IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments (original) (raw)
Related papers
Updates in Surgery, 2023
Colonic diverticulitis can be treated conservatively, but some cases require surgery. Patients can undergo Hartmann's procedure (H) or resection with primary anastomosis (RA), with or without diverting stoma. This multicenter observational retrospective study aims to evaluate the adherence to current guidelines by assessing the rate of RA and H in Lombardy, Italy, and to analyze differences in patients' features. This study included data collected from nine surgical units performing emergency surgery in Lombardy, in 2019 and 2021. Data for each year were retrospectively collected through a survey among Italian Society of Colorectal Surgery (SICCR) Lombardy members. Additional data were about: Hinchey's classification, laparoscopic (VLS) or converted procedures, procedures with more than two operators, procedures in which the first operator was older than 40 years, night or weekend procedures, older-than-80 patients, COVID-19 positivity (just 2021). The total number of operations performed was 254, 115 RA and 130 H (45.3% and 51.2%, diff. 12%, p = 0.73), and 9 (3.5%) other procedures. RAs were more frequent for Hinchey 1 and 2 patients, whereas Hs were more frequent for Hinchey 3 and 4. RAs without ileostomy were significantly less than Hs (66 vs. 130, p = 0.04). Laparoscopy was more used for RA compared to H (57 vs. 21, p = 0.03), whereas no difference was found between RA and H with respect to conversion rate, the presence of more than two operators in the team, the presence of a first operator older than 40 years, night or weekend operations, and for older-than-80 patients. This study confirms the adherence to current guidelines for the treatment of acute colonic diverticulitis in Lombardy, Italy. It can be considered as a preliminary survey with interesting results that may open the way to a further prospective observational study to clarify some aspects in the management of this disease.
Techniques in Coloproctology, 2020
Background Epidemiological studies show an increasing trend of hospitalization for acute diverticulitis (AD), but data regarding the trend in hospitalization for complicated AD in Italy are scarce. The aim of this study was to analyze the Italian trend in hospitalization for complicated AD, from 2008 to 2015. Methods Using the Italian Hospital Information System, we identified all patients with complicated colonic AD as a discharge diagnosis. Age-and sex-specific rates for AD as well as type of hospital admission (emergency/elective), type of complication (peritonitis, obstruction, bleeding, abscess, fistula, perforation, sepsis) and type of treatment (medical/surgical), were analyzed. Results A total of 41,622 patients with a discharge diagnosis of complicated AD were identified. Over the study period the admission rate grew from 8.8 to 11.8 per 100,000 inhabitants. The hospitalization rate was highest for patients ≥ 70 years, but the increase in the admission rate was higher among patients aged ≤ 60 years. There were more males in the group < 60 years and more females in the group ≥ 60 years old. The rate of emergency admissions associated with surgery showed a significant mean annual increase (+ 3.9% per year) in the rate of emergency admissions associated with surgery, whereas elective admissions for surgery remained stable. Peritonitis was the most frequent complication (35.5%). The rate of surgery increased in AD complicated by peritonitis (+ 5.1% per year), abscess (+ 5.8% per year) and decreased for obstruction (− 1.8% per year). Conclusions From 2008 to 2015, we documented an increasing rate of hospitalization for complicated AD, especially for younger patients, with an increase in surgery for peritonitis and abscess. Further studies are needed to clearly assess the risk factors for complications and risk of surgery.
Journal of Gastrointestinal Surgery, 2010
Introduction The existing literature regarding acute perforated diverticulitis only reports about short-term outcome; longterm following outcomes have not been assessed before. The aim of this study was to assess long-term quality of life (QOL) after emergency surgery for perforated diverticulitis. Patients and Methods Validated QOL questionnaires (EQ-VAS, EQ-5D index, QLQ-C30, and QLQ-CR38) were sent to all eligible patients who had undergone emergency surgery for perforated diverticulitis in five teaching hospitals between 1990 and 2005. Differences were compared between patients that had undergone Hartmann's procedure (HP) or resection with primary anastomosis (PA) and also compared to a sex-and age-matched sample of healthy subjects. Results Of a total of 340 patients, only 150 patients (44%) were found still alive in July 2007 (median follow-up 71 months). The response rate was 87%. In patients with PA, QOL was similar to the general population, whereas QOL after HP was significantly lower. The presence of a stoma was found to be an independent factor related to worse QOL. The deterioration in QOL was mainly due to problems in physical function and body image. Conclusions Survivors after perforated diverticulitis had a worse QOL than the general population, which was mainly due to the presence of an end colostomy. QOL may improve if these stomas are reversed or not be performed in the first place.
Abstract— Background: The aim of this study was to analyze the most appropriate surgical strategy in the management of patients with major inflammatory complications of colonic diverticular disease. Materials and Methods: Out of 539 patients affected by complicated diverticular disease of the colon, 125 consecutive patients (23.2%) who underwent urgent or emergency surgical intervention for diverticular perforation during a 13 year period (2000-2013), were retrospectively analyzed. According to the changes in the surgical approach over the time, the series was divided into two groups: 2000-2005 Group A (n=59), 2006-2013 Group B (n=66). The clinical diagnosis was confirmed by operative and pathologic findings. Results: Out of 109 patients, 28 underwent derivative procedure and 81 resection. There were no significant differences among the two groups of patients according to sex ratio and mean age. The overall percentage of patients in group B who underwent resective procedure (91%) was significantly greater in comparison with that in group A (53%). Colostomy and drainage was employed only during the first period (30%), (Group A vs Group B, p<0.05) and the proportion of patients who underwent primary resection and anastomosis was significantly higher during the second period (41%), (Group B vs Group A, p<0.05). Conclusions: It must be stressed that resection of the diseased segment at initial operation appears mandatory; one-stage procedure is indicated when infection is confined to the mesentery, while resection and anastomosis with covering colostomy (two-stage procedure) is preferable whenever peritoneal contamination has occurred. According to the literature Hartmann’s operation may be the procedure of choice in the patients presenting known impaired immunity or fecal contamination.
Journal of the American College of Surgeons, 2017
Background: About 25% of patients with acute diverticulitis require emergency intervention. Currently, most patients with diverticular peritonitis undergo a Hartmann's procedure. Our objective was to assess whether primary anastomosis (PA) with a diverting stoma allows lower mortality than Hartmann's procedure (HP) inpatients with diverticular peritonitis. Study Design: Multicenter randomized controlled trial conducted between June 2008 and May 2012: the DIVERTI study. Follow-up duration was up to 18 months. Setting: Tertiary care referral centers and associated centers in France. Participants: Random sample of 102 eligible participants with purulent or fecal diverticular peritonitis equally randomized to either a primary anastomosis arm or to a Hartmann's procedure arm. Data were analyzed on an intention-to-treat basis. The primary outcome was mortality rate at 18 months. Secondary outcomes were postoperative complications, operative time, length of hospital stay, rate of definitive stoma and morbidity. Results: All 102 patients enrolled were comparable for age (P = 0.4453), sex (P = 0.2347), Hinchey stage III vs IV (P = 0.2347) and Mannheim Peritonitis Index (P = 0.0606). Overall mortality did not differ significantly between Hartmann's procedure (7.7%) and primary anastomosis (4%) (P = 0.4233). Morbidity for both resection and stoma reversal operations were comparable (39% in the HP arm, vs 44% in the PA arm, P = 0.4233). At 18 months, 96% of PA patients and 65% of HP patients had a stoma reversal (P = 0.0001). Conclusions: Although mortality was similar in both arms, the rate of stoma reversal was significantly higher in the PA arm. This trial provides additional evidence in favor of PA with diverting ileostomy over HP in patients with diverticular peritonitis.
Laparoscopic Versus Open Hartmann Procedure for the Emergency Treatment of Diverticulitis
Diseases of the Colon & Rectum, 2013
Background-A laparoscopic approach has been proposed to reduce the high morbidity and mortality associated with the Hartmann's procedure for the emergency treatment of diverticulitis. Objective-The objective of our study was to determine whether a laparoscopic Hartmann's procedure reduces early morbidity or mortality for patients undergoing an emergency operation for diverticulitis. Design-This is a comparative effectiveness study. A subset of the entire American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patient sample matched on propensity for undergoing their procedure with the laparoscopic approach were used to compare postoperative outcomes between laparoscopic and open groups. Setting-This study uses data from the ACS NSQIP Participant User Files from 2005 through 2009. Patients-All patients who underwent an emergency laparoscopic or open partial colectomy with end colostomy for colonic diverticulitis were reviewed. Main Outcome Measures-The main outcome measures were 30-day mortality and morbidity. Results-1,186 patients undergoing emergency partial colectomy with end colostomy for diverticulitis were included in the analysis. Among the entire cohort, the laparoscopic group had fewer overall complications (26% vs. 41.7%, p=0.008) and shorter mean length of hospitalization (8.9 vs. 11.6 days, p=0.0008). Operative times were not significantly different between groups.
Comparison between open and laparoscopic reversal of Hartmann's procedure for diverticulitis
World journal of gastrointestinal surgery, 2013
To compare the open and laparoscopic Hartmann's reversal in patients first treated for complicated diverticulitis. Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann's procedures for acute complicated diverticulitis. Other indications for Hartmann's procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann's reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups. The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimat...
Surgical outcomes and their relation to the number of prior episodes of diverticulitis
Gastroenterology Report, 2013
Purpose: We aimed to investigate the relationship between the number of prior episodes of diverticulitis and outcomes of sigmoid colectomy. Methods: After institutional review board approval, a retrospective review was undertaken based on records of patients who underwent sigmoid resection with anastomosis for diverticulitis between 4 May 2007 and 29 February 2012. Patients were divided into two groups: 0-3 attacks (group 1) and !4 attacks (group 2). Statistical analyses were performed to determine whether the groups differed on demographic, intra-operative and postoperative variables. Results: We identified 247 patients who underwent sigmoid colectomy for diverticulitis (45 open, 202 laparoscopic). The two groups did not differ significantly in age, gender, American Society of Anesthesiologists score, past surgical history, body mass index, length of stay, use of a stoma or number of prior hospitalizations for diverticulitis. Group 1 had a higher rate of abscesses (30.6 vs 6.8%, P < 0.001) and fistulas (19.4 vs 0.9%, P < 0.001); a longer operative time (190.1 vs 166.3 min, P = 0.0024); and higher rates of postoperative complications (45.8 vs 23.3%, P < 0.001) and conversion (17.1 vs 4.4%, P = 0.0091). The most common surgical complications in groups 1 and 2 were wound infection (35 vs 10) and ileus (20 vs 8). Based on multivariate regression analysis, !4 attacks were independently correlated with a lower complication rate (odds ratio = 0.512, 95% confidence interval = 0.266-0.987, P = 0.046). Conclusions: Patients who had !4 previous attacks of diverticulitis had fewer postoperative complications.