scholarly journals Comparison of Diversion Strategies for Management of Acute Complicated Diverticulitis in a US Nationwide Cohort

2021 ◽  
Vol 4 (11) ◽  
pp. e2130674
Author(s):  
Yas Sanaiha ◽  
Joseph Hadaya ◽  
Esteban Aguayo ◽  
Formosa Chen ◽  
Peyman Benharash
Keyword(s):  
Complicated Diverticulitis

Mo1845 ASSOCIATION OF COMPLICATED DIVERTICULITIS WITH SUBSEQUENT DE NOVO INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 158 (6) ◽  
pp. S-947
Author(s):  
Asad Ur Rahman ◽  
Ishtiaq Hussain ◽  
Badar Hasan ◽  
Kanwarpreet Tandon ◽  
Fernando Castro
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
De Novo ◽  
Complicated Diverticulitis ◽  
Inflammatory Bowel

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

scholarly journals Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

2021 ◽  
Author(s):  
Eric M. Haas ◽  
Thais Reif de Paula ◽  
Roberto Luna-Saracho ◽  
Melissa Sara Smith ◽  
Jean-Paul J. LeFave
Keyword(s):  
Complicated Diverticulitis ◽  
Intracorporeal Anastomosis ◽  
Natural Orifice ◽  
Abdominal Incision ◽  
Stepwise Approach ◽  
Stapling Device ◽  
Video Recordings ◽  
Conversion Rates ◽  
Technical Modifications ◽  
Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

scholarly journals Complicated Diverticular Disease

2020 ◽  
Author(s):  
Kathleen M. Coakley ◽  
Bradley R. Davis ◽  
Kevin R. Kasten
Keyword(s):  
Postoperative Complications ◽  
Diverticular Disease ◽  
Surgical Intervention ◽  
Management Strategies ◽  
Significant Risk ◽  
Complicated Diverticulitis ◽  
Careful Attention ◽  
Correct Treatment ◽  
Treatment Paradigm ◽  
Colonic Diverticular Disease

AbstractThe modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.

Surgical treatment of acute complicated diverticulitis in the elderly

2020 ◽  
Vol 74 (6) ◽  
Author(s):  
Roberto Cirocchi ◽  
Riccardo Nascimbeni ◽  
Gian A. Binda ◽  
Nereo Vettoretto ◽  
Rosario Cuomo ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
The Elderly ◽  
Complicated Diverticulitis

scholarly journals Recurrent, Complicated Diverticulitis With Atypical Features

Cureus ◽  
2021 ◽  
Author(s):  
Shelley Persaud ◽  
Bir Singh ◽  
Francisco Brea ◽  
Johnathan Frunzi
Keyword(s):  
Complicated Diverticulitis ◽  
Atypical Features

scholarly journals Machine Learning Model for Outcome Prediction of Patients Suffering from Acute Diverticulitis Arriving at the Emergency Department—A Proof of Concept Study

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2102
Author(s):  
Eyal Klang ◽  
Robert Freeman ◽  
Matthew A. Levin ◽  
Shelly Soffer ◽  
Yiftach Barash ◽  
...  
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Acute Diverticulitis ◽  
External Validation ◽  
White Blood Cells ◽  
Learning Model ◽  
Complicated Diverticulitis ◽  
Gradient Boosting ◽  
Proof Of Concept ◽  
Machine Learning Model

Background & Aims: We aimed at identifying specific emergency department (ED) risk factors for developing complicated acute diverticulitis (AD) and evaluate a machine learning model (ML) for predicting complicated AD. Methods: We analyzed data retrieved from unselected consecutive large bowel AD patients from five hospitals from the Mount Sinai health system, NY. The study time frame was from January 2011 through March 2021. Data were used to train and evaluate a gradient-boosting machine learning model to identify patients with complicated diverticulitis, defined as a need for invasive intervention or in-hospital mortality. The model was trained and evaluated on data from four hospitals and externally validated on held-out data from the fifth hospital. Results: The final cohort included 4997 AD visits. Of them, 129 (2.9%) visits had complicated diverticulitis. Patients with complicated diverticulitis were more likely to be men, black, and arrive by ambulance. Regarding laboratory values, patients with complicated diverticulitis had higher levels of absolute neutrophils (AUC 0.73), higher white blood cells (AUC 0.70), platelet count (AUC 0.68) and lactate (AUC 0.61), and lower levels of albumin (AUC 0.69), chloride (AUC 0.64), and sodium (AUC 0.61). In the external validation cohort, the ML model showed AUC 0.85 (95% CI 0.78–0.91) for predicting complicated diverticulitis. For Youden’s index, the model showed a sensitivity of 88% with a false positive rate of 1:3.6. Conclusions: A ML model trained on clinical measures provides a proof of concept performance in predicting complications in patients presenting to the ED with AD. Clinically, it implies that a ML model may classify low-risk patients to be discharged from the ED for further treatment under an ambulatory setting.

scholarly journals The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1127
Author(s):  
Roberto Cirocchi ◽  
Riccardo Nascimbeni ◽  
Gloria Burini ◽  
Carlo Boselli ◽  
Francesco Barberini ◽  
...  
Keyword(s):  
Decision Making ◽  
Scoping Review ◽  
Percutaneous Drainage ◽  
Acute Diverticulitis ◽  
Treatment Strategies ◽  
Complicated Diverticulitis ◽  
Diffuse Peritonitis ◽  
Open Approach ◽  
Surgical Decision ◽  
Surgical Decision Making

Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.

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