[What is the Actual Benefit of Sigmoid Resection for Acute Diverticulitis? : Functional Outcome After Surgical and Conservative Treatment]

Overview

Journal Chirurg

Specialty General Surgery

Date 2013 Mar 23

PMID 23519381

Citations 5

Authors

J-P Ritz

J Grone

S Engelmann

K S Lehmann

H J Buhr

C Holmer

Affiliations

Soon will be listed here.

Abstract

Introduction: The correct therapeutic management of acute sigmoid diverticulitis (SD) is still controversially discussed. Essential to the success of therapy is primarily the long-term resolution of Patient symptoms after surgical or conservative therapy. The aim of this study was to compare the long-term outcome after conservative and surgical treatment of Patients with acute SD.

Patients And Methods: Consecutive admissions of all Patients with acute SD were prospectively recruited from January 2005 to June 2008 with the exception of a free perforation. The following data were recorded: age, sex, first or recurrent episode of SD, computed tomography (CT) stage, white blood cell count, C-reactive protein, persistent symptoms and recurrence after conservative and surgical therapy. Furthermore, information on the rates of postoperative sexual and bladder dysfunction was collected. The long-term outcome was evaluated by a standardized questionnaire. In June 2008 all Patients were contacted using a standardized questionnaire.

Results: A total of 153 Patients were included in the study of whom 70 (45.8 %) presented with the first episode, 83 (54.2 %) had a prior history of SD and 40 Patients were treated conservatively whereas 113 Patients were surgically treated by sigmoid resection. Uncomplicated SD was seen in 16 Patients (conservative 4, surgical 12, p = 0.961), phlegmonous SD was seen in 88 cases (conservative 29, surgical 59, p = 0.026) and covered perforated SD in 49 cases (conservative 7, surgical 42, p = 0.022). The median follow-up was 32 months (range 12-52 months). At follow-up 25 % of conservative and 8.8 % of Patients treated surgically complained about persistent symptoms (p = 0.009). The following symptoms occurred (conservative vs. surgery): painful defecation (22.5 % versus 8.8 %, p = 0.024.), constipation (25 % versus 8.8 %, p = 0.009), abdominal cramp (22.5 % versus 4.4 %, p = 0.001) and painful flatulence (25 % versus 8.8 %, p = 0.009). Sexual or bladder dysfunction occurred postoperatively in 7 % and 9 %, respectively. Of the conservatively treated Patients 32.5 % had a recurrence of SD during follow-up compared to 3.5 % of surgically treated Patients (p < 0.001).

Conclusions: Surgical treatment of acute SD is more effective than conservative therapy for the prophylaxis of recurrent SD and avoidance of persistent symptoms.

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