Diverticulitis - The Eastern Association for the Surgery of Trauma

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Eastern Association for the Surgery of Trauma

Diverticulitis

Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI).

Loire M, Bridoux V, Mege D, Mathonnet M, Mauvais F, Massonnaud C, Regimbeau JM, Tuech JJ.

Int J Colorectal Dis . 2021 Oct;36(10):2159-2164.

Rationale for inclusion: Median 9 year follow up shows lower long-term complications with primary anastomosis, including lower incisional hernia and reoperation rate, and higher quality of life scores compared to Hartmann's procedure, and equivalent survival between the groups.

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Laparoscopic lavage vs primary resection for acute perforated diverticulitis: long-term outcomes from the Scandinavian diverticulitis (SCANDIV) randomized clinical trial.

Azhar N, Johanssen A, Sundstrom T, Folkesson J, Wallon C, Korner H, Blecic L, Forsmo HM, Oresland T, Yaqub S, Buchwald P, Schultz JK.

JAMA Surg. 2021 Feb;156(2):121-7.

Rationale for inclusion: 5-year follow up on previously reported RCT shows similar rates of severe complications, but higher recurrence of diverticulitis in the laparoscopic lavage group, 30% of whom went on to sigmoid resection. Stoma prevalence was lower in laparoscopic lavage group.

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Evidence-based Reviews in Surgery Long-term outcome of surgery versus conservative management for reccurent and ongoing complaints after an episode of diverticulitis: five-year follow-up results of a multicenter randomized controlled trial (DIRECT-Trial).

Patel SV, Hendren S, Zaborowski A, Winter D.

Ann Surg. 2020 Aug;272(2):284-7.

Rationale for inclusion: Review of multicenter trial showing improved quality of life at 5-year follow-up in patients who undergo elective sigmoid resection compared to conservative management of ongoing symptomatic/recurrent left-sided diverticulitis. This highlights another consideration when making individualized recommendations regarding elective resection.

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Risk of emergency surgery or death after initial nonoperative management of complicated diverticulitis in Scotland and Switzerland.

Torney MSU, Moffa G, Kaech M, Haak F, Riss S, Deutschmann E, Bucher HC, Kettelhack C, Paterson HM.

JAMA Surg. 2020 Jul;155(7):600-6.

Rationale for inclusion: Population-based comparative study showed that despite 5-fold difference in elective interval resection following nonoperative management of acute episode, there was no difference in the rate of recurrent diverticulitis requiring emergent operation or inpatient death between the two groups. The findings should be taken into consideration when making individualized decisions regarding elective resection.

CAVEAT: Population-based comparative study showed that despite 5-fold difference in elective interval resection following nonoperative management of acute episode, there was no difference in the rate of recurrent diverticulitis requiring emergent operation or inpatient death between the two groups. The findings should be taken into consideration when making individualized decisions regarding elective resection.

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Laparoscopic Peritoneal Lavage vs Laparoscopic Sigmoidectomy in Complicated Acute Diverticulitis: A Multicenter Prospective Study

Tartaglia D, Di Saverio S, Stupalkowska W, Giannessi S, Robustelli V, Coccolini F, Ioannidus O, Nita GE, Munoz-Cruzado VM, Ciuro FP, Chiarugi M.

Int J Colorectal Dis. 2019 Dec; 34(12):2111-2120.

Rationale for Inclusion: Multicenter observational study showing laparoscopic peritoneal lavage has higher rate of recurrence and complications as compared to laparoscopic sigmoidectomy

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Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis

Isacson D, Smedh K, Nikberg M, Chabok A.

Br J Surg. 2019 Oct; 106(11):1542-1548.

Rationale for Inclusion: Long term follow up on a randomized study comparing uncomplicated diverticulitis treated with or without antibiotics showing no long term outcomes

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Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicenter, parallel-group, randomized, open-label, superiority trial

Lambrichts DPV, Vennix S, Musters GD, et al.

Lancet Gastroenterol Hepatol. 2019 Aug;4(8):599-610.

Rationale for Inclusion: Multicenter trial comparing Hartmann's vs sigmoidectomy and primary anastomosis in patients with Hinchey III and IV diverticulitis. It favors primary anastomosis in the appropriate patient.

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Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients

Lee JM, Chang JBP, El Hechi M, Kongkaewpaisan N, Bonde A, Mendoza AE, Saillant NN, Fagenholz PJ, Velmahos G, Kaafarani HM.

J Am Coll Surg. 2019 Jul;229(1):48-55.

Rationale for Inclusion: NSQIP data analysis showing PADLI just as safe as Hartmann's for acute diverticulitis

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Long-term follow-up of a multicenter cohort study on laparoscopic peritoneal lavage for perforated diverticulitis

Sneiders D, Lambrichts DPV, Swank HA, Blanken-Peeters CFJM, Nienhuijs SW, Govaert MJPM, Gerhards MF, Hoofwijk AGM, Bosker RJI, van der Bilt JDW, Heijnen BHM, Ten Cate Hoedemaker HO, Kleinrensink GJ, Lange JF, Bemelman WA.

Colorectal Dis. 2019 Jun;21(6):705-714.

Rationale for Inclusion: Long term follow up for patients who underwent laparoscopic peritoneal lavage for purulent diverticulitis showing increase risk of recurrence, reintervention and complications

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Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis.

van Dijk ST, Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA; Dutch Diverticular Disease (3D) Collaborative Study Group.

Am J Gastroenterol. 2018 Jul;113(7):1045-1052.

Rationale for inclusion: A follow up of the DIABOLO trial, this multicenter Dutch study, shows that omiting antibiotics for uncomplicated diverticultis did not result in more complicated attacks, or resections at 12 and 24 months follow up.

CAVEAT: Dutch study.

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Meta-analysis of surgical strategies in perforated left colonic diverticulitis with generalized peritonitis.

Schmidt S, Ismail T, Puhan MA, Soll C, Breitenstein S.

Langenbecks Arch Surg. 2018 Jun;403(4):425-433.

Rationale for inclusion: This meta-analysis suports the results of the DIVERTI trial. Results show that laparoscopic lavage are not superior to primary resection.

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Hartmann's Procedure or Primary Anastomosis for Generalized Peritonitis due to Perforated Diverticulitis: A Prospective Multicenter Randomized Trial (DIVERTI).

Bridoux V, Regimbeau JM, Ouaissi M, Mathonnet M, Mauvais F, Houivet E, Schwarz L, Mege D, Sielezneff I, Sabbagh C, Tuech JJ.

J Am Coll Surg. 2017 Dec;225(6):798-805.

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Rationale for inclusion: a well-designed prospective, multicenter, randomized controlled study comparing mortality between patients with diverticular peritonitis (Hinchey stage III and IV) who had a primary anastomosis with a protective diverting stoma versus patients who had a Hartmann’s procedure. No significant difference found in mortality, but primary anastomosis patients were > 30% more likely to have stoma reversal by 18 months.

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One-year results of the SCANDIV randomized clinical trial of laparoscopic lavage versus primary resection for acute perforated diverticulitis.

Schultz JK, Wallon C, Blecic L, Forsmo HM, Folkesson J, Buchwald P, Kørner H, Dahl F, Øresland T, Yaqub S.

Br J Surg. 2017 Sep;104(10):1382-1392.

Rationale for inclusion: Longer follow up on previously reported RCT showing similar rates of a second operation after the index operation, mortality, and complications. Lower incidence of stoma at one year in the laparoscopic lavage group.

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Failure of conservative treatment of acute diverticulitis with extradigestive air.

Colas PA, Duchalais E, Duplay Q, Serra-Maudet V, Kanane S, Ridereau-Zins C, Lermite E, Aubé C, Hamy A, Venara A.

World J Surg. 2017 Jul;41(7):1890-1895

Rationale for inclusion: Multicenter review of diverticulitis patients treated medically to identify clinical and CT findings associated with failure of medical management.

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Multicenter validation of American Association for the Surgery of Trauma grading system for acute colonic diverticulitis and its use for emergency general surgery quality improvement program.

Shafi S, Priest EL, Crandall ML, Klekar CS, Nazim A, Aboutanos M, Agarwal S, Bhattacharya B, Byrge N, Dhillon TS, Eboli DJ, Fielder D, Guillamondegui O, Gunter O, Inaba K, Mowery NT, Nirula R, Ross SE, Savage SA, Schuster KM, Schmoker RK, Siboni S, Siparsky N, Trust MD, Utter GH, Whelan J, Feliciano DV, Rozycki G; American Association for the Surgery of Trauma Patient Assessment Committee.

J Trauma Acute Care Surg. 2016 Mar;80(3):405-10; discussion 410-1.

Rationale for inclusion: This retrospective study found that the newly developed AAST grades for acute colonic diverticulitis were independently associated with clinical outcomes and resource use. This has important implications for EGS quality improvement program methodology.

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The impact of elective colon resection on rates of emergency surgery for diverticulitis.

Simianu VV, Strate LL, Billingham RP, Fichera A, Steele SR, Thirlby RC, Flum DR.

Ann Surg. 2016 Jan;263(1):123-9.

Rationale for inclusion: This retrospective cohort study found that although the rate of elective colectomy for diverticulitis has more than doubled since 1987, the rate of emergent surgical intervention has not declined. Perhaps this reinforces the notion that elective colectomy does not help reduce the need for emergency surgery and should not be done routinely.

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Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: The SCANDIV Randomized Clinical Trial.

Schultz JK, Yaqub S, Wallon C, Blecic L, Forsmo HM, Folkesson J, Buchwald P, Korner H, Dahl FA, Oresland T; SCANDIV Study Group.

JAMA. 2015 Oct 6;314(13):1364-75.

Rationale for inclusion: This multi-center, randomized clinical superiority trial found that the use of laparoscopic lavage did not reduce postoperative complications. There was no difference in mortality, postoperative length of stay or quality of life.

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Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial.

Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA.

Ann Surg. 2009 Jan;249(1):39-44.

Rationale for inclusion: This is a multi-center double-blind randomized controlled trial comparing laparoscopic versus open sigmoid resection for symptomatic diverticulitis. The study found that the laparoscopic approach was associated with longer operative times but lower complication rates, less pain and shorter hospital length of stay.

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Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?

Chapman JR, Dozois EJ, Wolff BG, Gullerud RE, Larson DR.

Ann Surg. 2006 Jun;243(6):876-830; discussion 880-3.

Rationale for inclusion: Retrospective study that found that patients with multiple (>2) episodes of diverticulitis are not at increased risk for poor outcomes compared to those with fewer attacks. Therefore elective resection may not be warranted in these patients.

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Treatment of perforated diverticular disease of the colon.

Hinchey EJ, Schaal PG, Richards GK.

Adv Surg. 1978;12:85-109.

Rationale for inclusion: Although several modifications and new grading systems have been proposed that provide a more contemporary overview of the disease, this discusses Hinchey's traditional classification for perforated diverticulitis.

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