Surgical approach for right‐sided colonic diverticular bleeding: A single‐center review of 43 consecutive cases

Abstract

Introduction: While Asian populations develop colonic diverticular disease predominantly in the right colon, Western populations mainly present with left-sided disease. The present study aimed to clarify the outcomes of surgical treatment for right-sided colonic diverticular bleeding. Methods: Medical records of 43 patients who underwent surgery for rightsided colonic diverticular bleeding between 2010 and 2019 were reviewed. Those whose general condition became unstable underwent open surgery at our institution. Patients were then divided into two groups, the open surgery group (n = 17) and laparoscopic surgery group (n = 26), after which operative outcomes between both groups were compared. Results: This study included 36 men and seven women with a median age of 76 (range: 37-91) years. Laparoscopic surgery had a significantly longer operative time (183.5 minutes vs 110 minutes; P < .001) and significantly lower intraoperative blood transfusion rate (19.2% vs 82.4%; P < .001) than open surgery. The laparoscopic surgery group had earlier resumption of postoperative meals than open surgery group (postoperative day 3 vs postoperative day 4; P = .010). No significant difference in postoperative complications was observed between both groups. With regard to long-term outcomes, none of the cases exhibited rebleeding from the right-sided colon. Conclusion:The present study revealed that laparoscopic surgery promoted lower intraoperative blood transfusion rates and earlier resumption of postoperative meals compared to open surgery for right-sided colonic diverticular bleeding. Hence, laparoscopic surgery can be feasible for right-sided colonic diverticular bleeding provided that the patientʼs general condition is stable.

Right‐sided colonic diverticulitis. Short and long‐term surgical outcomes and 2‐year quality of life

“…On the other hand, a recent study 16 from Kameyama et al. highlighted that surgical treatment seems to be superior to NOM in preventing metachronous local recurrence.…”

“…On the other hand, a recent study 16 from Kameyama et al highlighted that surgical treatment seems to be superior to NOM in preventing metachronous local recurrence. Furthermore, operative treatment provides better results in terms of QoL 17 but only on selected patients with complicated aRCD or with risk factors of recurrence, such as previous history of diverticulitis.…”

“…15 The laparoscopic approach seems to be safe and feasible in expert hands, even in difficult cases. 16 Al-Temimi et al 19 et found that RCD must be approached with targeted surgery to avoid postoperative complications and spare as much healthy tissue as possible, also considering the young cohort population. In our cohort of patients, 3 (9.2%) with cecal periappendicular diverticulitis underwent ileocaecetomy, while the other 45.3% cases had the diverticula on the edge between the cecal and ascending colon, so a standard right hemicolectomy was performed.…”