IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments

Sartelli, Massimo; Binda, Gian Andrea; Brandara, Francesco; Borasi, Andrea; Feroci, Francesco; Vadalà, Salvatore; Labricciosa, Francesco M.; Birindelli, Arianna; Luridiana, Gianluigi; Catena, Fausto; Saverio, Salomone Di; Catena, Fausto; Ansaloni, Luca; Campanile, Fabio Cesare; Agresta, Ferdinando; Piazza, Diego

doi:10.1007/s00268-016-3800-y

Cited by 12 publications

(8 citation statements)

References 62 publications

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“…Using our latest nationwide database, we confirmed that emergency surgery for CA poses a greater risk than that of UA. Several studies based on nationwide databases reported that the mortality rates associated with appendectomy range from 0.04% to 0.24% [12][13][14][15][16][17][18][19][20][21][22] (Table 3), similar to our results for the UA patients. The mortality rate for CA patients in the present study (0.13%), which was lower than that for CA patients in a nationwide study in the USA (0.18%-0.30%), 12,13 was significantly higher than that for the UA and EA patients.…”

Section: Discussionsupporting

confidence: 90%

Risk of emergency surgery for complicated appendicitis: Japanese nationwide study

Yamada

Endo

Hasegawa

et al. 2020

Annals of Gastroent Surgery

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Aim Appendicitis is divided into two categories: complicated appendicitis (CA) and uncomplicated appendicitis (UA). In pediatric patients with CA, the use of interval appendectomy (IA), which is non‐operative management followed by elective surgery, has decreased the number of postoperative complications. Before discussing the merit of IA for adult patients, we need to clarify whether the frequency and seriousness of the complication rate after emergency surgery is higher for CA than for UA. Methods This retrospective cohort study included adult patients who underwent appendectomy and who were registered in the National Clinical Database (NCD) from 2014 to 2016. Patients with CA who underwent emergency appendectomy comprised the CA group. Patients with UA comprised the UA group. Patients with chronic or recurrent appendicitis who underwent elective appendectomy comprised the elective appendectomy (EA) group. Primary outcomes were all morbidity, serious morbidity, and mortality within 30 days after appendectomy. Results We included 109 256 patients in the study: 14 798 CA, 86 876 UA, and 7582 EA patients. Compared with the UA group, the rates of all morbidity, serious morbidity, and mortality were significantly higher in the CA group. All morbidity, serious morbidity, and mortality rates were significantly lower in the EA group than in the other two groups. Conclusions We confirmed that emergency surgery for CA places the patient at relatively higher risk. We also showed that the risk associated with EA is significantly lower than that for the other methods.

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Section: Discussionsupporting

confidence: 90%

Risk of emergency surgery for complicated appendicitis: Japanese nationwide study

Yamada

Endo

Hasegawa

et al. 2020

Annals of Gastroent Surgery

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“…For an episode of acute diverticulitis to be considered ‘uncomplicated’ there must be evidence of the lack of perforation, abscess or free intra‐peritoneal fluid . CT scanning is widely regarded as the key diagnostic investigation for AUD . If the shift towards non‐antibiotic management of AUD were to continue in the National Health Service (NHS) setting, we would suggest caution in initiating this management unless the CT has been reviewed and reported by a radiologist with the appropriate expertise, in order not to miss any soft signs of perforation such as small gas bubbles or free fluid, which might necessitate the initiation of antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta‐analysis

Tandon

Fretwell²,

Nunes

et al. 2018

Colorectal Disease

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“…The diverting ileostomy approach following Hartman's colostomy reversal has been used more frequently in recent years for diverticular diseases [28][29][30]. Prospective multicenter studies have compared primary anastomosis and HP in patients with diverticular peritonitis and have reported that primary anastomosis and ileostomy may be preferred over Hartmann's colostomy.…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting the Reversal of Hartmann’s Procedure

Yalkın

Altıntoprak

Uzunoğlu

et al. 2022

BioMed Research International

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Aim. This paper investigates the risk factors preventing the reversal and nonreversal of Hartmann’s procedure, as a surgical technique that has been performed in our clinic for ten years. Methods. The study involved a ten-year Hartmann’s procedure followed up at our center. The patients were divided into Hartmann reversal and nonreversal groups. Groups were examined in terms of age, gender, diagnosis, stage of malignancy, ASA score, comorbidity, perioperative morbidity-mortality, and the length of the operation. Results. Age ( p < 0.001 ), ASA score ( p < 0.001 ), stage in case of malignancy ( p = 0.002 ), and comorbidities ( p < 0.001 ) were significant risk factors. The ratio of patients without any comorbidities to those with one or more comorbidities was 2.63 (95% CI 1.12–6.20). Among the malignant patients, the ratio of early-stage patients to advanced-stage patients in the group with reversal of Hartmann’s colostomy was 2.82 (95% CI 1.30–6.10). In addition, the ratio of older patients to younger patients in group 2 was 0.95 (95% CI 0.92–0.98). A univariate analysis revealed that younger patients, those with lower ASA scores, those without comorbidities, and those with early-stage malignancy had a greater chance of closure of the stoma. Conclusion. Although Hartmann’s procedure is performed in emergency surgery, the nonreversal of the colostomy is a problem in itself. It should be kept in mind that patients who have high risks are likely to have a permanent stoma.

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IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments

Abstract: The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.

Cited by 12 publications

References 62 publications

Risk of emergency surgery for complicated appendicitis: Japanese nationwide study

Risk of emergency surgery for complicated appendicitis: Japanese nationwide study

Antibiotics vs no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta‐analysis

Factors Predicting the Reversal of Hartmann’s Procedure

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