Recurrent diverticulitis after elective surgery

Giulio, Mari; Santambrogio, Gaia; Andrea, Costanzi; Calini, Giacomo; Angela, La Porta; Maggioni, Dario; Montroni, Isacco

doi:10.1007/s00384-022-04248-x

Cited by 2 publications

(2 citation statements)

References 22 publications

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“… 22 Also, an overlapping preoperative diagnosis of IBS has been associated with postoperative recurrence of SUDD, analogously to diverticulitis. 21 , 103 Therefore, excluding a diagnosis of IBS is mandatory before surgery.…”

Section: Symptomatic Uncomplicated Diverticular Diseasementioning

confidence: 99%

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management

Calini¹,

Aziz²,

Paolini³

et al. 2023

CEG

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Symptomatic Uncomplicated Diverticular Disease (SUDD) is a syndrome within the diverticular disease spectrum, characterized by local abdominal pain with bowel movement changes but without systemic inflammation. This narrative review reports current knowledge, delivers practical guidance, and reveals challenges for the clinical management of SUDD. A broad and common consensus on the definition of SUDD is still needed. However, it is mainly considered a chronic condition that impairs quality of life (QoL) and is characterized by persistent left lower quadrant abdominal pain with bowel movement changes (eg, diarrhea) and low-grade inflammation (eg, elevated calprotectin) but without systemic inflammation. Age, genetic predisposition, obesity, physical inactivity, low-fiber diet, and smoking are considered risk factors. The pathogenesis of SUDD is not entirely clarified. It seems to result from an interaction between fecal microbiota alterations, neuro-immune enteric interactions, and muscular system dysfunction associated with a low-grade and local inflammatory state. At diagnosis, it is essential to assess baseline clinical and Quality of Life (QoL) scores to evaluate treatment efficacy and, ideally, to enroll patients in cohort studies, clinical trials, or registries. SUDD treatments aim to improve symptoms and QoL, prevent recurrence, and avoid disease progression and complications. An overall healthy lifestyle – physical activity and a high-fiber diet, with a focus on whole grains, fruits, and vegetables – is encouraged. Probiotics could effectively reduce symptoms in patients with SUDD, but their utility is missing adequate evidence. Using Rifaximin plus fiber and Mesalazine offers potential in controlling symptoms in patients with SUDD and might prevent acute diverticulitis. Surgery could be considered in patients with medical treatment failure and persistently impaired QoL. Still, studies with well-defined diagnostic criteria for SUDD that evaluate the safety, QoL, effectiveness, and cost-effectiveness of these interventions using standard scores and comparable outcomes are needed.

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Section: Symptomatic Uncomplicated Diverticular Diseasementioning

confidence: 99%

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management

Calini¹,

Aziz²,

Paolini³

et al. 2023

CEG

View full text Add to dashboard Cite

show abstract

“…Elective colon resection, however, is related to a high rate of anastomotic bleeding or leakage or other postoperative complications ( Kirchhoff et al, 2010 ; Wu et al, 2017 ). Specifically, post-surgery development of diverticula still occurred in certain patients ( Giulio et al, 2022 ; Waser et al, 2023 ). Hence, there is a substantial desire for developing new therapeutic strategies to reduce the chance of recurrence of diverticulosis and its complications.…”

Section: Introductionmentioning

confidence: 99%

Novel patch biomaterial treatment for colon diverticulosis in swine model

Guo,

Patel,

Han

et al. 2023

Front. Bioeng. Biotechnol.

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Current leading managements for diverticular disease cannot prevent the recurrence of diverticulitis, bleeding and/or other complications. There is an immediate need for developing new minimal invasive therapeutic strategies to prevent and treat this disease. Through a biomechanical analysis of porcine colon with diverticular lesions, we proposed a novel adhesive patch concept aiming at mechanical reconstruction of the diseased colon wall. This study aims to evaluate the surgical feasibility (safety and efficacy) of pulmonary visceral pleura (PVP) patch therapy using a pig model of diverticulosis. Six female Yucatan miniature pigs underwent collagenase injection (CI) for the development of diverticular lesions. The lesions in each animal either received patch implantation (treated group, n = 40 for 6 pigs) or left intact (untreated group, n = 44 for 6 pigs). The normal colonic wall in each animal received patch implantation at two spots to serve as control (n = 12 for 6 pigs). After 3 months of observation, the performance and safety of the patch treatment were evaluated through macroscopic and histological examination. We found that 95% of pouch-like herniation of the mucosa was prevented from the colon wall with the treatment. The pouch diameter was significantly reduced in the treated group as compared to the untreated group (p < 0.001). The patch application caused a significant increase in the levels of collagen of the colon tissue as compared to the untreated and control groups (p < 0.001). No difference was found in the lymphocyte and macrophage inflammatory infiltrate between the groups. Our results suggest that patch treatment efficiently inhibits the diverticular pouch deformation and promotes the healing of the colon wall with a normal inflammatory response, which may minimize the risk of diverticulosis reoccurrence and complications over time.

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Recurrent diverticulitis after elective surgery

Cited by 2 publications

References 22 publications

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management

Novel patch biomaterial treatment for colon diverticulosis in swine model

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