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International Journal of Colorectal Disease

, Volume 33, Issue 3, pp 317–326 | Cite as

Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis

  • Martina Brandlhuber
  • Christian Genzinger
  • Bernhard Brandlhuber
  • Wieland H. Sommer
  • Mario H. Müller
  • Martin E. KreisEmail author
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Diverticular disease Sigmoid diverticulitis Quality of life Hansen and stock classification German classification of diverticular disease 

Notes

Acknowledgements

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Martina Brandlhuber
    • 1
  • Christian Genzinger
    • 2
  • Bernhard Brandlhuber
    • 3
  • Wieland H. Sommer
    • 1
  • Mario H. Müller
    • 4
  • Martin E. Kreis
    • 5
    Email author
  1. 1.Department of RadiologyLudwig Maximilian University of MunichMunichGermany
  2. 2.Department of AnesthesiologyLudwig Maximilian University of MunichMunichGermany
  3. 3.Department of Internal MedicineKlinik Mühldorf am InnMühldorf am InnGermany
  4. 4.Department of Visceral SurgeryVivantes Klinikum NeuköllnBerlinGermany
  5. 5.Department of General-, Visceral- and Vascular SurgeryCharité University Medicine BerlinBerlinGermany

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