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Changes in the approach to acute diverticulitis

Alberto Mangano, Eduardo Fernandes, Valentina Valle, Roberto Bustos, Federico Gheza, Pier C Giulianotti
BACKGROUND: The routine mobilization of the left colonic flexure as a standard procedure during left colonic/rectal resection is a controversial topic in open and minimally invasive surgery. According to some authors, this manuever may increase the risk of iatrogenic spleen damage; for others this does not change the odds. Ligaments over-traction is the most frequent injury mechanism. Some documented risk factors are reported: laparotomic approach, male gender, vascular disease, cancer, diverticulitis, surgery performed in emergency-setting...
May 25, 2018: Minerva Chirurgica
(no author information available yet)
No abstract text is available yet for this article.
March 1, 2018: JAMA Surgery
Marco von Strauss Und Torney, Sarah Thommen, Salome Dell-Kuster, Henry Hoffmann, Rachel Rosenthal, James Young, Christoph Kettelhack
INTRODUCTION: The standard of care for acute uncomplicated diverticulitis used to be an elective colon resection after second or third episode. This practice was replaced by a more conservative and individualised approach. This study investigates current surgical practice in the treatment of acute uncomplicated diverticulitis in Switzerland. METHODS: Retrospective cross sectional analysis of all hospital admissions due to uncomplicated diverticulitis in Switzerland using prospectively collected data from the Swiss federal statistical office in two periods: 2004 to 2005 and 2010 to 2011...
March 29, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Tommaso Testa, Federico Costanzo
Introduction. In the last years many mini-invasive approaches were developed in order to reduce postoperative pain and complication after haemorrhoid surgery: one of these alternatives is represented by Hemorpex System, a relatively young technique that combines transanal dearterialization with mucopexy through a dedicated proctoscope. Case Presentation. A 78-year-old male patient was admitted to the Emergency Department for acute urinary retention and elevated temperature. Hemorpex procedure was performed 4 years before...
2016: Case Reports in Surgery
Marja A Boermeester, David J Humes, George C Velmahos, Kjetil Søreide
BACKGROUND: Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. METHODS: We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases...
October 2016: World Journal of Surgery
O Estrada Ferrer, N Ruiz Edo, L-A Hidalgo Grau, M Abadal Prades, M Del Bas Rubia, E M Garcia Torralbo, A Heredia Budo, X Suñol Sala
BACKGROUND: A growing body of knowledge is calling into question the use of antibiotics in acute diverticulitis (AD). Moreover, recent studies provide evidence regarding the security of treating patients with AD as outpatients. The aim of this study was to evaluate a restrictive antibiotic outpatient protocol for the treatment of mild-to-moderate episodes of AD. METHODS: All patients with symptoms of AD presenting to our emergency department were assigned a modified Neff stage...
May 2016: Techniques in Coloproctology
Antonio Tursi
Diverticulosis of the colon is a widespread disease, and its prevalence is increasing especially in the developing world. The underlying pathological mechanisms that cause the formation of colonic diverticula remain unclear but are likely to be the result of complex interactions among age, diet, genetic factors, colonic motility, and changes in colonic structure. The large majority of patients remain asymptomatic throughout their life, one fifth of them become symptomatic (developing the so-called 'diverticular disease') while only a minority of these will develop acute diverticulitis...
March 2016: Therapeutic Advances in Gastroenterology
D Z Khan, M E Kelly, J O'Reilly, W Khan, R Waldron, K Barry, I Z Khan
INTRODUCTION: Diverticulitis is a common surgical admission that presents with a wide range of symptoms and severity. Overall there has been a shift to conservative management practices, including the consideration of non-antibiotic treatment approaches in select cases. METHODS: A national survey of all consultant surgeons evaluating their practices was performed. Reasons for changes in management, use of radiological imaging, role of non-antibiotic treatment approaches and indications for elective surgical management were evaluated...
August 2017: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Manu Kaushik, Jasneet Singh Bhullar, Sandiya Bindroo, Hemindermeet Singh, Vijay K Mittal
BACKGROUND: Diverticulitis is a common condition which carries significant morbidity and socioeconomic burden (McGillicuddy et al in Arch Surg 144:1157-1162, 2009). The surgical management of diverticulitis has undergone significant changes in recent years. This article reviews the role of minimally invasive approach in management of complicated diverticulitis, with a focus on recent concepts and advances. MATERIALS AND METHODS: A literature review of past 10 years (January 2004 to September 2014) was performed using the electronic database MEDLINE from PubMed which included articles only in English...
March 2016: Digestive Diseases and Sciences
Tanja Kaneko, Wolfgang Heinz
Diagnostic ultrasound is without doubt the imaging technique of choice in patients with acute abdominal pain. Point-of-care ultrasound examinations can help to reduce the number of possible differential diagnoses by exclusion or - as a best case scenario - show us directly the correct diagnosis. Hence patients can benefit from a very early appropriate therapeutic approach. This article illustrates where and how we should "look". After focusing on basic technical settings, typical pathological sonomorphologic changes in patients with some of the most important illnesses are characterized (e...
October 2015: Deutsche Medizinische Wochenschrift
Rebekah Jaung, Jason Robertson, Ryash Vather, David Rowbotham, Ian P Bissett
Acute diverticulitis (AD) is one of the most common acute admission diagnoses for general surgery, and its prevalence is increasing, in part due to the ageing population. Currently, most patients who present to a tertiary hospital are admitted for a period of treatment and observation. Simple, safe and cost-effective strategies for improving our current treatment of this condition will be invaluable in providing the most appropriate management for individual patients and for reducing the health resources expended on hospital admissions and parenteral antibiotics...
October 2015: ANZ Journal of Surgery
K Moubax, D Urbain
Diverticulosis of the colon is a common disease with an increasing incidence in Western countries. Recent literature has shown some changes in the traditional approach of this disease. The theory that diverticulosis is caused by a reduced intake of dietary fibre, is doubtful. There might be some chemical and histological overlap between diverticulitis, inflammatory bowel disease and irritable bowel disease. High quality clinical study found no effect for antibiotics in acute, uncomplicated diverticulitis. Cyclic administration of mesalazine and rifaximin result in reduced symptoms of diverticular disease...
January 2015: Acta Gastro-enterologica Belgica
Carla J Gargallo Puyuelo, Federico Sopeña, Angel Lanas Arbeloa
Diverticular disease represents the most common disease affecting the colon in the Western world. Most cases remain asymptomatic, but some others will have symptoms or develop complications. The aims of treatment in symptomatic uncomplicated diverticular disease are to prevent complications and reduce the frequency and intensity of symptoms. Fibre, probiotics, mesalazine, rifaximin and their combinations seem to be usually an effective therapy. In the uncomplicated diverticulitis, outpatient management is considered the optimal approach in the majority of patients, and oral antibiotics remain the mainstay of treatment...
December 2015: Gastroenterología y Hepatología
Nicole Wieghard, Cristina B Geltzeiler, Vassiliki L Tsikitis
Sigmoid diverticulitis is an increasingly common Western disease associated with a high morbidity and cost of treatment. Improvement in the understanding of the disease process, along with advances in the diagnosis and medical management has led to recent changes in treatment recommendations. The natural history of diverticulitis is more benign than previously thought, and current trends favor more conservative, less invasive management. Despite current recommendations of more restrictive indications for surgery, practice trends indicate an increase in elective operations being performed for the treatment of diverticulitis...
January 2015: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Debbie Li, Nancy N Baxter, Robin S McLeod, Rahim Moineddin, Andrew S Wilton, Avery B Nathens
BACKGROUND: There is increasing evidence to support the use of percutaneous abscess drainage, laparoscopy, and primary anastomosis in managing acute diverticulitis. OBJECTIVE: The aim of this study was to evaluate how practices have evolved and to determine the effects on clinical outcomes. DESIGN: This is a population-based retrospective cohort study using administrative discharge data. SETTING: This study was conducted in Ontario, Canada...
December 2014: Diseases of the Colon and Rectum
Tafadzwa P Makarawo, Steffan Eichenauer, Uma Shah, Amy Jaeger, Alasdair McKendrick, Vijay K Mittal
The surgical management of diverticulitis continues to evolve but recent literature has not qualified just how different current practice is compared with the previous era. This study aims to update the seminal paper by Rodkey and Welch regarding indications and operation types performed for diverticulitis by comparing their findings with present practice at a community based institution. The charts of 407 patients admitted with "diverticular disease" between 2005 and 2010 were identified. For each admission, patients' demographics, presentations and management were recorded...
July 2014: International Surgery
J Bingener, I Ibrahim-zada
BACKGROUND: Patient benefits from natural orifice transluminal endoscopic surgery (NOTES) are of interest in acute-care surgery. This review provides an overview of the historical development of NOTES procedures, and addresses their current uses and limitations for intra-abdominal emergency conditions. METHODS: A PubMed search was carried out for articles describing NOTES approaches for appendicectomy, percutaneous gastrostomy, hollow viscus perforation and pancreatic necrosectomy...
January 2014: British Journal of Surgery
Federico Sopeña, Angel Lanas
Colonic diverticular disease is common in Western countries and its prevalence increases with age. The large majority of patients (80-85%) will remain entirely asymptomatic throughout their life. In symptomatic cases, most patients will have diverticulosis without inflammation while the remainder will have diverticulitis with or without complications. About 1-2% will require hospitalization and 0.5% will require surgery. Factors predicting the development of symptoms remain to be identified. However, it is generally recognized that diverticular disease is probably related to complex interactions between colon structure, intestinal motility, diet, and genetic features...
November 2011: Therapeutic Advances in Gastroenterology
J-P Ritz, K S Lehmann, A J Kroesen, H J Buhr, C Holmer
INTRODUCTION: Sigmoid resection is now considered as a standard procedure for acute and recurrent sigmoid diverticulitis (SD). In the last decade significant changes in preoperative diagnosis with computed tomography (CT) scanning and surgical access (laparoscopy) have been implemented. The aim of this study was to examine whether this has led to changes in the indications for surgical therapy. PATIENTS AND METHODS: Consecutive admissions of 1,154 patients from January 1995 to December 2009 with acute SD were prospectively included...
August 2011: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
M Betzler
In the context of the controversy regarding the appropriate management of colon diverticulitis without generalised peritonitis - conservative or operative - a review of the literature was per-formed. The progress in diagnostic and therapeutic measures has led to a change in the therapeutic approach during the last 10 years. Because of the lack of randomised controlled trials in patients with diverticulitis (without generalised -peritonitis) comparing medical and surgical treatments, there are still several unanswered questions, such as whether and when to operate and what the recurrence rate is, especially after medical treatment...
April 2010: Zentralblatt Für Chirurgie
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