Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis

Luu, Le Huy; Vuong, Nguyen Lam; Yen, Vo Thi Hong; Phuong, Do Thi Thu; Vu, Bui Khac; Thanh, Nguyen Viet; Khanh, Nguyen Thien; Hai, Nguyen Van

doi:10.1007/s00464-019-06981-x

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…Laparoscopic diverticulectomy (LD) is a minimally invasive surgical procedure, with a low complication rate compared to right colectomy [23,27]. A recent study showed that LD is safe and effective in patients who are concerned about disease progression and recurrence [13]. Furthermore, previous studies revealed that colectomy is executed when complications occur or when malignancy is strongly suspected [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…The primary endpoint was recurrence, based on CT evidence of recurrent RCD at 1 month after discharge. Recurrence within 1 month of discharge was regarded as treatment failure [13]. The secondary endpoints included treatment success, death and complications.…”

Section: Outcome Definitions and Follow-upmentioning

confidence: 99%

“…Conservative treatment with intravenous antibiotics and bowel rest is usually recommended for the management of acute uncomplicated RCD in Asia [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Chen

Zhou

et al. 2022

Preprint

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Background: Acute right-sided colonic diverticulitis (RCD) is a common disease in Asian populations for which the optimal treatment remains controversial. The aim of this study was to investigate management and evaluate long-term outcomes of treatment in patients with acute RCD. Methods: We retrospectively collected and analyzed clinical data for patients with acute RCD admitted to the Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. The patients were divided into two groups, according to primary treatment strategy, which was either conservative treatment or surgical treatment. Results: A total of 162 consecutive patients with acute RCD were enrolled in the study. There was no significant difference in age, sex, history of abdominal surgery, medical co-morbidities, fever, previous history of RCD, treatment success rate and incidence of complications between the conservative and surgery groups. However, the recurrence rate in conservative groups was significantly higher than in surgery groups (16.53% vs 2.44%, P = 0.020). And more frequent bowel movements and previous history of RCD increased the risk of recurrence of acute RCD. Moreover, there was no significant difference in either treatment success rate or the overall recurrence rate between the patients with uncomplicated diverticulitis and patients with complicated diverticulitis. Conclusions: Surgical treatment is also safe and effective for acute RCD. Surgical treatment should mainly be considered for patients with acute RCD with recurrence risk factors (more frequent bowel movements and previous history of RCD) or with complicated acute RCD.

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Section: Discussionmentioning

confidence: 99%

Section: Outcome Definitions and Follow-upmentioning

confidence: 99%

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Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Chen

Zhou

et al. 2022

Preprint

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“…In the only recent study that defends the surgical approach, Luu et al [ 63 ] stated that laparoscopic diverticulectomy could be offered to selected patients (younger patients, who live in remote areas or with higher risks of recurrence). The author points out that, compared to conservative management, minimally invasive approach has similar outcomes in terms of complications (12.2% vs 8.6%) and treatment failure (13.5% vs 9.9%) and with a lower recurrence rate (0% vs 16.6%).…”

Section: Discussionmentioning

confidence: 99%

Right sided diverticulitis in western countries: A review

Epifani¹,

Cassini²,

Cirocchi³

et al. 2021

WJGS

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BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear, the management of right colonic diverticulitis is not well established. This disease can no longer be ignored due to significant spread throughout Asia. AIM To analyse epidemiology, diagnosis and treatment of right-sided diverticulitis in western countries. METHODS MEDLINE and PubMed searches were performed using the key words “right-sided diverticulitis’’, ‘‘right colon diverticulitis’’, ‘‘caecal diverticulitis’’, ‘‘ascending colon diverticulitis’’ and ‘‘caecum diverticula’’ in order to find relevant articles published until 2021. RESULTS A total of 18 studies with 422 patients were found. Correct diagnosis was made only in 32.2%, mostly intraoperatively or via CT scan. The main reason for misdiagnosis was a suspected acute appendicitis (56.8%). The treatment was a non-operative management (NOM) in 184 patients (43.6%) and surgical in 238 patients (56.4%), seven of which after NOM failure. Recurrence rate was low (5.45%), similar to eastern studies and inferior to left -sided diverticulitis. Recurrent patients were successfully conservatively retreated in most cases . CONCLUSION The management of right- sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left- sided diverticulitis. Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality. NOM offers a safe and effective treatment; surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded. Further studies are needed to clarify the correct treatment.

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“…Luu et al reported that both laparoscopic diverticulectomy and non‐operative treatment were safe and effective in patients with uncomplicated right‐sided colonic diverticulitis. Laparoscopic diverticulectomy could be an option in a case with possible recurrence …”

Section: Diverticulitismentioning

confidence: 99%

Essential updates 2018/2019: Colorectal (benign)

Ogino

Mizushima

Matsuda

et al. 2019

Annals of Gastroent Surgery

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This review outlines current topics on the surgical treatment of benign colorectal diseases, with a focus on inflammatory bowel disease (IBD) and diverticulitis. Treatment options for IBD and diverticulitis have evolved in the last few years as a result of medical advances in technology and new clinical trials. Therefore, treatment options and strategies need to be updated to provide optimal care for patients. The purpose of this review is to elucidate recent global trends and update the surgical treatment strategy for IBD and diverticulitis based on literature published in the past 2 years. Prevalence of IBD, including ulcerative colitis and Crohn's disease, has increased over the last few decades. During this period, many new medical therapies were introduced for the treatment of IBD, including biological therapy, immunomodulators, and leukocyte apheresis therapy. As a result, new surgical strategies for IBD are required. In order to improve surgical outcomes in IBD patients, the influence of preoperative treatment on postoperative complications needs to be considered. The incidence of diverticulitis is also increasing with lifestyle changes and increasing numbers of older people. For diverticulitis with perforation and generalized peritonitis, surgery is the gold standard. Elective surgery after conservative treatment of diverticulitis is also an option because of high recurrence rates. With an increase in diverticulitis, systematic strategies are essential for an appropriate approach to diverticulitis, taking into account various factors, including the patient's background.

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Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis

Cited by 7 publications

References 28 publications

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Right sided diverticulitis in western countries: A review

Essential updates 2018/2019: Colorectal (benign)

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