Acute and Elective Laparoscopic Resection for Complicated Sigmoid Diverticulitis: Clinical and Histological Outcome

Zdichavsky, Marty; Kratt, Thomas; Stüker, D; Meile, Tobias; Feilitzsch, M von; Wichmann, Dörte; Königsrainer, Alfred

doi:10.1007/s11605-013-2296-0

Cited by 13 publications

(24 citation statements)

References 30 publications

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“…The stage of in ammation in diverticulitis surgery is the key for safe and successful surgery. Zdichavsky et al showed in 2013 that in histopathological examination of surgical specimen in early resected patients the stage of in ammation was more acute than in delayed cases [16]. Our intraoperative ndings con rmed this study in complicated diverticulitis disease.…”

Section: Resultssupporting

confidence: 83%

“…Low number of patients, retrospective analyse are the main limitations of this study. An early operation approach is safe and showed a comparable morbidity in literature as well as in our study [16]. A detailed patient's history is required not to miss past episodes of diverticulitis.…”

supporting

confidence: 72%

“…There are currently two options regarding the time of surgery: Delayed elective variant, in which the operation is done in an in ammation free stadium [13,14], and the early elective option, in which the operation is performed in the acute in ammation stage [15,16]. A delayed surgery can lead to more adhesions and brosis, which is possibly associated with a higher morbidity.…”

mentioning

confidence: 99%

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Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

Tschann

Lechner

Feurstein

et al. 2020

Preprint

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Background:Diverticular disease appears to be one of the most common conditions in the western world. The standard approach in treatment of diverticular disease is a laparoscopic resection, usually after an inflammation free time of 4 to 6 weeks. The aim of this study was to evaluate the timing of operation.Methods:61 patients underwent left-sided colonic resection because of diverticular disease between January 2017 and February 2020. 37 patients were treated because of complicated diverticulitis (CDD stage 2a or 2b) either early within 7 days after first symptoms (group A: n = 17) or delayed about 6 weeks after the first contact and conservative therapy (group B: n = 20).Results:Overall mortality was 0%. The average operation time was shorter in the early elective group (Group A: 140,4 min vs. Group B: 151,2 min (p = 0,29). The hospital stay (group A: 9,9 d vs. group B: 16,9 d) and the postoperative stay (group A: 4,8 d vs. group B: 8,1 d) was significantly longer in group B (p = 0,01). We observed – although not reliable due to low number of patients - more postoperative complications in the delayed group (group A: 5,9% vs. group B: 15,0%) (p = 0,61).Conclusion:The data in this study confirm the early operation as safe and efficient due to lower costs. We can recommend an early approach in selected cases with the first episode of a complicated diverticulitis.

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Section: Resultssupporting

confidence: 83%

supporting

confidence: 72%

mentioning

confidence: 99%

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Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

Tschann

Lechner

Feurstein

et al. 2020

Preprint

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“…However, the cited paper by Zdichavsky et al [22] describes a semi-acute series after failed medical management of low grades of perforated diverticulitis. Although a slightly different population, these series do support the feasibility of laparoscopic sigmoidectomy in a contaminated abdomen.…”

Section: Discussionmentioning

confidence: 99%

Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort

Vennix

Lips

Saverio³

et al. 2015

Surg Endosc

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Background Hartmann’s procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compared morbidity and hospital stay following acute laparoscopic sigmoidectomy (LS) and open sigmoidectomy (OS) for perforated diverticulitis.MethodsThis retrospective cohort parallel to the Ladies trial included patients from 28 Dutch academic or teaching hospitals between July 2010 and July 2014. Patients with LS were matched 1:2 to OS using the propensity score for age, gender, previous laparotomy, CRP level, gastrointestinal surgeon, and Hinchey classification.ResultsThe propensity-matched cohort consisted of 39 patients with LS and 78 patients with OS, selected from a sample of 307 consecutive patients with purulent or faecal perforated diverticulitis. In both groups, 66 % of the patients had Hartmann’s procedure and 34 % had primary anastomosis. The hospital stay was shorter following LS (LS 7 vs OS 9 days; P = 0.016), and the postoperative morbidity rate was lower following LS (LS 44 % vs OS 66 %; P = 0.016). Mortality was low in both groups (LS 3 % vs OS 4 %; P = 0.685). The stoma reversal rate after Hartmann’s procedure was higher following laparoscopy, with a probability of being stoma-free at 12 months of 88 and 62 % in the laparoscopic and open groups, respectively (P = 0.019). After primary anastomosis, the probability of reversal was 100 % in both groups.ConclusionsIn this propensity score-matched cohort, laparoscopic sigmoidectomy is superior to open sigmoidectomy for perforated diverticulitis with regard to postoperative morbidity and hospital stay.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-015-4694-8) contains supplementary material, which is available to authorized users.

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“…Применительно к значению видеолапароскопической хирургической технологии в лечении ВОДБ, следует обратить внимание на итоги одноцентрового исследования Zdichavsky M. и соавт. [52], в рамках которого авторами были получены прекрасные результаты с низким числом осложнений: 14 % -при экстренных и 7 % -при плановых лапароскопических резекциях и отсутствием летальности. В исследовании Royds J. и соавт.…”

Section: плановая хирургия водбunclassified

COMPLICATED DIVERTICULAR DISEASE: CONTEMPORARY CONCEPT OF TREATMENT (review)

et al. 2016

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1 ГБОУ ВПО «Северо-Осетинская государственная медицинская академия Минздрава России», г. Владикавказ (и.о. ректора -д.м.н. О.В.Ремизов) 2 ГБОУ ВПО «Волгоградский государственный медицинский университет Минздрава России», г. Волгоград (ректор -академик РАН В.И.Петров) 3 НУЗ «Узловая больница на ст. Владикавказ ОАО «РЖД», г. Владикавказ (директор -Т.К.Карсанова) 4 СПб ГБУЗ «Городская больница № 9», г. Санкт-Петербург (главный врач -Н.Н.Гриненко) В обзоре представлены обоснованные с позиций доказательной медицины принципы дифференцированного подхода к лечению воспалительных осложнений дивертикулярной болезни (ВОДБ). Основой для эффективного решения стратегических задач при ВОДБ является общепринятая дефиниция и классификация клинических форм заболевания. Принципы дифференцированной лечебной тактики при ВОДБ включают: консервативные методы лечения при неосложнённых формах, пункционно-дренирующий метод при абсцессах, резекционный (преимущественно, лапароскопический) подход при распространенном перитоните с расширением возможности выполнения первично-восстановительных (с протективной стомой) неотложных операций, а в случае планового хирургического лечения хронических осложнений -необходимость максимально широкого применения лапароскопических технологий. [Ключевые слова: дивертикулярная болезнь, воспалительные осложнения, лечение, хирургия] The review respresents contemporary trends in treatment of diverticular disease. The basement of optimal decision making for these patients are clear diagnostic criteria, relevant diagnostic methods and comprehensive universal classification. The spectrum of therapies for diverticular disease includes conservative treatment for uncomplicated forms, percutaneous drainage for abscesses, resection for peritonitis. A possibility of primary anastomosis in case of resection for free perforation with or without protective stoma is discussed. Laparoscopic technologies for chronic complications of diverticular disease is a main trend to improve short, late and functional results in elective surgery.

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Acute and Elective Laparoscopic Resection for Complicated Sigmoid Diverticulitis: Clinical and Histological Outcome

Cited by 13 publications

References 30 publications

Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort

COMPLICATED DIVERTICULAR DISEASE: CONTEMPORARY CONCEPT OF TREATMENT (review)

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