Diverticulitis

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OBJECTIVE: To determine the impact of elective colectomy on emergency diverticulitis surgery at the population level. BACKGROUND: Current recommendations suggest avoiding elective colon resection for uncomplicated diverticulitis because of uncertain effectiveness at reducing recurrence and emergency surgery. The influence of these recommendations on use of elective colectomy or rates of emergency surgery remains undetermined. METHODS: A retrospective cohort study using a statewide hospital discharge database identified all patients admitted for diverticulitis in Washington State (1987-2012)...

BACKGROUND: There is a controversy regarding the best urgent surgical treatment of colonic diverticulitis. We sought to compare outcomes of patients who underwent surgery for diverticulitis by the type of admission. METHODS: The National Surgical Quality Improvement Program databases were used to examine the clinical data of patients who underwent colorectal resection for diverticulitis during 2012 to 2013. Multivariate regression analysis was performed to identify outcomes of patients...

BACKGROUND: Diverticulitis in admitted inpatients is well reported. This study examined colonic diverticulitis treated in the emergency department (ED). METHODS: The 2010 Nationwide Emergency Department Sample was used to examine relationships among patient age and inpatient admission, surgical intervention, and in-hospital mortality among ED patients with a primary diagnosis of diverticulitis. RESULTS: Of 310,983 ED visits for primary diverticulitis, 53% resulted in hospitalization and 6% in surgical intervention...

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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...

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BACKGROUND: Guideline-concordant delay in elective laparoscopic colectomy for diverticulitis may result in repeated bouts of inflammation. We aimed to determine whether conversion rates from elective laparoscopic colectomy are higher after multiple episodes of diverticulitis. METHODS: Prospective cohort study evaluating laparoscopic colectomy conversion rates for diverticulitis from 42 hospitals was conducted. RESULTS: Between 2010 and 2013, 1,790 laparoscopic colectomies for diverticulitis (mean age 57...

OBJECTIVE: This study aims to determine the long-term outcomes of diverticulitis and to apply the findings to current practice patterns. BACKGROUND: The long-term morbidity and mortality of diverticulitis are not well defined. Current practice guidelines for diverticulitis are based on limited evidence. METHODS: The California Office of Statewide Health Planning and Development database was queried for longitudinal observations across all hospitals from 1995 to 2009...

OBJECTIVE: To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial. BACKGROUND: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment. METHODS: Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287)...

BACKGROUND: We conducted a retrospective cohort study to compare the outcomes of laparoscopic colon resection (LCR) with open colon resection (OCR) for complicated diverticular disease (CDD) during emergent hospital admission. METHODS: Charts from all patients undergoing colon resection for CDD during emergent hospital admission at a single academic institution were reviewed. The primary outcomes were overall 30-day postoperative morbidity and mortality. RESULTS: From 2000 to 2010, 125 cases were retrieved (49 LCR and 86 OCR)...

BACKGROUND: Over the past few years, the laparoscopic peritoneal lavage has emerged as a therapeutic alternative to standard resection procedures. However, its effectiveness and applicability remain debatable. OBJECTIVE: The aim of this study was to assess laparoscopic lavage in controlling abdominal sepsis secondary to purulent peritonitis. DESIGN: This study was conducted as a retrospective analysis of prospectively collected data. SETTING: This study was conducted at a single tertiary care institution...

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...

BACKGROUND: Initial management of diverticulitis with abscess formation has progressed from a surgical emergency to nonoperative management with antibiotics and percutaneous drainage followed by delayed resection. Controversy has arisen regarding the necessity of elective surgery, when nonoperative management has successfully resolved the index attack. OBJECTIVE: The aim of this systematic review was to analyze the literature to determine the recurrence rate in those patients who were successfully managed nonoperatively and determine the role of elective surgical resection...

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Hartmann's procedure (HP) is the most performed technique for acute diverticulitis. Laparoscopic lavage and drainage (LLD) is an option evaluated as definitive treatment for diverticulitis Hinchey grade II-III. Aim of the study is to analyze and compare LLD vs HP outcomes. From January 1st 2009 and December 31st 2012 we prospectively enrolled 30 patients with diagnosis of acute diverticulitis Hinchey grade II-III. Fourteen patients underwent to LLD (LLD group, LLDG) and 16 patients to HP (Hartmann group, HG)...

BACKGROUND: Laparoscopic peritoneal lavage has been proposed for generalized peritonitis from perforated diverticulitis to avoid a stoma. Reports of its feasibility and safety are promising. This study aimed to establish determinants of failure to enable improved selection of patients for this approach. METHODS: The study included all patients with perforated sigmoid diverticulitis who underwent emergency laparoscopic peritoneal lavage from January 2000 to December 2013...

BACKGROUND: The aim of our study was to evaluate factors associated with percutaneous drainage (PCD) failure, complications, and stoma creation for patients undergoing sigmoidectomy for diverticular abscess. METHODS: Data for patients with diverticular abscess greater than or equal to 3 cm in diameter treated with initial PCD from 1994 to 2012 were identified. RESULTS: One hundred fourteen patients (54% male) with a mean age of 57 years and a mean abscess diameter of 7...

OBJECTIVE: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines. BACKGROUND: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown...

BACKGROUND: Perforated diverticulitis (PD) remains a serious acute abdominal condition. The aims of this study were to measure its incidence in a large UK population and to identify factors affecting outcomes. METHODS: Computerized searches of hospital coding databases for PD were performed in five hospitals in East Anglia, UK. Data were collected from hospital records over 5 years (1995-2000). Incidence was calculated using population data, and factors associated with mortality and morbidity were identified using univariable and multivariable testing...