1
|
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.
Collapse
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
| |
Collapse
|
2
|
Yu HW, An AR, Kang HI, Suh YJ, Kwon H, Kim SJ, Chai YJ, Choi JY, Choi H, Lee KE, Cho B. Does Thyroidectomy Impact Quality of Life: Retrospective Case-Control Study of Post-Thyroidectomy Patients and Matched Individuals from the General Population. ACTA ACUST UNITED AC 2020; 56:medicina56110603. [PMID: 33182641 PMCID: PMC7697461 DOI: 10.3390/medicina56110603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The study assesses quality of life (QoL) in patients who underwent thyroidectomy compared to the general population. Materials and Methods: QoL data from post-thyroidectomy patients and individuals with no subjective health concerns, who had attended a routine health screening visit, were evaluated. QoL was assessed using the modified version of Korean Short Form 12 questionnaire (SF-12). Patients and controls were matched using the propensity score approach and a ratio of 1:4. Results: Data from a total of 105 patients and 420 controls were analyzed. For five SF-12 items, lower QoL was found in patients (p < 0.05). Multivariate analysis revealed that a follow-up duration of <1-year, female sex, and an age of >50 years were independent risk factors. No significant difference was found between controls and patients who were >1-year post-surgery. Conclusions: For specific SF-12 items, QoL was lower in post-thyroidectomy patients than in controls. No intergroup difference in QoL was found >1-year post-surgery.
Collapse
Affiliation(s)
- Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (H.W.Y.); (J.Y.C.)
| | - Ah Reum An
- Department of Family Medicine, Seoul National University Hospital Healthcare System Gangnam Center and College of Medicine, Seoul 06236, Korea; (A.R.A.); (B.C.)
| | - Hye In Kang
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea;
| | - Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea;
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University College of Medicine, Seoul 07985, Korea;
| | - Su-jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul 03080, Korea;
- Correspondence: (S.-j.K.); (H.C.)
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul 07061, Korea;
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (H.W.Y.); (J.Y.C.)
| | - Hochun Choi
- Department of Family Medicine, Seoul National University Hospital Healthcare System Gangnam Center and College of Medicine, Seoul 06236, Korea; (A.R.A.); (B.C.)
- Correspondence: (S.-j.K.); (H.C.)
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul 03080, Korea;
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital Healthcare System Gangnam Center and College of Medicine, Seoul 06236, Korea; (A.R.A.); (B.C.)
| |
Collapse
|
3
|
Ahmed AM, Moahammed AT, Mattar OM, Mohamed EM, Faraag EA, AlSafadi AM, Hirayama K, Huy NT. Surgical treatment of diverticulitis and its complications: A systematic review and meta-analysis of randomized control trials. Surgeon 2018; 16:372-383. [PMID: 30033140 DOI: 10.1016/j.surge.2018.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/24/2018] [Accepted: 03/30/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE The surgical interventions of diverticulitis vary according to its grade and severity. There is a controversy about the best of these different surgical procedures. We aimed to systematically review and meta-analyze randomized controlled trials (RCTs) comparing outcomes and complications between different surgical approaches for acute diverticulitis and its complications. METHODS Nine electronic databases including PubMed, Scopus, and Web of Science were searched for RCTs comparing different surgical procedures for different grades of diverticulitis. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered in PROSPERO (CRD42015032290). RESULTS Outcome data were analyzed from five RCTs comparing laparoscopic sigmoid resection (LSR) (n = 247) versus open sigmoid resection (OSR) (n = 237) for treatment of acute complicated diverticulitis with minimal heterogeneity. There was no significant difference in short-term postoperative overall morbidity (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61-1.31; P = 0.56) and long-term postoperative major morbidity (RR 0.78, 95% CI 0.46-1.31, P = 0.34). In other six RCTs compared laparoscopic lavage with resection for treatment of perforated diverticulitis with peritonitis, the postoperative mortality rate was non-significant in both short-term (RR 1.55, 95% CI 0.79-3.04; P = 0.21) and long-term (RR 0.67, 95% CI 0.29-1.58; P = 0.36) follow up. CONCLUSIONS LSR is not superior over OSR regarding postoperative morbidity and mortality for acute symptomatic diverticulitis. Furthermore, laparoscopic lavage was proved to be as safe as resection for perforated diverticulitis with peritonitis. Further RCTs are still needed to make an accurate decision regarding these and other procedures.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, 70000, Viet Nam; Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan.
| |
Collapse
|
4
|
Polese L, Bressan A, Savarino E, Vecchiato M, Turoldo A, Frigo A, Sturniolo GC, De Manzini N, Petri R, Merigliano S. Quality of life after laparoscopic sigmoid resection for uncomplicated diverticular disease. Int J Colorectal Dis 2018. [PMID: 29525902 DOI: 10.1007/s00384-018-3005-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL). METHODS All consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease. RESULTS Ninety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p < 0.0001). The surgically treated patients reported a worse quality of life before treatment with respect to the patients treated conservatively (mean 21.12 surgical vs 15.41 conservative, p = 0.0048). The surgically treated patients presented better post-treatment global scores with respect to the conservatively treated patients (mean: 6.90 surgical vs 10.61 conservative, p = 0.0186). Covariance analysis confirmed that the differences between the pre- and post-treatment DV-QoL scores were significantly higher in the surgical (p = 0.0002) with respect to the non-surgical patients. As far as single items were concerned, differences between the two groups were found in the pre- and post-treatment "concerns" and "behavioral changes" DV-QoL items. CONCLUSIONS Sigmoidectomy reduces concerns about diverticulitis and behavioral changes due to the disease. Quality of life should be considered when referring patients with uncomplicated diverticulitis to surgery. Prospective studies are required to confirm this result.
Collapse
Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy. .,Clinica Chirurgica 3^, Policlinico Universitario, sesto piano. Via Giustiniani 2, 35128, Padova, Italy.
| | - Alice Bressan
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy
| | - Massimo Vecchiato
- Department of General Surgery, University Hospital of Udine, Udine, Italy
| | - Angelo Turoldo
- Department of Medical and Surgical Sciences, University of Trieste, Trieste, Italy
| | - Annachiara Frigo
- Department of Cardiology, Chest and Vascular Surgery, University of Padova, Padova, Italy
| | | | - Nicolò De Manzini
- Department of Medical and Surgical Sciences, University of Trieste, Trieste, Italy
| | - Roberto Petri
- Department of General Surgery, University Hospital of Udine, Udine, Italy
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, Padova University, Padova, Italy
| |
Collapse
|
5
|
Andeweg CS, Berg R, Staal JB, ten Broek RPG, van Goor H. Patient-reported Outcomes After Conservative or Surgical Management of Recurrent and Chronic Complaints of Diverticulitis: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:183-90. [PMID: 26305068 DOI: 10.1016/j.cgh.2015.08.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with diverticulitis develop recurrences and chronic abdominal symptoms. Recurrent diverticulitis is seldom complicated, which has led to a conservative treatment approach. However, some studies suggest that surgical intervention reduces recurrence and chronic abdominal problems. We conducted a systematic review and meta-analysis of quality of life (QOL) and other patient-reported outcomes (PROs) after conservative vs surgical treatment of uncomplicated diverticulitis. METHODS We searched the CENTRAL, MEDLINE, EMBASE, and PsycInfo databases for randomized trials and cohort studies reporting on QOL or other PROs after conservative or operative treatment for uncomplicated diverticulitis from January 1990 through May 2014. Eight PROs were defined and graded according to their clinical relevance. Risk of bias was assessed by using the Cochrane Collaboration tool. Subgroup and sensitivity analyses were performed to test the robustness of the results. The review protocol was registered through PROSPERO (CRD42013005854). RESULTS We analyzed data from 21 studies that comprised 1858 patients; all studies had a high risk of bias. There were no head-to-head comparisons of gastrointestinal symptoms or general QOL between elective surgical vs conservative treatment of recurrent diverticulitis. On the basis of Short-Form 36 scores, patients had higher QOL scores after elective laparoscopic resection (73.4; 95% confidence interval [CI], 65.7-81.1) than conservative treatment (58.1; 95% CI, 47.2-69.1). A lower proportion of patients had gastrointestinal symptoms after laparoscopic surgery (9%; 95% CI, 4%-14%) than conservative treatment (36%; 95% CI, 27%-45%) in all cohorts and in 1 trial comparing these treatments (odds ratio, 0.35; 95% CI, 0.16-0.7). The proportion of patients with chronic abdominal pain after elective laparoscopy was 11% (95% CI, 1%-21%) compared with 38% (95% CI, 19%-56%) after conservative treatment. CONCLUSIONS On the basis of a systematic review and meta-analysis, patients have better QOL and fewer symptoms after laparoscopic surgery vs conservative treatment. However, studies of PROs for treatment of diverticulitis were of low quality.
Collapse
Affiliation(s)
| | - Rosalyn Berg
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Bart Staal
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Damle RN, Flahive JM, Davids JS, Sweeney WB, Sturrock PR, Maykel JA, Alavi K. Surgeon Volume Correlates with Reduced Mortality and Improved Quality in the Surgical Management of Diverticulitis. J Gastrointest Surg 2016; 20:335-42. [PMID: 26487333 DOI: 10.1007/s11605-015-2990-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Volume has been shown to be an important determinant of quality and cost outcomes. METHODS We performed a retrospective study of patients who underwent surgery for diverticulitis using the University HealthSystem Consortium database from 2008–2012. Outcomes evaluated included minimally invasive approach, stoma creation, intensive-care admission, post-operative complications, length of stay, and total direct hospital costs by surgeon volume. Surgeon volume was categorized into four categories by mean annual volumes: very-high (VHVS) (>31), high (HVS) (13–31), medium (MVS) (6–12), and low (LVS) (≤5). RESULTS A total of 19,212 patients with a mean age of 59 years, 54 % female makeup, and 55 % rate of private insurance were included. Similar to the unadjusted analysis, multivariable analysis revealed decreasing odds of stoma creation, complications, ICU admission, reoperation, readmission, and inpatient mortality with increasing surgeon volume. Additionally, compared with LVS, a higher surgeon volume was associated with higher rates of the minimally invasive approach. Median length of stay and costs were also notably lower with increasing surgeon volume. CONCLUSION Quality and the use of minimally invasive technique are tightly associated with surgeon volume. Further studies are necessary to validate the direct association of volume with outcomes in surgery for diverticulitis.
Collapse
|
7
|
Bargellini T, Martellucci J, Tonelli P, Valeri A. Long-term results of treatment of acute diverticulitis: still lessons to be learned? Updates Surg 2012; 65:125-30. [DOI: 10.1007/s13304-012-0194-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/17/2012] [Indexed: 02/07/2023]
|
8
|
Raue W, Paolucci V, Asperger W, Albrecht R, Büchler MW, Schwenk W. Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial. Langenbecks Arch Surg 2011; 396:973-80. [PMID: 21779829 DOI: 10.1007/s00423-011-0825-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/27/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE Elective laparoscopic sigmoid resection (LSR) for symptomatic diverticular disease is supposed to have significant short-term advantages compared to open surgery (open sigmoid resection (OSR)). This opinion is rather based on inferences from trials on colonic resections for malignant diseases or minor laparoscopic surgery. This randomized controlled trial was conducted to compare quality of life as well as morbidity and clinical outcome after LSR vs. OSR following a midterm follow-up period. METHODS Patients presenting with a symptomatic sigmoid diverticular disease stage II/III (Stock/Hansen) were randomly allocated to LSR or OSR in a prospective multicenter trial. Endpoints included the quality of life assessed with a standardized questionnaire, postoperative mortality, and complications within the follow-up of 12 months after operation. RESULTS A total of 143 patients randomized between 2005 and 2008 in 12 centers could be analyzed. The recruitment was aborted for nonachievement of the planned sample size. Seventy-five patients were allocated to LSR, and 68 received OSR. Nine operations were converted to OSR (9%) and analyzed as intention to treat. Groups were comparable for age, gender, body mass index, comorbidity, and indication for surgery. Operation time was longer for LSR (p < 0.001). Quality of life did not differ between LSR and OSR, either during the early postoperative course or after 12 months (p = 0.172). Also, mortality and morbidity, including subgroups of major and minor morbidity, were compared. CONCLUSION LSR was not superior to OSR regarding postoperative quality of life and incidence of complications in this trial.
Collapse
Affiliation(s)
- Wieland Raue
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité-University Medicine Berlin, Campus Mitte, Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|