Surgical Treatment of Diverticulitis

2019 ◽  
Author(s):  
Tiffany K Weidner ◽  
John T Kidwell ◽  
David A Etzioni
Keyword(s):  
Surgical Treatment ◽  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Sigmoid Resection ◽  
Hartmann Procedure ◽  
Laparoscopic Lavage ◽  
Uncomplicated Diverticulitis ◽  
Recurrent Diverticulitis ◽  
Purulent Peritonitis

Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis.  This review contains 8 figures, 4 tables, and 67 references. Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis

scholarly journals Complicated diverticular disease: the changing paradigm for treatment

2012 ◽  
Vol 39 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Abe Fingerhut ◽  
Nicolas Veyrie
Keyword(s):  
Diverticular Disease ◽  
Bed Rest ◽  
Minimal Invasive ◽  
Primary Resection ◽  
Hartmann’S Procedure ◽  
Hartmann Procedure ◽  
Laparoscopic Lavage ◽  
Hartmann's Procedure ◽  
Therapeutic Algorithms ◽  
Purulent Peritonitis

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

scholarly journals Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1288
Author(s):  
Marilia Carabotti ◽  
Francesca Falangone ◽  
Rosario Cuomo ◽  
Bruno Annibale
Keyword(s):  
Systematic Review ◽  
Diverticular Disease ◽  
Dietary Habits ◽  
Acute Diverticulitis ◽  
High Quality ◽  
Eligibility Criteria ◽  
Diverticular Bleeding ◽  
Recurrent Diverticulitis ◽  
Increased Risk

Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.

scholarly journals Management of colonic diverticulitis

BMJ ◽  
2021 ◽  
pp. n72
Author(s):  
Anne F Peery
Keyword(s):  
Gastrointestinal Disease ◽  
Acute Diverticulitis ◽  
Anaerobic Bacteria ◽  
Gastrointestinal Symptoms ◽  
Colon Resection ◽  
Acute Onset ◽  
Colonic Diverticulitis ◽  
Uncomplicated Diverticulitis ◽  
Recurrent Diverticulitis ◽  
Primary Resection And Anastomosis

ABSTRACT Left sided colonic diverticulitis is a common and costly gastrointestinal disease in Western countries, characterized by acute onset of often severe abdominal pain. Imaging is necessary to make an initial diagnosis and determine disease severity. Colonoscopy should be done six to eight weeks after diagnosis to rule out a missed colon malignancy. Antibiotic treatment is used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis. The clinical course of diverticulitis commonly includes unpredictable recurrences and chronic gastrointestinal symptoms, which are a detriment to quality of life. A better understanding of prognosis has prompted a shift toward non-operative approaches. The decision to undergo prophylactic colon resection should be individualized to consider the severity of diverticulitis, the patient’s health and immune status, and the patient’s preferences and values, as well as benefits and risks. Because only a section of colon is removed, recurrent diverticulitis remains a risk. Acute diverticulitis with an abscess is treated with antibiotics that cover Gram negative and anaerobic bacteria, with or without percutaneous drainage. Acute diverticulitis with purulent or feculent contamination of the peritoneal cavity is managed with surgery; primary resection and anastomosis is the procedure of choice in stable patients.

Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease

2001 ◽  
Vol 88 (5) ◽  
pp. 693-697 ◽  
Author(s):  
A. W. Gooszen ◽  
R. A. E. M. Tollenaar ◽  
R. H. Geelkerken ◽  
H. J. Smeets ◽  
W. A. Bemelman ◽  
...  
Keyword(s):  
Prospective Study ◽  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Sigmoid Resection

scholarly journals P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Elisa Mäkäräinen ◽  
Tero Rautio ◽  
Filip Muysoms ◽  
Joonas Kauppila
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Incisional Hernia ◽  
Parastomal Hernia ◽  
Primary Anastomosis ◽  
Controlled Trials ◽  
Hartmann Procedure ◽  
Randomized Controlled ◽  
Hernia Incidence

Abstract Aim The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis. Material and Methods The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion. Results The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted. Conclusions The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.

scholarly journals ACTUAL CLINICAL APPROACH FOR COMPLICATED DIVERTICULAR DISEASE IN GENERAL SURGERY DEPARTMENT

2018 ◽  
pp. 54-58
Author(s):  
B. K. Gibert ◽  
I. A. Matveev ◽  
N. A. Borodin ◽  
P. A. Zkhukov ◽  
A. N. Zakharova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Diverticular Disease ◽  
General Surgery ◽  
Acute Diverticulitis ◽  
Daily Clinical Practice ◽  
Clinical Approach ◽  
Free Perforation ◽  
Hartmann Procedure ◽  
Surgery Department ◽  
Federal Guidelines

AIM. To revise clinical approaches for patients with complicated diverticular disease used in daily clinical practice in tertiary referral regional center and its compliance with Federal Guidelines. PATIENTS AND METHODS. Twenty-three patients with inflammatory complications of diverticular disease were treated in a General Surgery Department of Regional Hospital of Tumen City in 2015-2016. Preoperative ultrasound was performed for 19 (82.6%) patients, CT - only for 4 (17.4%), laparoscopy - for 13 (56.5%). Seven of them had uncomplicated acute diverticulitis and were treated conservatively. Sixteen (69.6°%) patients underwent Hartmann procedure. Five of them had phlegmonous diverticulitis, 10 - sealed perforation and only 1 - free perforation with fecal peritonitis. RESULTS. According to recent studies in diverticular disease, conservative approach had positive prognosis in 15 of 16 operated patients. All procedures included extended resections with an aim to remove not only inflamed segment of bowel but segments with multiple diverticula as well. Distal part of sigmoid colon was included in specimen in all cases. CONCLUSION. None of recommendations of Federal Guidelines was used in daily clinical practice for patients with diverticular disease and indications for surgery were unreasonably extended in majority of cases. A juridical status of Federal Clinical Recommendations should be increased.

scholarly journals Diverticulitis

2008 ◽  
Vol 55 (3) ◽  
pp. 97-102 ◽  
Author(s):  
J. Pfeifer
Keyword(s):  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Treatment Modalities ◽  
Perforated Diverticulitis ◽  
Western World ◽  
Common Disease ◽  
Concomitant Treatment ◽  
Wide Range ◽  
Life Threatening

Diverticular disease produces a wide range of clinical presentations varying from minimal clinical discomfort to life-threatening complications. Often there is a considerable discrepancy between clinical, radiologic, endoscopic and pathologic findings. Diverticulosis is a quite common disease affecting about 2/3 of people in the Western world over the age 80. The exact incidence of acute diverticulitis is unclear. We distinguish between uncomplicated and complicated diverticular disease forms. The latter includes abscess formation, stricture, obstruction, and free perforation causing life-threatening peritonitis. Several classifications for perforated diverticulitis have been proposed. From the practical point of view the Hansen-Stock classification seems to be the most appropriate one as it includes all forms of diverticular disease; it can also be used preoperatively. Prophylactic resection to avoid complications is not justified in minimally symptomatic individuals. Timing of the operation depends on the clinical course and the grade of peritonitis and on concomitant treatment modalities. Emergency operations should be avoided if possible, to reduce morbidity and mortality. Elective operations should be performed best 6-8 weeks after a second diverticulitis attack. Resection plus primary anastomosis is preferred to a Hartmann?s procedure, if possible. Elective surgery should be done laparoscopically. In acute diverticulitis the goal is to treat uncomplicated forms conservatively, while complicated forms should undergo elective, laparoscopic colon resection.

scholarly journals Laparoscopic Lavage in Complicated Diverticulitis with Colonic Perforation, Always Be Closing?

2021 ◽  
pp. 765-771
Author(s):  
Jasper Sijberden ◽  
Heleen Snijders ◽  
Susanna van Aalten
Keyword(s):  
Acute Diverticulitis ◽  
Case Series ◽  
Lower Abdominal Pain ◽  
Colonic Perforation ◽  
Postoperative Treatment ◽  
Laparoscopic Lavage ◽  
Intravenous Antibiotics ◽  
Purulent Peritonitis ◽  
Good Clinical Condition

Laparoscopic lavage is seen as an acceptable alternative to colonic resection in selected patients with acute diverticulitis with purulent peritonitis. There is no consensus on what surgical technique should be used when performing this procedure. This case series describes the disease course of 3 patients with acute diverticulitis with purulent peritonitis treated with laparoscopic lavage and direct suturing of a colonic perforation. All patients (38- and 71-year-old males and a 44-year-old female) were seen in the emergency department due to acute lower abdominal pain. Clinical examination and laboratory and imaging studies were suggestive of perforated diverticular disease. Laparoscopic lavage with placement of drain(s) and direct suturing of a colonic perforation was performed. Postoperative treatment with intravenous antibiotics was continued for a variable term. Postoperative courses were uneventful. Patients were discharged on postoperative days 5, 5, and 7. At almost 1-year follow-up, all patients are in good clinical condition and have not had a recurrent episode of diverticulitis<i>.</i> Therefore, this case series shows promising results of laparoscopic lavage with direct suturing of colonic perforation in patients with diverticulitis with perforation and purulent peritonitis.

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