Ergebnisse der Sigmaresektion bei akuter und komplizierter Divertikulitis

Ritz, J.‐P.; Reißfelder, Christoph; Holmer, Christoph; Buhr, H. J.

doi:10.1007/s00104-008-1488-8

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…Surgical complications are among the major outcome parameters that might influence the choice between the two treatment strategies. In contrast to previous published data [2, 17, 22], surgical complications in the present study were slightly lower in group A than in group B. Intra‐abdominal abscess, SSI, and anastomotic leak appeared to be the most important surgical complications in this study, which might be explained by the presence of residual inflammatory tissue, especially in group A patients. The slightly lower percentage of severe surgical complications in group A (risk 9% versus 10%) could be interpreted as an advantage compared to group B.…”

Section: Discussioncontrasting

confidence: 99%

“…Due to patients’ needs such as increased comfort and avoiding unnecessary days of hospitalization, early elective surgery has become increasingly popular. Both group A and group B had a postoperative hospital stay of 8 days, which is comparable to other studies [1, 2, 17, 22]. As presented in our multivariate analysis, neither timing of operation nor severity of diverticulitis had a significant impact on length of hospital stay.…”

Section: Discussionsupporting

confidence: 88%

“…Both group A and group B had a postoperative hospital stay of 8 days, which is comparable to other studies [1,2,17,22]. As presented in our multivariate analysis, neither timing of operation nor severity of diverticulitis had a significant impact on length of hospital stay.…”

Section: Discussionsupporting

confidence: 88%

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Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

et al. 2012

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Background The optimal timing of elective surgery in diverticulitis remains unclear. We attempted to investigate early elective versus late elective laparoscopic surgery in acute recurrent diverticulitis in a retrospective study. Method Data of patients undergoing elective laparoscopic surgery for diverticulitis were retrospectively gathered, including Hinchey stages I-II a/b. The primary endpoint was in-hospital complications according to the ClavienDindo classification. Secondary endpoints were surgical complications, operative time, conversion rate, and length of hospital stay. Results Of 237 patients, 81 (34%) underwent early elective operation (group A) and 156 (66%) underwent late elective operation (group B). In-hospital complications developed in 32% in group A and in 34% in group B (risk difference 2%, 95% Confidence Interval (95% CI): -11%, 14%). Higher age (p = 0.048) and borderline higher American Society of Anesthesiologists score (p = 0.056) were risk factors for in-hospital complications. Severe surgical complications occurred in 9% of patients in group A and 10% in group B (risk difference 2%, 95% CI: -6%, 9%). Conversion rate was 9% in group A and 3% in group B (p = 0.070). Severity of disease did not seem to have an impact on complications or length of hospital stay. The median postoperative hospital stay was 8 days in both groups (interquartile range 6-10). Mean operative time was 220 min (SD 64) in group A and 202 min (SD 48) in group B. Conclusions This is the first study comparing early versus late elective surgery for diverticulitis in terms of the postoperative outcome using a validated classification. Although the retrospective setting and large confidence intervals don't allow definitive recommendations, these results are of utmost importance for the design of future prospective, randomized controlled trials.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 88%

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Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

et al. 2012

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“…The operation time has proved to be a suitable parameter for characterizing the learning curve [ 24 , 25 ]. The operative times, calculated on the basis of the dissection and suturing time, recorded in this study are comparable with the data already published [ 17 , 23 , 29 , 30 ]. The operation time in the present study was significantly reduced through the combination of ultrasonic scissors and bipolar coagulation mode (BDD).…”

Section: Discussionsupporting

confidence: 88%

Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study

Weyhe

Uslar

Tabriz

et al. 2017

Int J Colorectal Dis

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PurposeSurgical outcome is influenced by multiple patient-specific factors and operative expertise of the surgeon. Clinical relevance of medical technical innovations often remains unclear even though laparoscopic surgical procedures are characterized by continual advancement of various devices. Lately, in dissection and sealing technology, fast-cutting ultrasonic scissors are combined with simultaneous bipolar coagulation (bimodal dissection device (BDD)). We investigated how this new technology, operative expertise, and patient-specific factors (body mass index, age) influence operation time in laparoscopic-assisted sigmoid resection.MethodsBetween 2008 and 2016, 161 laparoscopic sigmoid resections (52% conventional dissection device (CDD); 48% BDD) performed in a single center were retrospectively evaluated. Biometric patient data, complication rates, and surgery duration, reflecting the learning curve, were analyzed. Operations were performed by experienced surgeons (n = 3) and trainees (n = 4).ResultsMinor postoperative complications (e.g., impaired wound healing, non-revisional secondary bleeding) occurred in 11 cases (6.8%). Major complications (e.g., bleeding requiring revision, anastomotic leakage) were observed in 3.7%. No heat-related coagulation damage was observed. BDD reduced operation time for both experienced (CDD 150 min, BDD 125 min; p < 0.001) and trainee surgeons (CDD 169 min, BDD 135 min; p = 0.036). Reduction of operation time (indicative of a learning curve in progress) was observed for all surgeons. The curve was steeper using BDD.ConclusionsPatient-specific factors did not have a significant effect on operation time. Even taking the learning curve into account, a combination of ultrasonic dissection and simultaneous bipolar coagulation reduces operation time of laparoscopic-assisted sigmoid resection, regardless of surgeon’s expertise.

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“…On the other hand, other series have indicated that early surgery was associated with a significant increase in conversion rate (37.7% vs 12.9%, P < 0.001) and longer hospitalization (13.5 vs 10.5 days; P < 0.001) 34. A prospective German study evaluating the optimal timing of laparoscopic sigmoid resection for uncomplicated and complicated diverticular disease showed that patients having early surgery (4–8 days after initiation of antibiotic therapy, n = 244) incurred in an increased number of conversions (9.7% vs 0.9%), increased minor morbidity (25.9% vs 12.9%) and wound infection rates (16.4% vs 4.6%) than patients who had delayed surgery 35. Based on this data we continue favoring delaying elective surgery by an interval of 4–6 weeks after the latest disease episode.…”

Section: Elective Surgical Management Of Uncomplicated Diverticular Dmentioning

confidence: 99%

New and emerging treatments for the prevention of recurrent diverticulitis

Martin

Stocchi

2011

CEG

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Sigmoid diverticulitis is a common benign condition which carries significant morbidity and socioeconomic burden. This article describes the management of sigmoid diverticulitis with a focus on indications for surgical intervention. The mainstay of management of uncomplicated diverticulitis is broad-spectrum antibiotic therapy. The old surgical dictum that two episodes of sigmoid diverticulitis warranted surgical intervention has been challenged by recently published data. Surgery for diverticulitis thus needs to be tailored to suit individual presentation; patients presenting with recurrent diverticulitis, severe symptoms or debilitating disease impacting patient’s quality of life mandate surgical intervention. Complicated diverticular disease typically prompts intervention to resect a diseased, strictured sigmoid colon, fistulizing disease, or a life-threatening colonic perforation. Laterally, minimally invasive surgery has been utilized in the management of this disease and recent data suggests that localized colonic perforation may be managed by laparoscopic peritoneal lavage, without resection. This review focuses discussion on available evidence for contemporary surgical and nonoperative management of diverticulitis.

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Ergebnisse der Sigmaresektion bei akuter und komplizierter Divertikulitis

Cited by 11 publications

References 23 publications

Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study

New and emerging treatments for the prevention of recurrent diverticulitis

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