular disease in Germany. The disease has a number of subtypes, each of which has an appropriate treatment. In this article, we present the current surgical indications and optimal timing of surgery for diverticular disease. METHODS This review is based on publications that were retrieved by an extensive, selective search in Medline and the Cochrane Library (1998-2018) for studies and guidelines with information on the indications for surgery in diverticular disease. RESULTS Studies of evidence grades 2 to 4 were available. Patients receiving a diagnosis of freely perforated diverticulitis and peritonitis (Classification of Diverticular Disease [CDD] type 2c) should be operated on at once. Covered perforated diverticulitis with a macroabscess (>1 cm, CDD type 2b) may be an indication for elective surgery after successful conservative treatment. New evidence from a randomized, controlled trial suggests that elective surgery should also be considered for patients with chronic recurrent diverticulitis (CDD type 3b). The decisive factor in such cases is the impairment of the quality of life for the individual patient. Elective surgery is indicated in chronic recurrent diverticulitis with complications (fistulae, stenoses). Asymptomatic diverticulosis (CDD type 0) and uncomplicated diverticulitis (CDD type 1) are not surgical indications. Likewise, in diverticular hemorrhage (CDD type 4), surgery is only indicated in exceptional cases, when conservative treatment fails. CONCLUSION The surgical indication and the proper timing of surgery depend on the type of disease that is present. Future studies should more thoroughly investigate the effect of surgery on the quality of life in patients with the various types of diverticular disease.
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Affiliation(s)
- Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Christian Galata
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jörg-Peter Ritz
- Department of General and Visceral Surgery, Helios Klinikum Schwerin, Schwerin, Germany
| | - Thomas Schiedeck
- Department of General, Visceral, Thoracic and Pediatric Surgery, Klinikum Ludwigsburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
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Epidemiology of Diverticulitis and Prevalence of First-Ever Colorectal Cancer Postdiverticulitis in Adults in the United States: A Population-Based National Study. Dis Colon Rectum 2021; 64:181-189. [PMID: 33044246 DOI: 10.1097/dcr.0000000000001837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of acute diverticulitis is increasing, and previous studies showed a wide range of prevalence of colorectal cancer after diverticulitis. There is a lack of high-quality evidence to support performing colonoscopy after diverticulitis. OBJECTIVE We aimed to describe the incidence of first-ever diverticulitis and prevalence of first-ever colorectal cancer postdiverticulitis in the United States. DESIGN This is a retrospective cohort study. SETTINGS We queried a national database that contains data from 26 major integrated healthcare systems in the United States. PATIENTS We identified an aggregated patient cohort aged ≥18 years with a diagnosis of first-ever diverticulitis from February 2015 to February 2020, followed by first-ever colorectal cancer diagnosis, at least 1 day after and within 1 year of diverticulitis. MAIN OUTCOME MEASURES The incidence of first-ever diverticulitis was calculated. The prevalence and OR of first-ever colorectal cancer after diverticulitis were analyzed. RESULTS Among 31,778,290 individuals, we found the incidence of first-ever acute diverticulitis to be 2.9%. The prevalence of colorectal cancer within 1 year of first-ever acute diverticulitis was 0.57%, whereas the prevalence of colorectal cancer without a history of diverticulitis was 0.31% (OR = 1.8 (95% CI, 1.76-1.86)). The majority (92.3%) of the postdiverticulitis colorectal cancer were diagnosed within the first 6 months. The risk of colorectal cancer postdiverticulitis was higher in women (OR = 1.9), African Americans (OR = 2.0), and adults aged 18 to 65 years (OR = 2.3). LIMITATIONS We are unable to validate the diagnostic code because patient information in our database is deidentified. CONCLUSIONS Individuals are twice as likely to be diagnosed with colorectal cancer within 1 year of their first episode of acute diverticulitis compared with individuals without diverticulitis. We advocate for colonoscopy after the first occurrence of acute diverticulitis to screen for colorectal cancer, particularly for patients without a recent colonoscopy. See Video Abstract at http://links.lww.com/DCR/B412.
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Wirth U, Schardey J, von Ahnen T, Zimmermann P, Kühn F, Werner J, Schardey HM, Rau BM, Gumpp J. Oral antibiotic bowel decontamination in open and laparoscopic sigmoid resections for diverticular disease. Int J Colorectal Dis 2021; 36:1667-1676. [PMID: 33606074 PMCID: PMC8279973 DOI: 10.1007/s00384-021-03890-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE There is an ongoing debate on whether or not to use oral antibiotic bowel decontamination in colorectal surgery, despite the numerous different regimens in terms of antibiotic substances and duration of application. As we routinely use oral antibiotic bowel decontamination (selective decontamination of the digestive tract (SDD) regimen and SDD regimen plus vancomycin since 2016) in surgery for diverticular disease, our aim was to retrospectively analyze the perioperative outcome in two independent centers. METHODS Data from two centers with a routine use of oral antibiotic bowel decontamination for up to 20 years of experience were analyzed for the perioperative outcome of 384 patients undergoing surgery for diverticular disease. RESULTS Overall morbidity was 12.8%, overall mortality was 0.3%, the overall rate of anastomotic leakage (AL) was 1.0%, and surgical site infections (SSIs) were 5.5% and 7.8% of all infectious complications including urinary tract infections and pneumonia. No serious adverse events were related to use of oral antibiotic bowel decontamination. Most of the patients (93.8%) completed the perioperative regimen. Additional use of vancomycin to the SDD regimen did not show a further reduction of infectious complications, including SSI and AL. CONCLUSION Oral antibiotic decontamination appears to be safe and effective with low rates of AL and infectious complications in surgery for diverticular disease.
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Affiliation(s)
- Ulrich Wirth
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University of Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Josefine Schardey
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University of Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Thomas von Ahnen
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany
| | - Petra Zimmermann
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University of Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Florian Kühn
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University of Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University of Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Hans Martin Schardey
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany
| | - Bettina M. Rau
- Department of Surgery, Kliniken des Landkreises Neumarkt, Neumarkt, Germany
| | - Julia Gumpp
- Department of Surgery, Kliniken des Landkreises Neumarkt, Neumarkt, Germany
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Farkas N, Conroy M, Harris H, Kenny R, Baig MK. Hartmann's at 100: Relevant or redundant? Curr Probl Surg 2020; 58:100951. [PMID: 34392941 DOI: 10.1016/j.cpsurg.2020.100951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Nicholas Farkas
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom.
| | - Michael Conroy
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Holly Harris
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Ross Kenny
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Mirza Khurrum Baig
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
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Receptors for pro-resolving mediators as a therapeutic tool for smooth muscle remodeling-associated disorders. Pharmacol Res 2020; 164:105340. [PMID: 33276103 DOI: 10.1016/j.phrs.2020.105340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/16/2022]
Abstract
Respiratory airway, blood vessel and intestinal wall remodeling, in which smooth muscle remodeling plays a major role, is a key pathological event underlying the development of several associated diseases, including asthma, cardiovascular disorders (e.g., atherosclerosis, hypertension, and aneurism formation), and inflammatory bowel disease. However, the mechanisms underlying these remodeling processes remain poorly understood. We hypothesize that the creation of chronic inflammation-mediated networks that support and exacerbate the airway, as well as vascular and intestinal wall remodeling, is a crucial pathogenic mechanism governing the development of the associated diseases. The failed inflammation resolution might be one of the causal pathogenic mechanisms. Hence, it is reasonable to assume that applying specialized, pro-resolving mediators (SPMs), acting via cognate G-protein coupled receptors (GPCRs), could potentially be an effective pathway for treating these disorders. However, several obstacles, such as poor understanding of the SPM/receptor signaling pathways, SMP rapid inactivation as well as their complex and costly synthesis, limit their translational potential. In this connection, stable, small-molecule SPM mimetics and receptor agonists have emerged as new, potentially suitable drugs. It has been recently shown in preclinical studies that they can effectively attenuate the manifestations of asthma, atherosclerosis and Crohn's disease. Remarkably, some biased SPM receptor agonists, which cause a signaling response in the desired inflammation pro-resolving direction, revealed similar beneficial effects. These encouraging observations suggest that SPM mimetics and receptor agonists can be applied as a novel approach for the treatment of various chronic inflammation conditions, including airway, vascular and intestinal wall remodeling-associated disorders.
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Treating acute colonic diverticulitis with extraluminal pericolic air: An Acute Care Surgery in the Netherlands (ACCSENT) multicenter retrospective cohort study. Surgery 2020; 169:1182-1187. [PMID: 33257036 DOI: 10.1016/j.surg.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Owing to improved quality of computed tomography, a new category of complicated acute diverticulitis, including patients with pericolic air but without abscess formation, can be defined (Hinchey 1a). Recent studies question whether this new category of acute diverticulitis could be treated as uncomplicated cases. The aim of our study is to report on the clinical course of acute diverticulitis Hinchey 1a in current clinical practice. METHODS For this multicenter retrospective cohort study, patients presenting at the emergency department with Hinchey 1a acute diverticulitis as demonstrated by computed tomography scan, were identified. The primary outcome measure was successful conservative treatment with observation alone, antibiotics, and/or hospital admission. Readmissions, percutaneous drainage of abscesses, and emergency operations were considered as failure. RESULTS Between October 2016 and October 2018, 1,199 patients were clinically suspected for acute diverticulitis, of whom 101 (8.4%) were radiologically diagnosed to have type 1a acute diverticulitis (average age 57 (±13) years, 45% female) and started with conservative treatment. This was successful in 86 (85%) patients. One of the 15 unsuccessfully treated patients (1%) received percutaneous drainage of an abdominal abscess. Surgery was required in 9 cases (9%) after a median time of 6 days (range, 3 to 69 days). Although a difference in the volume of extraluminal air on computed tomography scan was found, this was not shown to be a risk factor for the clinical course. CONCLUSION Patients with type 1a acute diverticulitis can be treated successfully by conservative therapy in the majority of cases (85%). More research is required to define predictive factors for successful conservative management.
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Nascimbeni R, Amato A, Cirocchi R, Serventi A, Laghi A, Bellini M, Tellan G, Zago M, Scarpignato C, Binda GA. Management of perforated diverticulitis with generalized peritonitis. A multidisciplinary review and position paper. Tech Coloproctol 2020; 25:153-165. [PMID: 33155148 PMCID: PMC7884367 DOI: 10.1007/s10151-020-02346-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann’s procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure.
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Affiliation(s)
- R Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124, Brescia, Italy.
| | - A Amato
- Unit of Coloproctology, Department of Surgery, Borea Hospital, Sanremo, Italy
| | - R Cirocchi
- Department of Surgical and Medical Sciences, University of Perugia, Terni, Italy
| | - A Serventi
- Department of Surgery, Galliano Hospital, Acqui Terme, Italy
| | - A Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - M Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Tellan
- Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Zago
- Department of Robotic and Emergency Surgery, Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - C Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta
- Faculty of Medicine, Chinese University of Hong Kong, ShaTin, Hong Kong
| | - G A Binda
- General Surgery, Biomedical Institute, Genoa, Italy
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Current management of acute left colon diverticulitis: What have Italian surgeons learned after the IPOD study? Updates Surg 2020; 73:139-148. [PMID: 33010025 DOI: 10.1007/s13304-020-00891-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
The acute left diverticulitis is a common problem encountered by surgeons in the acute setting. Some years ago, the Italian Prospective Observational Diverticulitis (IPOD) study showed several disputes in managing acute left colon diverticulitis in Italian surgical department. The aim of this study is to check the compliance of Italian surgeons with clinical evidence-based guidelines in non-university hospitals. A 21 multiple-choice questions survey was sent to the Italian Society of Hospital Surgeons (ACOI) mailing list members, from the 1st April 2019 to 6th June 2019. One hundred and seventy-four Italian general surgeons (the ACOI collaborative diverticulitis group) joined the project and answered to the survey. The response rate was 7% (174/2500 ACOI members). Despite current international guidelines about the management of acute diverticulitis, several controversies have emerged from the analysis of this survey in the clinical practice of Italian surgeons, resulting from their low compliance with evidence-based recommendations.
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Maconi G, Pini A, Pasqualone E, Ardizzone S, Bassotti G. Abdominal Symptoms and Colonic Diverticula in Marfan’s Syndrome: A Clinical and Ultrasonographic Case Control Study. J Clin Med 2020; 9:jcm9103141. [PMID: 32998474 PMCID: PMC7599469 DOI: 10.3390/jcm9103141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Marfan’s syndrome (MFS) seems to be frequently associated with colonic diverticulosis, but the prevalence of diverticula and symptoms evocative of diverticular disease in this population are still unknown. Methods: This prospective case control study included 90 consecutive patients with MFS, 90 unselected controls, and 90 asymptomatic subjects. The clinical characteristics, including lower gastrointestinal symptoms, and ultrasonographic features of the bowel, including diverticula and thickening of the muscularis propria of the sigmoid colon, were investigated. In addition, the genotype of MFS patients was assessed. The characteristics of patients and controls were compared using parametric tests. Results: Complaints of abdominal symptoms were made by 23 (25.6%) patients with MFS and 48 (53%) control subjects (p < 0.01). Constipation and bloating were reported less frequently by MFS patients than controls (constipation: 13.3% vs. 26.6%, p = 0.039; bloating: 3.3% vs. 41.1%, p < 0.0001), while other symptoms were not significantly different. Sigmoid diverticulosis was detected in 12 (12.3%) patients with MFS, as well as in 3 (3.3%) asymptomatic healthy subjects and 4 (4.4%) random controls (p = 0.0310). The genetic variants of MFS were not correlated with symptoms or diverticula. Conclusion: Patients with MFS have a greater prevalence of diverticula, although less abdominal symptoms, compared to the general population. Symptoms and diverticula in MFS are not correlated with any genetic variant.
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Affiliation(s)
- Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy; (E.P.); (S.A.)
- Correspondence: Giovanni ; Tel.: +39-023-904-3164
| | - Alessandro Pini
- Cardiovascular-Genetic Center, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Elia Pasqualone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy; (E.P.); (S.A.)
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy; (E.P.); (S.A.)
| | - Gabrio Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia Medical School, 06122 Perugia, Italy;
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46
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Schultz JK, Azhar N, Binda GA, Barbara G, Biondo S, Boermeester MA, Chabok A, Consten ECJ, van Dijk ST, Johanssen A, Kruis W, Lambrichts D, Post S, Ris F, Rockall TA, Samuelsson A, Di Saverio S, Tartaglia D, Thorisson A, Winter DC, Bemelman W, Angenete E. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis 2020; 22 Suppl 2:5-28. [PMID: 32638537 DOI: 10.1111/codi.15140] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/07/2020] [Indexed: 02/08/2023]
Abstract
AIM The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. METHODS The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. RESULTS This guideline contains 38 evidence based consensus statements on the management of diverticular disease. CONCLUSION This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.
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Affiliation(s)
- J K Schultz
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - N Azhar
- Colorectal Unit, Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - G A Binda
- Colorectal Surgery, BioMedical Institute, Genova, Italy
| | - G Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - S Biondo
- Department of General and Digestive Surgery - Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - M A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Chabok
- Colorectal Unit, Department of Surgery, Centre for Clinical Research Uppsala University, Västmanlands Hospital Västerås, Västerås, Sweden
| | - E C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.,Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S T van Dijk
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Johanssen
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - W Kruis
- Faculty of Medicine, University of Cologne, Cologne, Germany
| | - D Lambrichts
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Post
- Mannheim Faculty of Medicine, University of Heidelberg, Mannheim, Germany
| | - F Ris
- Division of Visceral Surgery, Geneva University hospitals and Medical School, Geneva, Switzerland
| | - T A Rockall
- Minimal Access Therapy Training Unit (mattu), Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - A Samuelsson
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden.,Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.,Department of General Surgery, ASST Sette Laghi, University Hospital of Varese, University of Insubria, Varese, Italy
| | - D Tartaglia
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - A Thorisson
- Department of Radiology, Västmanland's Hospital Västerås, Västerås, Sweden.,Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås, Västerås, Sweden
| | - D C Winter
- St Vincent's University Hospital, Dublin, Ireland
| | - W Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E Angenete
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Abstract
PURPOSE Large bowel obstruction and megacolon formation secondary to complicated diverticulitis is rare. METHODS We present a case of an 84-year-old woman surviving large bowel obstruction and mega-megacolon formation secondary to complicated diverticulitis, with an impressive presentation of abdominal distention. RESULTS The patient's symptoms, laboratory test results, and imaging were consistent with large bowel obstruction. The patient underwent urgent exploratory laparotomy. Upon entry in the abdomen, it was unexpected that the extreme colonic wall thickening had prevented perforation, indicating the longtime course of illness. The biopsy of the specimen from the site of the obstruction demonstrated an inflammatory obstructing mass. CONCLUSION This report aims to point out the atypical and in-extremes presentation of an otherwise common disease.
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48
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MDCT in the Setting of Suspected Colonic Diverticulitis: Prevalence and Diagnostic Yield for Diverticulitis and Alternative Diagnoses. AJR Am J Roentgenol 2020; 215:39-49. [DOI: 10.2214/ajr.19.21852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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49
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Pesce A, Barchitta M, Agodi A, Salerno M, La Greca G, Magro G, Latteri S, Puleo S. Comparison of clinical and pathological findings of patients undergoing elective colectomy for uncomplicated diverticulitis. Sci Rep 2020; 10:8854. [PMID: 32483125 PMCID: PMC7264214 DOI: 10.1038/s41598-020-65727-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Diverticular disease affects ∼5-10% people worldwide, yet the indications for elective colectomy in uncomplicated diverticulitis are unclear. As there is no strong scientific evidence regarding histology in diverticular disease, the primary outcome of the study was to analyze the degree of inflammation of colonic wall in patients that underwent elective colectomy for uncomplicated diverticulitis and to retrospectively assess the correlation between patient clinical history and pathological features of surgical specimens in order to find some predictive factors that may be strictly correlated with histology. An observational retrospective study was conducted. Patients undergoing elective colectomy for uncomplicated diverticulitis between January 2014 and January 2016 in an academic medical center were collected. The majority of patients (46.2%) had previously encountered one episode of acute diverticulitis prior to colectomy, while 21.5% and 10.8% had experienced two and three or more prior episodes respectively. Most patients had recurrent or chronic abdominal pain in the left iliac fossa (66.2%) for diverticular disease and a large proportion also experienced constipation (40.0%). Diverticulitis was identified pathologically as being "mild" in 44.6% patients and "severe" in 55.4% patients. The mean age was significantly lower in patients with severe diverticulitis (56.7 years) than in patients with mild diverticulitis (67.0 years). 71.9% of males had severe diverticulitis compared to 39.4% of females. Males have a 3.9 times higher risk of histological severe diverticulitis than females (OR = 3.932; 1.390-11.122; p = 0.008). Multivariate logistic regression analysis confirmed that age and gender were independent factors associated with histological diagnosis. Single-institution data and retrospective design were main limitations of this study. Age and gender are independent factors associated with severity inflammation index derived at histological analysis and they could be translated to clinical practice to better categorize patients with uncomplicated diverticulitis at the bedside.
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Affiliation(s)
- Antonio Pesce
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Monica Salerno
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Legal Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Gaetano La Greca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Saverio Latteri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Stefano Puleo
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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Trans-stomal single-port laparoscopic Hartmann's reversal is an efficacious and efficient procedure: a case-controlled study. Tech Coloproctol 2020; 24:455-462. [PMID: 32200457 DOI: 10.1007/s10151-020-02166-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hartman's reversal remains challenging and is associated with a widely variable success rate. In a previous study, we reported that laparoscopy may lower the mortality and morbidity rates of the procedure. The aim of the current study was to assess the operative results of single-port laparoscopic Hartmann's reversal (SP-HR) as compared to the more standard, multi-port laparoscopic variant (MP-HR). METHODS We performed a retrospective, non-randomized, case-controlled study of 44 consecutive patients who had SP-HR (Group A) compared to 44 patients who had MP-HR (Group B). The study was conducted in a high-volume colorectal unit in a 1200-bed university affiliated hospital, The Poissy-Saint Germain Medical Complex, France. RESULTS Preoperative patients' characteristics (sex, body mass index, American Society of Anesthesiologists status, prior surgery, comorbidities, colonic disease) were comparable in both groups. The conversion rate was 13.6% and 4.5% in Group A and in Group B, respectively (p = 0.084) and consisted of placement of any additional ports. Conversion to open surgery did not occur in any patient in either group (p = 1). Mean operative time was shorter in Group A than in in Group B, (105 vs. 155 min; p = 0.0133). The mortality rate was 2.2% in Group A and 0% in Group B (p = 0.3145). The overall morbidity rate was 11.4% in Group A and 18.2% in Group B (p = 0.5344). The median length of hospital stay was significantly shorter in Group than in Group B (4.8 vs. 6.8 days; p = 0.0102). CONCLUSIONS The SP-HR technique was found to be safe and efficient. It compares favorably with MP-HR. Moreover, indirect cost savings could be induced by the reduction in the length of hospital stay.
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