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1 "Acute diverticulitis surgery"
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Original Article
Safety of Nonoperative Management After Acute Diverticulitis
Javier Suarez Alecha, Sonia Amoza Pais, Xavi Batlle Marin, Begoña Oronoz Martinez, Enrique Balen Ribera, Concepción Yarnoz Irazabal
Ann Coloproctol. 2014;30(5):216-221.   Published online October 28, 2014
DOI: https://doi.org/10.3393/ac.2014.30.5.216
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  • 8 Web of Science
  • 8 Citations
AbstractAbstract PDF
Purpose

The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery.

Methods

We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode.

Results

Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458).

Conclusion

After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively.

Citations

Citations to this article as recorded by  
  • Elective surgical versus conservative management of complicated diverticulitis: A systematic review and meta‐analysis
    Marcus Yeow, Nicholas Syn, Choon Seng Chong
    Journal of Digestive Diseases.2022; 23(2): 91.     CrossRef
  • Surgical approach for right‐sided colonic diverticular bleeding: A single‐center review of 43 consecutive cases
    Hitoshi Kameyama, Toshiyuki Yamazaki, Akira Iwaya, Hiroaki Uehara, Shiori Utsumi, Motoharu Hirai, Masaru Komatsu, Akira Kubota, Tomohiro Katada, Kazuaki Kobayashi, Daisuke Sato, Naoyuki Yokoyama, Shirou Kuwabara, Tetsuya Otani
    Asian Journal of Endoscopic Surgery.2021; 14(4): 717.     CrossRef
  • Nonoperative Treatment of Diverticulitis
    Matthew Symer, Heather L. Yeo
    Advances in Surgery.2021; 55: 49.     CrossRef
  • Do Patients Mandate Resection After a First Episode of Acute Diverticulitis of the Colon with a Complication?
    Ryan Francis Bendl, Roberto Bergamaschi
    Advances in Surgery.2017; 51(1): 179.     CrossRef
  • 20-Year Trends in the Management of Diverticulitis Across New York State: an Analysis of 265,724 Patients
    Ryan Lamm, Steven N. Mathews, Jie Yang, Lijuan Kang, Dana Telem, Aurora D. Pryor, Mark Talamini, Jill Genua
    Journal of Gastrointestinal Surgery.2017; 21(1): 78.     CrossRef
  • Medically Treated Diverticular Abscess Associated With High Risk of Recurrence and Disease Complications
    Bikash Devaraj, Wendy Liu, James Tatum, Kyle Cologne, Andreas M. Kaiser
    Diseases of the Colon & Rectum.2016; 59(3): 208.     CrossRef
  • Nonoperative treatment of acute appendicitis in children: A feasibility study
    Joseph Hartwich, Francois I. Luks, Debra Watson-Smith, Arlet G. Kurkchubasche, Christopher S. Muratore, Hale E. Wills, Thomas F. Tracy
    Journal of Pediatric Surgery.2016; 51(1): 111.     CrossRef
  • Nonoperative Management of Acute Complicated Diverticulitis
    Byung Chun Kim
    Annals of Coloproctology.2014; 30(5): 206.     CrossRef
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