Surgical Endoscopy

, Volume 13, Issue 4, pp 430–436 | Cite as

Diagnosis and treatment of diverticular disease

Results of a consensus development conference
  • L. Köhler
  • S. Sauerland
  • E. Neugebauer
  • R. Caprilli
  • A. Fingerhut
  • N. Y. Haboubi
  • L. Hultén
  • C. G. S. Hüscher
  • A. Jansen
  • H-U. Kauczor
  • M. R. B. Keighley
  • F. Köckerling
  • W. Kruis
  • A. Lacy
  • K. Lauterbach
  • J. Leroy
  • J. M. Müller
  • H. E. Myrvold
  • P. Spinelli
Article

Abstract

Background: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art.

Methods: A multidisciplinary panel of international experts (n= 16) was selected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified during a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized statement was mailed to all panel members for approval (Delphi method).

Results: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined separately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considered. For patients in whom a concomitant carcinoma cannot be excluded and those with chronic complications (fistula, stenosis, or bleeding) surgery is also indicated. Laparoscopic sigmoid colectomy is recommended only for uncomplicated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases.

Conclusions: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Key words: Consensus development conference — Diverticulitis — Contrast enema — Hartmann resection — Laparoscopic colectomy — Intraabdominal infections 

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Copyright information

© Springer-Verlag New York Inc. 1999

Authors and Affiliations

  • L. Köhler
    • 1
  • S. Sauerland
    • 2
  • E. Neugebauer
    • 2
  • R. Caprilli
    • 3
  • A. Fingerhut
    • 4
  • N. Y. Haboubi
    • 5
  • L. Hultén
    • 6
  • C. G. S. Hüscher
    • 7
  • A. Jansen
    • 8
  • H-U. Kauczor
    • 9
  • M. R. B. Keighley
    • 10
  • F. Köckerling
    • 11
  • W. Kruis
    • 12
  • A. Lacy
    • 13
  • K. Lauterbach
    • 14
  • J. Leroy
    • 15
  • J. M. Müller
    • 16
  • H. E. Myrvold
    • 17
  • P. Spinelli
    • 18
  1. 1.Surgical Clinic Merheim, II Department of Surgery, University of Cologne, Ostmerheimer Str. 200, 51109 Cologne, GermanyGermany
  2. 2.Biochemical and Experimental Division, II Department of Surgery, University of Cologne, Ostmerheimer Str. 200, 51109 Cologne, GermanyGermany
  3. 3.la Cattedra di Gastroenterologia, Policlinico Umberto I, Università degli studi di Roma ``La sapienza'', RomaItaly
  4. 4.Centre Hospitalier Intercommunal, PoissyFrance
  5. 5.Department of Histopathology, Withington Hospital, ManchesterUK
  6. 6.Department of Surgery, Sahlgrenska Sjukhuset, Göteborg, SwedenSE
  7. 7.Divisione di Chirurgia Thoracica, Istituto Nazionale per lo Studio e la Cura dei Tumori, MilanoItaly
  8. 8.Department of Surgery, Kennemer Gasthuis, Haarlem, The NetherlandsNL
  9. 9.Klinik und Poliklinik für Radiologie, Johannes-Gutenberg-Universität Mainz, Mainz, GermanyGermany
  10. 10.Department of Surgery, Queen Elizabeth Hospital, Birmingham, United KingdomUK
  11. 11.Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Hanover, GermanyGermany
  12. 12.Department of Gastroenterology, Evangelisches Krankenhaus Kalk, KölnGermany
  13. 13.Department of Surgery, Hospital Clínic, Barcelona, SpainSpain
  14. 14.Institut für Gesundheitsökonomie, Universität zu Köln, KölnGermany
  15. 15.Department of Digestive Surgery, Digestive Cancer Research Institute (IRCAD) and European Institute of Telesurgery (EITS), Strasbourg, FranceFrance
  16. 16.Department of Surgery, Charité, Humboldt-Universität, BerlinGermany
  17. 17.Department of Surgery, Trondheim University Hospital, Trondheim, NorwayNorway
  18. 18.Divisione di Diagnostica e Chirurgia Endoscopica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, ItalyItaly

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