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By Andy Kerwin Acute Care Surgeon at The University of Florida College of Medicine-Jacksonville
Pascal Gervaz, Patrick Ambrosetti
Laparoscopic lavage and drainage is a novel approach for managing patients with Hinchey III diverticulitis. However, this less invasive technique has important limitations, which are highlighted in this systematic review. We performed a PubMed search and identified 6 individual series reporting the results of this procedure. An analysis was performed regarding treatment-related morbidity, success rates, and subsequent elective sigmoid resection. Data was available for 287 patients only, of which 213 (74%) were actually presenting with Hinchey III diverticulitis...
May 27, 2016: World Journal of Gastrointestinal Surgery
Anders Thornell, Eva Angenete, Thue Bisgaard, David Bock, Jakob Burcharth, Jane Heath, Hans-Christian Pommergaard, Jacob Rosenberg, Nikolaj Stilling, Stefan Skullman, Eva Haglind
BACKGROUND: Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. OBJECTIVE: To compare laparoscopic lavage with open colon resection and colostomy (Hartmann procedure) for perforated diverticulitis with purulent peritonitis. DESIGN: Randomized, controlled, multicenter, open-label trial...
February 2, 2016: Annals of Internal Medicine
L Daniels, Ç Ünlü, N de Korte, S van Dieren, H B Stockmann, B C Vrouenraets, E C Consten, J A van der Hoeven, Q A Eijsbouts, I F Faneyte, W A Bemelman, M G Dijkgraaf, M A Boermeester
BACKGROUND: Antibiotics are advised in most guidelines on acute diverticulitis, despite a lack of evidence to support their routine use. This trial compared the effectiveness of a strategy with or without antibiotics for a first episode of uncomplicated acute diverticulitis. METHODS: Patients with CT-proven, primary, left-sided, uncomplicated, acute diverticulitis were included at 22 clinical sites in the Netherlands, and assigned randomly to an observational or antibiotic treatment strategy...
January 2017: British Journal of Surgery
Johannes Kurt Schultz, Sheraz Yaqub, Conny Wallon, Ljiljana Blecic, Håvard Mjørud Forsmo, Joakim Folkesson, Pamela Buchwald, Hartwig Körner, Fredrik A Dahl, Tom Øresland
IMPORTANCE: Perforated colonic diverticulitis usually requires surgical resection, which is associated with significant morbidity. Cohort studies have suggested that laparoscopic lavage may treat perforated diverticulitis with less morbidity than resection procedures. OBJECTIVE: To compare the outcomes from laparoscopic lavage with those for colon resection for perforated diverticulitis. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized clinical superiority trial recruiting participants from 21 centers in Sweden and Norway from February 2010 to June 2014...
October 6, 2015: JAMA: the Journal of the American Medical Association
John Rose, Ralitza P Parina, Omar Faiz, David C Chang, Mark A Talamini
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...
December 2015: Annals of Surgery
Eva Angenete, Anders Thornell, Jakob Burcharth, Hans-Christian Pommergaard, Stefan Skullman, Thue Bisgaard, Per Jess, Zoltan Läckberg, Peter Matthiessen, Jane Heath, Jacob Rosenberg, Eva Haglind
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)...
January 2016: Annals of Surgery
Debbie Li, Charles de Mestral, Nancy N Baxter, Robin S McLeod, Rahim Moineddin, Andrew S Wilton, Avery B Nathens
OBJECTIVE: To characterize the clinical course of patients with diverticulitis after nonoperative management and determine factors associated with readmission and subsequent emergency surgery. BACKGROUND: Clinical course of this disease remains poorly understood; indications for elective colectomy are unclear. METHODS: This was a retrospective cohort study of patients managed nonoperatively after a first episode of diverticulitis in Ontario, Canada (2002-2012)...
September 2014: Annals of Surgery
Arden M Morris, Scott E Regenbogen, Karin M Hardiman, Samantha Hendren
IMPORTANCE: Diverticulitis is a common disease. Recent changes in understanding its natural history have substantially modified treatment paradigms. OBJECTIVE: To review the etiology and natural history of diverticulitis and recent changes in treatment guidelines. EVIDENCE REVIEW: We searched the MEDLINE and Cochrane databases for English-language articles pertaining to diagnosis and management of diverticulitis published between January 1, 2000, and March 31, 2013...
January 15, 2014: JAMA: the Journal of the American Medical Association
F D McDermott, D Collins, A Heeney, D C Winter
BACKGROUND: The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management. METHODS: A literature review was performed on the electronic databases MEDLINE from PubMed, Embase and the Cochrane Library for publications in English...
January 2014: British Journal of Surgery
Sebastiano Biondo, Thomas Golda, Esther Kreisler, Eloy Espin, Francesc Vallribera, Fabiola Oteiza, Antonio Codina-Cazador, Marcel Pujadas, Blas Flor
OBJECTIVE: We compare the results of 2 different strategies for the management of patients with uncomplicated left colonic diverticulitis and to analyze differences in quality of life and economic costs. BACKGROUND: The most frequent standard management of acute uncomplicated diverticulitis still is hospital admission both in Europe and United States. METHODS: This multicenter, randomized controlled trial included patients older than 18 years with acute uncomplicated diverticulitis...
January 2014: Annals of Surgery
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