Diverticulitis Surgery Outcomes: Insights from Our Clinical Practice

Abstract

Aim: To assess outcomes of diverticulitis surgery, focusing on various patient phases at a tertiary center and incorporating literature insights. Materials and Method: Analysis included diverticular disease surgeries at *** University's General Surgery Clinic over five years, examining demographics, disease specifics, surgical details, stoma aspects, and complications. Patients were categorized into emergency and elective groups for comparison based on Hinchey scores and stoma status. Results: Of the patients, 72% were male, with an average age of 58.46. The sigmoid colon was predominantly affected (84%). Percutaneous drainage was used preoperatively in 44%, and 56% required a stoma, primarily Hartmann colostomies (36%). The median stoma closure time was 5 months, with 10 patients unable to have their stoma closed. Emergency surgeries were associated with higher Hinchey stages (III-IV) and an increased need for stoma creation (81% vs. 16% in elective surgeries). Conclusion: The study indicates a median 5-month duration for stoma reversal, with sigmoid colon being the common site regardless of gender. Emergency surgeries showed a higher rate of stoma creation, suggesting elective surgeries could reduce stoma necessity. Further investigation is needed for broader applicability.

Keywords

• Diverticular disease
• Hinchey classification
• Hartmann procedure
• Complications
• Stoma closure

Kaynakça

1. 1. Lin M, Raman SR. Evaluation of quality of life and surgical outcomes for treatment of diverticular disease. Clin Colon Rectal Surg. 2018;31(4):251-257.
2. 2. Neale JA. Surgical management of diverticular disease in the elective setting. Clin Colon Rectal Surg. 2018;31(4):236-242.
3. 3. Zaborowski AM, Winter DC. Evidence-based treatment strategies for acute diverticulitis. Int J Colorectal Dis. 2021;36:467-475.
4. 4. Nally DM, Kavanagh DO. Current controversies in the management of diverticulitis: a review. Dig Surg. 2019;36(3):195-205.
5. 5. Germer CT, Buhr HJ. Sigmoid diverticulitis. Surgical indications and timing. Chirurg. 2002;73:681-689.
6. 6. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, et al. The American society of colon and rectal surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020;63:728-747.
7. 7. Galetin T, Galetin A, Vestweber KH, Rink AD. Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis. 2018;33:261-272.
8. 8. Leifeld L, Germer CT, Böhm S, Dumoulin FL, Frieling T, Kreis M, et al. S3-Leitlinie Divertikelkrankheit/Divertikulitis – gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). Z Gastroenterol. 2022;60:613-688.

9. 9. Stocchi L. Current indications and role of surgery in the management of sigmoid diverticulitis. World J Gastroenterol. 2010;16(7):804-817.
10. 10. Simianu VV, Strate LL, Billingham RP, Fichera A, Steele SR, Thirlby RC, et al. The impact of elective colon resection on rates of emergency surgery for diverticulitis. Ann Surg. 2016;263(1):123-129.
11. 11. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85-109.
12. 12. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57(3):284-294.
13. 13. Lué A, Laredo V, Lanas A. Medical treatment of diverticular disease: antibiotics. J Clin Gastroenterol. 2016;50(Suppl 1):S57-S59.
14. 14. Vennix S, Musters GD, Mulder IM, Swank HA, Consten EC, Belgers EH, et al. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet. 2015;386(10000):1269-1277.