Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis
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It is controversial whether patients fare better with conservative or surgical treatment in certain stages of acute diverticulitis (AD), in particular when phlegmonous inflammation or covered micro- or macro-perforation are present. The aim of this study was to determine long-term quality of life (QoL) for AD patients who received either surgery or conservative treatment in different stages.
We included patients treated for AD at the University Hospital Grosshadern, Munich, Germany, between January 1, 2000, and December 31, 2010. Patients were classified by the Hansen and Stock (HS) classification, the modified Hinchey classification, and the German classification of diverticular disease (CDD). Pre-therapeutic staging was based on multidetector computed tomography. Long-term QoL was assessed by the Cleveland Global Quality of Life (CGQL) questionnaire, the Short Form 36 (SF-36), and the Gastrointestinal Quality of Life Index (GIQLI). Data are mean ± SEM.
Patients with phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) had a better long-term QoL on the GIQLI when they were operated (78.5 ± 2.5 vs. 70.7 ± 2.1; p < 0.05). Patients with micro-abscess (CDD 2a) had a better long-term QoL on the GIQLI, CGQL, and the “Role Physical” scale of the SF-36 when they were not operated (GIQLI 86.9 ± 2.1 vs. 76.8 ± 1.0; p = 0.10; CGQL 82.8 ± 5.1 vs. 65.3 ± 11.0; p = 0.08; SF-36/Role Physical 100 ± 0.0 vs. 41.7 ± 13.9; p < 0.001). Patients with macro-abscess (CDD 2b) had a better long-term QoL when they were operated (GIQLI 89.3 ± 1.4 vs. 69.5 ± 4.5; p < 0.01; CGQL 80.3 ± 7.6 vs. 60.5 ± 5.8; p < 0.05; SF-36/Role Physical 95.8 ± 4.2 vs. 47.9 ± 13.6; p < 0.001).
Considering long-term QoL, phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) should be treated conservatively. In patients with covered perforation, abscess size should guide the decision on whether to perform surgery later on or not. In the light of long-term quality of life, patients fare better after elective sigmoid colectomy when abscess size exceeds 1 cm.
KeywordsDiverticular disease Sigmoid diverticulitis Quality of life Hansen and stock classification German classification of diverticular disease
The authors are most grateful to Dres. Ursula and Günther Karpitschka for their profound support.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 6.Andeweg CS, Mulder IM, Felt-Bersma RJ, Verbon A, van der Wilt GJ, van Goor H, Lange JF, Stoker J, Boermeester MA, Bleichrodt RP, Netherlands Society of Surgery, Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health echnology Assessment and Dieticians (2013) Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 30(4-6):278–292. https://doi.org/10.1159/000354035 CrossRefPubMedGoogle Scholar
- 17.Schreyer AG, Layer G, German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) (2015) S2k guidelines for diverticular disease and diverticulitis: diagnosis, classification, and therapy for the radiologist. Rofo 187(8):676–684. https://doi.org/10.1055/s-0034-1399526 CrossRefPubMedGoogle Scholar
- 18.Kruis W, Germer CT, Leifeld L, German Society for Gastroenterology, Digestive and Metabolic Diseases and The German Society for General and Visceral Surgery (2014) Diverticular disease: guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery. Digestion 90(3):190–207. https://doi.org/10.1159/000367625 CrossRefPubMedGoogle Scholar
- 19.Leifeld L, Germer CT, Böhm S, Dumoulin FL, Häuser W, Kreis M, Labenz J, Lembcke B, Post S, Reinshagen M, Ritz JP, Sauerbruch T, Wedel T, von Rahden B, Kruis W (2014) S2k guidelines diverticular disease/diverticulitis. Z Gastroenterol 52(7):663–710. https://doi.org/10.1055/s-0034-1366692 CrossRefPubMedGoogle Scholar
- 21.Kiran RP, Delaney CP, Senagore AJ, O'Brien-Ermlich B, Mascha E, Thornton J, Fazio VW (2003) Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn's disease. Am J Gastroenterol 98(8):1783–1789. https://doi.org/10.1111/j.1572-0241.2003.07592.x CrossRefPubMedGoogle Scholar
- 24.Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45(7):962–966. https://doi.org/10.1007/s10350-004-6336-4 CrossRefPubMedGoogle Scholar
- 29.Janes S, Meagher A, Faragher IG, Shedda S, Frizelle FA (2009) The place of elective surgery following acute diverticulitis in young patients: when is surgery indicated? An analysis of the literature. Dis Colon Rectum 52(5):1008–1016. https://doi.org/10.1007/DCR.0b013e3181a0a8a9 CrossRefPubMedGoogle Scholar