New and emerging treatments for the prevention of recurrent diverticulitis

Martin, Seán T.; Stocchi, Luca

doi:10.2147/ceg.s15373

Cited by 6 publications

(2 citation statements)

References 82 publications

(84 reference statements)

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“…In most cases, this resection may be done in the elective setting, avoiding the need for a temporary stoma. Indeed, several systemic reviews and meta-analyses [19,20,21,22,23] concluded that further investigation is needed in order to define the role of laparoscopic peritoneal lavage and drainage in the treatment of acute diverticulitis. The LADIES trial, a Dutch multicenter prospective trial [24] that compared peritoneal lavage, Hartmann procedure and resection with primary anastomosis has been prematurely terminated at interim analysis owing to high complication rates in the lavage and drainage group.…”

Section: Discussionmentioning

confidence: 99%

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Horesh

Zbar²,

Haim³

et al. 2015

Dig Surg

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Background: Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently peritoneal lavage and drainage without resection in cases of purulent peritonitis have been suggested. This study aims to review our initial experience with laparoscopic peritoneal lavage for complicated diverticulitis. Methods: Retrospective review of all patients who underwent emergent peritoneal lavage and drainage for acute complicated diverticulitis. Results: Five-hundred-thirty-eight patients admitted for acute diverticulitis between 2007 and 2012 were recorded in the database. Thirty seven underwent emergent surgery of which 10 had peritoneal lavage and drainage without colonic resection for complicated diverticulitis causing peritonitis. Peritoneal lavage and drainage resulted in the resolution of acute symptoms in all cases. In long-term follow-up, 3 (30%) patients required elective resection owing to symptomatic disease, two of these due to recurrent diverticulitis, and one owing to complicated fistula following the procedure. Conclusion: Peritoneal lavage is a feasible option for complicated diverticulitis with purulent non-fecal peritonitis, but a significant portion of the patients may require elective resection. Comparative studies with emergent resection are needed to determine the role of peritoneal lavage in complicated diverticulitis.

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Section: Discussionmentioning

confidence: 99%

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Horesh

Zbar²,

Haim³

et al. 2015

Dig Surg

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“…[17, 19, 20]. As a result, some authors have argued for interval resection following an initial episode of diverticulitis in IMS patients [4, 17, 21, 22] [23]. However, these studies are limited by small sample sizes, variable types of immunosuppression, and a lack of follow-up beyond the initial hospitalization for diverticulitis.…”

Section: Introductionmentioning

confidence: 99%

Colonic diverticulitis in chemotherapy patients: Should operative indications change? A retrospective cohort study

Samdani¹,

Pieracci²,

Eachempati³

et al. 2014

International Journal of Surgery

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Introduction Management of the immunosuppressed patient with diverticular disease remains controversial. We report the largest series of colon cancer patients undergoing chemotherapy and hospitalized for acute diverticulitis, to determine whether recent treatment with systemic chemotherapy is associated with increased risk for/increased severity of recurrent diverticulitis. Methods Retrospective cohort study of adult patients hospitalized for an initial episode of acute colonic diverticulitis at Memorial Sloan Kettering Cancer Center, 1988–2004. Outcomes in patients receiving systemic chemotherapy within one month of admission for diverticulitis (“Chemo”) were compared to outcomes of patients not receiving chemotherapy within the past month (“No-chemo”). Results A total 131 patients met inclusion criteria. Chemo patients did not differ significantly from No-chemo group in terms of severity of acute diverticulitis at index admission (13.2% vs. 4.4%, respectively, p=0.12), resumption of chemotherapy (median 2 months), failure of non-operative management (13.2% vs 4.4%, respectively, p=0.12), frequency of recurrence (20.5% vs 18.55), hospital length of stay (p=0.08), and likelihood of interval resection (24.0% vs. 16.2%, respectively, p=0.39). Chemo patients recurred with more severe disease, were more likely to undergo emergent surgery (75.0% vs. 23.5%, respectively, p=0.03), and were more likely to be diverted (100.0% vs. 25.0%, respectively, p=0.03). Chemo patients were significantly more likely to incur a postoperative complication (100% vs 9.1% p <0.01) following interval resection. Overall mortality was significantly higher in the Chemo vs. No-chemo group. Median survival in Chemo patients was 3.4 years; in No-chemo patients, median survival was not reached at 10 years Conclusion Our data do not support routine elective surgery for acute diverticulitis in patients receiving chemotherapy. Nonoperative management in the acute or interval setting appears preferable whenever possible.

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Factors Associated with Repeated Health Resource Utilization in Patients with Diverticulitis

Mathews

Lamm

Yang

et al. 2017

Journal of Gastrointestinal Surgery

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Conservative management trends in diverticulitis may lead to increased hospitalizations secondary to repeated attacks. The study aimed to characterize trends in management and risk-assess patients with diverticulitis that required multiple admissions to identify high utilizers. A total of 265,724 patients with diverticulitis were identified from 1995 to 2014 from the New York SPARCS database. Patients with ≥2 hospital admissions were stratified across demographics, comorbidities, insurance status, and surgical intervention. In total, 42,850 patients had ≥2 hospital admissions. Risk factors for ≥2 admissions included younger age, White race, obesity, hypertension, pulmonary disease, hypothyroidism, rheumatoid arthritis, and depression. Fifty-two percent of these patients went on to have surgery. The percentage of elective cases increased from 59 to 70 %, while emergent cases conversely decreased from 41 to 30 %. One in five patients admitted with diverticulitis required two or more admissions. Numerous patient factors were correlated with increased risk of readmission. These factors may be used to guide treatment decisions and help reduce economic burden in frequent utilizers. Trends in surgery rates for these patients could reflect improved treatment options and/or changing clinical practice patterns.

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New and emerging treatments for the prevention of recurrent diverticulitis

Cited by 6 publications

References 82 publications

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

Colonic diverticulitis in chemotherapy patients: Should operative indications change? A retrospective cohort study

Factors Associated with Repeated Health Resource Utilization in Patients with Diverticulitis

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