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Wang A, Liu Z, Li Q, Xu X, Zhu X, Zhou H. Laparoscopic sigmoid vaginoplasty for vaginal revision in a male-to-female transsexual-a video vignette. Colorectal Dis 2024. [PMID: 39252188 DOI: 10.1111/codi.17159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/30/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024]
Affiliation(s)
- Anqi Wang
- Department of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Zhiwan Liu
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Qingchu Li
- Department of Radiology, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Xinyun Xu
- Department of Breast and Thyroid Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Xiaohai Zhu
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Haiyang Zhou
- Department of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
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Carabotti M, Sgamato C, Amato A, Beltrame B, Binda GA, Germanà B, Leandro G, Pasquale L, Peralta S, Viggiani MT, Severi C, Annibale B, Cuomo R. Italian guidelines for the diagnosis and management of colonic diverticulosis and diverticular disease. Dig Liver Dis 2024:S1590-8658(24)00841-7. [PMID: 39004551 DOI: 10.1016/j.dld.2024.06.031] [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] [Received: 03/03/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024]
Abstract
Colonic diverticulosis and diverticular disease are among the most common gastrointestinal disorders encountered in clinical practice. These Italian guidelines focus on the diagnosis and management of diverticulosis and diverticular disease in the adult population, providing practical and evidence-based recommendations for clinicians. Experts from five Italian scientific societies, constituting a multidisciplinary panel, conducted a comprehensive review of meta-analyses, systematic reviews, randomised controlled trials, and observational studies to formulate 14 PICO questions. The assessment of the quality of the evidence and the formulation of the recommendations were carried out using an adaptation of the GRADE methodology. The guidelines covered the following topics: i) Management of diverticulosis; ii) Symptomatic uncomplicated diverticular disease: diagnosis and treatment; iii) Acute diverticulitis: diagnosis and treatment; iv) Management of diverticular disease complications; v) Prevention of recurrent acute diverticulitis; vi) Interventional management of diverticular disease.
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Affiliation(s)
- Marilia Carabotti
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Costantino Sgamato
- Gastroenterology and Endoscopy Unit, "Sant'Anna e San Sebastiano" Hospital Caserta, 81100 Caserta, Italy
| | | | - Benedetta Beltrame
- Department of Technical-Health Care Professions Dietetics Unit- AUSL Toscana Centro Santa Maria Nuova Hospital, Italy
| | | | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy San Martino Hospital, Belluno, Italy
| | | | - Luigi Pasquale
- Gastroenterology and Digestive Endoscopy, Avellino, Italy
| | - Sergio Peralta
- UOS Diagnostic and Interventional Digestive Endoscopy AOU Policlinico P.Giaccone, Palermo, Italy
| | | | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rosario Cuomo
- Gastroenterology and Endoscopy Unit, "Sant'Anna e San Sebastiano" Hospital Caserta, 81100 Caserta, Italy
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Sacks OA, Hall J. Management of Diverticulitis: A Review. JAMA Surg 2024; 159:696-703. [PMID: 38630452 DOI: 10.1001/jamasurg.2023.8104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Importance Care of patients with diverticulitis is undergoing a paradigm shift. This narrative review summarizes the current evidence for left-sided uncomplicated and complicated diverticulitis. The latest pathophysiology, advances in diagnosis, and prevention strategies are also reviewed. Observations Treatment is moving to the outpatient setting, physicians are forgoing antibiotics for uncomplicated disease, and the decision for elective surgery for diverticulitis has become preference sensitive. Furthermore, the most current data guiding surgical management of diverticulitis include the adoption of new minimally invasive and robot-assisted techniques. Conclusions and Relevance This review provides an updated summary of the best practices in the management of diverticulitis to guide colorectal and general surgeons in their treatment of patients with this common disease.
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Affiliation(s)
- Olivia A Sacks
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jason Hall
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
- Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
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Paasch C, De Santo G, Berndt N, Strik MW, Lefering R, Siegel R. Feasibility of laparoscopic resection for perforated diverticulitis: a retrospective observational study of 77 consecutive patients. Acta Chir Belg 2023; 123:632-639. [PMID: 36062887 DOI: 10.1080/00015458.2022.2122006] [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: 09/29/2021] [Accepted: 09/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Perforated colonic diverticulitis with purulent or fecal contamination (PCD) is a surgical emergency with high morbidity and mortality. Traditionally, open surgery as a Hartmann procedure (HP) has been performed. Feasibility of the laparoscopic approach (LA) either with primary anastomosis (PA) or as an HP has been shown, but evidence and implementation into daily routine remain low. We analysed all patients with PCD and emergency surgery at our institution to compare post-operative outcomes between LA and open surgery. Our results should add more evidence about the potential benefit of LA in treating PCD. METHODS This retrospective analysis conducted at a tertiary care centre in Germany included all patients with PCD undergoing emergency surgery between June 2007 and February 2019. Mortality and postoperative morbidity according to Clavien-Dindo-Classification are the primary endpoints. Secondary endpoints were stoma-free survival and length of hospital stay. RESULTS Seventy-seven patients were identified (41 female/36 male; median age 67.9 years). Sixty patients underwent a LA (conversion in 9 of 60, 15%). PA has been performed in 25 of 77 patients (22 LA, 3 with open surgery). Severe complications and death (Clavien-Dindo-Classification grade IIIb-V) were lower in patients with LA (17/60, 28%) compared to open surgery (9/17, 53%; p = 0.082) as well as the length of hospital stay (LOS; LA 9 days vs. open surgery 17 days; p = 0.016). CONCLUSION The LA is feasible in the majority of patients with PCD and may be warranted as a routine in emergency surgery. Although limited by a selection bias of this retrospective study, the LA seems to reduce morbidity and LOS.
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Affiliation(s)
- Christoph Paasch
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Brandenburg an der Havel, Germany
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Gianluca De Santo
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Nadja Berndt
- Medical School, Charité - University Medicine Berlin, Berlin, Germany
| | - Martin W Strik
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Robert Siegel
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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Wang A, Sun Z, Wu Z, Zhao J, Zhou H. Laparoscopic-assisted posterior-anterior approach for giant sacral schwannoma - a video vignette. Colorectal Dis 2023; 25:2287-2288. [PMID: 37837255 DOI: 10.1111/codi.16786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Anqi Wang
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Ziwei Sun
- Division of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Zheyu Wu
- Division of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Jian Zhao
- Division of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Haiyang Zhou
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
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Dreifuss NH, Casas MA, Angeramo CA, Schlottmann F, Laxague F, Bun ME, Rotholtz NA. Sigmoid resection and primary anastomosis for perforated diverticulitis with peritonitis: To divert or not to divert-A systematic review and meta-analysis. Surgery 2023:S0039-6060(23)00241-6. [PMID: 37258308 DOI: 10.1016/j.surg.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of this study was to compare the clinical outcomes of sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with a proximal diversion in perforated diverticulitis with diffuse peritonitis. METHOD A systematic literature search on sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with proximal diversion for diverticulitis with diffuse peritonitis was conducted in the Medline and EMBASE databases. Randomized clinical trials and observational studies reporting the primary outcome of interest (30-day mortality) were included. Secondary outcomes were major morbidity, anastomotic leak, reoperation, stoma nonreversal rates, and length of hospital stay. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes. RESULTS A total of 17 studies involving 544 patients (sigmoid resection and primary anastomosis: 287 versus sigmoid resection and primary anastomosis with proximal diversion: 257) were included. Thirty-day mortality (odds ratio 1.12, 95% confidence interval 0.53-2.40, P = .76), major morbidity (odds ratio 1.40, 95% confidence interval 0.80-2.44, P = .24), anastomotic leak (odds ratio 0.34, 95% confidence interval 0.099-1.20, P = .10), reoperation (odds ratio 0.49, 95% confidence interval 0.17-1.46, P = .20), and length of stay (sigmoid resection and primary anastomosis: 12.1 vs resection and primary anastomosis with diverting ileostomy: 15 days, P = .44) were similar between groups. The risk of definitive stoma was significantly lower after sigmoid resection and primary anastomosis (odds ratio 0.05, 95% confidence interval 0.006-0.35, P = .003). CONCLUSION Sigmoid resection and primary anastomosis with or without proximal diversion have similar postoperative outcomes in selected patients with diverticulitis and diffuse peritonitis. However, further randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- Nicolás H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Maria A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Maximiliano E Bun
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Nicolás A Rotholtz
- Department of Surgery, Hospital Alemán of Buenos Aires, Argentina; Colorectal Surgery Division, Department of Surgery, Hospital Alemán of Buenos Aires, Argentina.
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Angeramo CA, Laxague F, Schlottmann F, Bun ME, Rotholtz NA. Consecutive Laparoscopic Colorectal Resections in a Single Workday by the Same Surgeon: Efficient or Risky? J Laparoendosc Adv Surg Tech A 2022; 32:969-973. [PMID: 35245094 DOI: 10.1089/lap.2021.0818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: As laparoscopic colorectal surgery (LCS) continues increasing worldwide, surgeons may need to perform more than one LCS per day to accommodate this higher demand. We aimed to determine the safety of performing consecutive LCSs by the same surgeon in a single workday. Materials and Methods: Consecutive LCSs performed by the same surgeon from 2006 to 2019 were included. The sample was divided into two groups: patients who underwent the first (G1) and those who underwent the second and the third (G2) colorectal resections in a single workday. LCSs were stratified into level I (low complexity), level II (medium complexity), and level III (high complexity). Demographics, operative variables, and postoperative outcomes were compared between groups. Results: From a total of 1433 LCSs, 142 (10%) were included in G1 and 158 (11%) in G2. There was a higher rate of complexity level III LCS (G1: 23% versus G2: 6%, P < .0001) and a longer operative time (G1: 160 minutes versus G2: 139 minutes, P = .002) in G1. There were no differences in anastomotic leak, overall morbidity, or mortality rates. Mean length of hospital stay and readmission rates were similar between groups. Conclusion: Multiple consecutive laparoscopic colorectal resections can be safely performed by the same surgeon in a single workday. This efficient strategy should be encouraged at high-volume centers with experienced colorectal surgeons.
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Affiliation(s)
- Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Maximiliano E Bun
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.,Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Nicolás A Rotholtz
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.,Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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Loire M, Bridoux V, Mege D, Mathonnet M, Mauvais F, Massonnaud C, Regimbeau JM, Tuech JJ. Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI). Int J Colorectal Dis 2021; 36:2159-2164. [PMID: 34086087 DOI: 10.1007/s00384-021-03962-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical management of Hinchey III and IV diverticulitis involves Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. These procedures were evaluated in four randomized controlled trials. Early results from these trials demonstrated similar rates of complications but higher rates of colonic restoration after PRA than HP. Long-term follow-up has not been reported to date. The aim of this study was to analyze long-term outcomes and quality of life (QoL) in patients previously enrolled in a prospective randomized trial comparing HP and PRA for generalized peritonitis due to perforated diverticulitis (DIVERTI trial). STUDY DESIGN Follow-up data were available for 78 of 102 patients. Demographic data, incisional hernia rate, need for additional surgery related to the primary procedure, and QoL were recorded. RESULTS The overall survival rate was 76% and did not differ between the two groups. Incisional hernia was reported in 21 (52%) patients in the HP arm and in 11 (29%) patients in the PRA arm (p = 0.035). The HP arm demonstrated significantly lower SF-36 physical and mental component scores. The mean general QoL (EQ-VAS) and mean EQ-5D index scores were better after PRA than after HP, but this difference was not statistically significant. The results of GIQLI, which measures intestine-specific QOL, did not differ between the two groups. CONCLUSIONS This follow-up study with a median follow-up time of > 9 years among living patients indicates that PRA for perforated diverticulitis is associated with fewer long-term complications and better QoL than HP. PRA significantly reduced the incisional hernia rate and the need for reoperation. Long-term survival was not jeopardized by the PRA approach. Future studies are needed to address the utility of protective stoma.
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Affiliation(s)
- M Loire
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France
| | - D Mege
- Department of Digestive Surgery, Marseille University Hospital La Timone, Marseille, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais General Hospital, Beauvais, France
| | - C Massonnaud
- Department of Biostatistics, Rouen University Hospital, 76000, Rouen, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - J J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France.
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Dreifuss NH, Bras Harriott C, Schlottmann F, Bun ME, Rotholtz NA. Laparoscopic resection and primary anastomosis for perforated diverticulitis: with or without loop ileostomy? Updates Surg 2021; 73:555-560. [PMID: 33486710 DOI: 10.1007/s13304-020-00952-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evidence is growing about the benefits of laparoscopic resection with primary anastomosis (RPA) in perforated diverticulitis. However, the role of a diverting ileostomy in this setting is unclear. The aim of this study was to analyze the outcomes of laparoscopic RPA with or without a proximal diversion in Hinchey III diverticulitis. METHODS This is a retrospective analysis of patients undergoing laparoscopic sigmoidectomy for perforated Hinchey III diverticulitis during the period 2000-2019. The sample was divided into two groups: RPA without diversion (G1) and RPA with protective ileostomy (G2). Primary outcomes of interest were 30-day overall morbidity, mortality, length of hospital stay (LOS), and urgent reoperation rates. Secondary outcomes of interest included operative time, readmission, and anastomotic leak rates. RESULTS Laparoscopic RPA was performed in 94 patients: 76 without diversion (G1) and 18 with proximal loop ileostomy (G2). Mortality (G1: 1.3% vs. G2: 0%, p = 0.6), urgent reoperation (G1: 7.9% vs. G2: 5.6%, p = 0.73), and anastomotic leak rates (G1: 5.3% vs. G2: 0%, p = 0.32) were comparable between groups. Higher overall morbidity (G1: 27.6% vs. G2: 55.6%, p = 0.02) and readmission rates (G1: 1.3% vs. G2: 11.1%, p = 0.03), and longer LOS (G1: 6.3 vs. G2: 9.2 days, p = 0.02) and operative time (G1: 182.4 vs. G2: 230.2 min, p = 0.003) were found in patients with proximal diversion. CONCLUSION Laparoscopic RPA had favorable outcomes in selected patients with Hinchey III diverticulitis. The addition of a proximal ileostomy resulted in increased morbidity, readmissions, and length of stay. Further investigation is needed to establish which patients might benefit from proximal diversion.
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Affiliation(s)
- Nicolás H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Maximiliano E Bun
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.,Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
| | - Nicolás A Rotholtz
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina. .,Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
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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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11
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Dreifuss NH, Schlottmann F, Bun ME, Rotholtz NA. Emergent laparoscopic sigmoid resection for perforated diverticulitis: can it be safely performed by residents? Colorectal Dis 2020; 22:952-958. [PMID: 31955484 DOI: 10.1111/codi.14973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022]
Abstract
AIM Outcomes after resident involvement in emergent colectomies have rarely been studied. The aim of this study was to analyse the outcomes of laparoscopic sigmoidectomy for Hinchey III diverticulitis performed by residents. METHOD This study was a retrospective analysis of patients undergoing laparoscopic sigmoidectomy for diverticulitis. The sample was divided into two groups: patients operated on by a supervised resident (SR) or a senior surgeon (SS). Supervising surgeons and SSs could be general surgeons (GSs) or colorectal surgeons (CSs). A SR was considered the first surgeon if he/she completed at least three of five defined steps of the procedure. The primary end-points included length of hospital stay (LOS), morbidity and 30-day mortality. A sub-analysis of patients operated on by a SR assisted by either a CS or GS was performed. RESULTS Supervised residents and SSs operated on 59 and 42 patients, respectively. The presence of a CS was more frequent in the SS group (SR 41% vs SS 81%, P < 0.001). LOS (SR 9.4 days vs SS 6.4 days, P = 0.04) was higher in the SR group. Overall morbidity (SR 39% vs SS 43%, P = 0.69) and 30-day mortality (SR 5% vs SS 5%, P = 0.94) were also comparable among the groups. Procedures performed by SRs and supervised by a CS were associated with lower morbidity (GS 48% vs CS 25%, P = 0.06) and mortality (GS 8% vs CS 0%, P = 0.26). CONCLUSION Laparoscopic sigmoidectomy for Hinchey III diverticulitis has comparable outcomes when performed by a supervised SR or a SS. Procedures performed by residents assisted by a CS seem to have better outcomes than those assisted by a GS.
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Affiliation(s)
- N H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - F Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - M E Bun
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.,Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - N A Rotholtz
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.,Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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12
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Binda GA. Management of acute perforated diverticulitis with generalized peritonitis: is this the end of the Hartmann’s era? Tech Coloproctol 2020; 24:509-511. [DOI: 10.1007/s10151-020-02201-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 01/20/2023]
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