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Elective colonic resection after acute diverticulitis improves quality of life, intestinal symptoms and functional outcome: experts’ perspectives and review of literature

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Abstract

The decision whether to operate for diverticular disease and the appropriate selection of right candidates for elective colectomy after recovery from an uncomplicated episode of acute diverticulitis remains controversial. Although both the impact of symptomatic disease and occurrence of its complications are extensively studied, there is no consensus about the role of elective colonic resection in the management of symptomatic recurrent diverticulitis. In this study, the database of ERIC, the Web of Science, EMBASE, and MEDLINE were searched for the English-language published articles about the functional outcomes and symptomatic improvement in patients after elective surgery for diverticular disease. A majority of clinical trials showed that elective surgery following a successful conservative treatment of acute diverticulitis resulted in significantly better social and functional well-being. In addition, elective surgery greatly reduces the potential events of disease recurrence, thus decreasing financial burden on the national health services. However, to obtain the best functional outcome surgical intervention must be individualized and tailored to meet every single patient’s specific indigenous symptomatology.

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References

  1. Bugiantella W, Rondelli F, Longaroni M, Mariani E, Sanguinetti A, Avenia N (2015) Left colon acute diverticulitis: an update on diagnosis, treatment and prevention. Int J Surg 13:157–164

    Article  PubMed  Google Scholar 

  2. Comparato G, Pilotto A, Franze A, Franceschi M, Di Mario F (2007) Diverticular disease in the elderly. Dig Dis 25(2):151–159

    Article  PubMed  Google Scholar 

  3. Hjern F, Johansson C, Mellgren A, Baxter N, Hjern A (2006) Diverticular disease and migration—the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther 23(6):797–805

    Article  CAS  PubMed  Google Scholar 

  4. Salzman H, Lillie D (2005) Diverticular disease: diagnosis and treatment. Am Fam Physician 72(7):1229–1234

    PubMed  Google Scholar 

  5. Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217

    Article  PubMed  Google Scholar 

  6. Humes DJ (2012) Changing epidemiology: does it increase our understanding? Dig Dis 30(1):6–11

    Article  PubMed  Google Scholar 

  7. Cuomo R, Barbara G, Pace F, Annese V, Bassotti G, Binda GA, et al (2014) Italian consensus conference for colonic diverticulosis and diverticular disease. United Eur Gastroenterol J 2(5):413–442. doi:10.1177/2050640614547068

    Article  Google Scholar 

  8. Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harrington J et al (2005) Complicated diverticulitis: is it time to rethink the rules? Ann Surg 242(4):576

    PubMed  PubMed Central  Google Scholar 

  9. Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES et al (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg 249(1):39–44

    Article  PubMed  Google Scholar 

  10. Floch MH, White JA (2006) Management of diverticular disease is changing. World J Gastroenterol WJG 12(20):3225–3228

    Article  PubMed  Google Scholar 

  11. Guzzo J, Hyman N (2004) Diverticulitis in young patients: is resection after a single attack always warranted? Dis Colon Rectum 47(7):1187–1191

    Article  PubMed  Google Scholar 

  12. Dharmarajan S, Hunt SR, Birnbaum EH, Fleshman JW, Mutch MG (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54(6):663–671

    Article  PubMed  Google Scholar 

  13. Myers E, Hurley M, O’sullivan G, Kavanagh D, Wilson I, Winter D (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95(1):97–101

    Article  CAS  PubMed  Google Scholar 

  14. Binda G, Cuomo R, Laghi A, Nascimbeni R, Serventi A, Bellini D, et al. (2015) Practice parameters for the treatment of colonic diverticular disease: Italian society of colon and rectal surgery (SICCR) guidelines. Tech Coloproctol 19(10):615–626

    Article  CAS  PubMed  Google Scholar 

  15. Rafferty J, Shellito P, Hyman NH, Buie WD (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49(7):939–944

    Article  PubMed  Google Scholar 

  16. Forgione A, Leroy J, Cahill RA, Bailey C, Simone M, Mutter D et al (2009) Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy. Ann Surg 249(2):218–224

    Article  PubMed  Google Scholar 

  17. Thörn M, Graf W, Stefànsson T, Påhlman L (2002) Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease. Am J Surg 183(1):7–11

    Article  PubMed  Google Scholar 

  18. Martin G, Dupré A, Mulliez A, Prunel F, Slim K, Pezet D (2015) Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery. J Visc Surg 152(1):5–10

    Article  CAS  PubMed  Google Scholar 

  19. Pendse D, Taylor S (2013) Complications of CT colonography: a review. Eur J Radiol 82(8):1159–1165

    Article  CAS  PubMed  Google Scholar 

  20. von Wagner C, Smith S, Halligan S, Ghanouni A, Power E, Lilford RJ et al (2011) Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients. Eur Radiol 21(10):2046–2055

    Article  Google Scholar 

  21. Hainaux B, Agneessens E, Bertinotti R, De Maertelaer V, Rubesova E, Capelluto E et al (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. Am J Roentgenol 187(5):1179–1183

    Article  Google Scholar 

  22. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294

    Article  PubMed  Google Scholar 

  23. Ambrosetti P, Francis K, Weintraub D, Weintraub J (2007) Functional results following elective laparoscopic sigmoidectomy after CT-proven diagnosis of acute diverticulitis evaluation of 43 patients and review of the literature. J Gastrointest Surg 11(6):767–772

    Article  PubMed  Google Scholar 

  24. Tursi A, Brandimarte G, Di Mario F, Andreoli A, Annunziata ML, Astegiano M et al (2015) Development and validation of an endoscopic classification of diverticular disease of the colon: the DICA classification. Dig Dis 33(1):68–76

    Article  PubMed  Google Scholar 

  25. Tursi A (2015) The role of colonoscopy in managing diverticular disease of the colon. J Gastrointest Liver Dis JGLD 24(1):85–93

    Google Scholar 

  26. Elliott T, Yego S, Irvin T (1997) Five-year audit of the acute complications of diverticular disease. Br J Surg 84(4):535–539

    Article  CAS  PubMed  Google Scholar 

  27. Somasekar K, Foster M, Haray P (2002) The natural history of diverticular disease: is there a role for elective colectomy? J R Coll Surg Edinburgh 47(2):481–484

    CAS  Google Scholar 

  28. Janes S, Meagher A, Frizelle F (2005) Elective surgery after acute diverticulitis. Br J Surg 92(2):133–142

    Article  CAS  PubMed  Google Scholar 

  29. Nelson RS, Ewing BM, Wengert TJ, Thorson AG (2008) Clinical outcomes of complicated diverticulitis managed nonoperatively. Am J Surg 196(6):969–974

    Article  PubMed  Google Scholar 

  30. Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363(9409):631–639

    Article  PubMed  Google Scholar 

  31. Sonoda T (2015) Laparoscopic sigmoidectomy/left colectomy. Minimally invasive approaches to colon and rectal disease. Springer, Berlin, pp 71–80

    Google Scholar 

  32. Keighley MRB, Keighley MR (2008) Surgery of the anus rectum and colon. Saunders Elsevier

  33. Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL (2009) Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum 52(9):1558–1563

    Article  PubMed  Google Scholar 

  34. Vestweber B, Vestweber K-H, Paul C, Rink AD (2015) Single-port laparoscopic resection for diverticular disease: experiences with more than 300 consecutive patients. Surg Endosc 30(1):50–58

    Article  PubMed  Google Scholar 

  35. Borchert DH, Schachtebeck M, Schoepe J, Federlein M, Bunse J, Gellert K et al (2015) Observational study on preservation of the superior rectal artery in sigmoid resection for diverticular disease. Int J Surg 21:45–50

    Article  CAS  PubMed  Google Scholar 

  36. Masoni L, Mari FS, Nigri G, Favi F, Gasparrini M, Dall’Oglio A et al (2013) Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc 27(1):199–206

    Article  PubMed  Google Scholar 

  37. Cirocchi R, Trastulli S, Farinella E, Desiderio J, Listorti C, Parisi A et al (2012) Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials. Colorectal Dis 14(9):e521–e529

    Article  CAS  PubMed  Google Scholar 

  38. Van De Wall BJ, Draaisma WA, Van Iersel JJ, Consten EC, Wiezer MJ, Broeders IA (2013) Elective resection for ongoing diverticular disease significantly improves quality of life. Dig Surg 30(3):190–197

    Article  PubMed  Google Scholar 

  39. Levack MM, Savitt LR, Berger DL, Shellito PC, Hodin RA, Rattner DW et al (2012) Sigmoidectomy syndrome? Patients’ perspectives on the functional outcomes following surgery for diverticulitis. Dis Colon Rectum 55(1):10–17

    Article  PubMed  Google Scholar 

  40. Pasternak I, Wiedemann N, Basilicata G, Melcher GA (2012) Gastrointestinal quality of life after laparoscopic-assisted sigmoidectomy for diverticular disease. Int J Colorectal Dis 27(6):781–787

    Article  PubMed  Google Scholar 

  41. Eypasch E, Williams J, Wood-Dauphinee S, Ure B, Schmulling C, Neugebauer E et al (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82(2):216–222

    Article  CAS  PubMed  Google Scholar 

  42. Bolster L, Papagrigoriadis S (2003) Diverticular disease has an impact on quality of life—results of a preliminary study. Colorectal Dis 5(4):320–323

    Article  CAS  PubMed  Google Scholar 

  43. Schwenk W, Neudecker J, Haase O, Raue W, Strohm T, Müller J (2004) Comparison of EORTC quality of life core questionnaire (EORTC-QLQ-C30) and gastrointestinal quality of life index (GIQLI) in patients undergoing elective colorectal cancer resection. Int J Colorectal Dis 19(6):554–560

    Article  CAS  PubMed  Google Scholar 

  44. Regenbogen SE, Hardiman KM, Hendren S, Morris AM (2014) Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg 149(3):292–303

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Niguarda Cà Granda Hospital, Milan, Italy

    Antonello Forgione

  2. AIMS Academy-Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

    Antonello Forgione

  3. Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia

    Salman Yousuf Guraya

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  1. Antonello Forgione
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  2. Salman Yousuf Guraya
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Correspondence to Antonello Forgione.

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Forgione, A., Guraya, S.Y. Elective colonic resection after acute diverticulitis improves quality of life, intestinal symptoms and functional outcome: experts’ perspectives and review of literature. Updates Surg 68, 53–58 (2016). https://doi.org/10.1007/s13304-016-0349-0

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  • DOI: https://doi.org/10.1007/s13304-016-0349-0

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