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Journal of Gastrointestinal Surgery

, Volume 11, Issue 4, pp 542–548 | Cite as

Controversies in the Surgical Management of Sigmoid Diverticulitis

  • Liliana Bordeianou
  • Richard Hodin
Article

Abstract

The timing and appropriateness of surgical treatment of sigmoid diverticular disease remain a topic of controversy. We have reviewed the current literature on this topic, focusing on issues related to the indications and types of surgery. Current evidence would suggest that elective surgery for diverticulitis can be avoided in patients with uncomplicated disease, regardless of the number of recurrent episodes. Furthermore, the need for elective surgey should not be influenced by the age of the patient. Operation should be undertaken in patients with severe attacks, as determined by their clinical and radiological evaluation.

Keywords

Sigmoid diverticulitis Surgical management Diagnosis Elective surgery 

References

  1. 1.
    Wong WD, Wexner SD, Lowry A, et al. Practice parameters for the treatment of sigmoid diverticulitis-supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000;43:290–297.PubMedCrossRefGoogle Scholar
  2. 2.
    Salem L, Flum DR. Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 2004;47:1953–1964.PubMedCrossRefGoogle Scholar
  3. 3.
    American Gastroenterological Association. The Burden of Gastrointestinal Diseases. Bethesda, MD: American Gastroenterological Association, 2001.Google Scholar
  4. 4.
    Stollman L, Raskin J. Diverticular disease of the colon. J Clin Gastroenterol 1999;29:241–252.PubMedCrossRefGoogle Scholar
  5. 5.
    Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ 1971;1:450.Google Scholar
  6. 6.
    Ornstein MH, Littlewood ER, Baird IM, Fowler J, Cox AG. Are fiber supplements really necessary in diverticular disease of the colon? A controlled clinical trial. Br Med J 1981;282:1353–1356.Google Scholar
  7. 7.
    Papagrigoriades S, Macey L, Bourantas N, Rennie JA. Smoking may be associated with complications in diverticular disease. Br J Surg 1999;86:923.CrossRefGoogle Scholar
  8. 8.
    Golder M, Burleigh DE, Belai A, et al. Smooth muscle cholinergic denervation hypersensitivity in diverticular disease. Lancet 2003;361:1945–1951.PubMedCrossRefGoogle Scholar
  9. 9.
    Lawrimore T, Rhea J. Computed tomography evaluation of diverticulitis. J Intensive Care Med 2004;19(4):194–204.PubMedCrossRefGoogle Scholar
  10. 10.
    Kohler L, Sauerland S, Neugebauer E, et al. E.A.E.S. consensus statement: diagnosis and treatment of diverticular disease. Results of a consensus conference. Surg Endosc 1999;13:430–436.PubMedCrossRefGoogle Scholar
  11. 11.
    Hinchey EJ, Schaal PGH, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85–109.PubMedGoogle Scholar
  12. 12.
    Ambrosetti P, Jenny A, Becker C, Terrier F, Morel P. Acute left colonic diverticulosis: compared performance of computed tomography and water-soluble contrast enema. Prospective evaluation of 420 patients. Dis Colon Rectum 2000;43:1363–1367.PubMedCrossRefGoogle Scholar
  13. 13.
    O’Sullivan GC, Murphy D, O’Brien M, Ireland A. Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. Am J Surg 1996;171:432–434.PubMedCrossRefGoogle Scholar
  14. 14.
    Rizk N, Barat C, Faranda C, Catheline JM, Champault G. Traitement laparoscopique des peritonitis generalisees par perforation diverticulaire du colon sigmoide. A propos de dix cas. Chirurgie 1998;123:358–362.PubMedCrossRefGoogle Scholar
  15. 15.
    Belmonte C, Klas JV, Perez JJ, Wong WD, Rothenberger DA, Goldberg SM, Madoff RD. The Hartmann procedure: first choice or last resort in diverticular disease? Arch Surg 1996;131(6):612–617.PubMedGoogle Scholar
  16. 16.
    Salem L, Flum DR. Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 2004;47(11);1953–1964.PubMedCrossRefGoogle Scholar
  17. 17.
    Parks TG. Natural history of diverticular disease of the colon: a review of 521 cases. BMJ 1969;4:639–642.PubMedCrossRefGoogle Scholar
  18. 18.
    Alexander J, Karl RC, Skinner DB. Results of changing trends in the surgical management of complications of diverticular disease. Surgery 1983;94:683–690.PubMedGoogle Scholar
  19. 19.
    Makela J, Vuolio S, Kiviniemi H, Laitinen S. Natural history of diverticular disease. When to operate? Dis Colon Rectum 1998;41(12):1523–1528.PubMedCrossRefGoogle Scholar
  20. 20.
    Somasekar K, Foster ME, Haray PN. The natural history of diverticular disease: is there a role for elective colectomy? J R Coll Surg Edinb 2002;47(2):481–484.PubMedGoogle Scholar
  21. 21.
    Bookey EL, Chapius PH, Pheils MT. Elective resection for diverticular disease and carcinoma. Comparison of postoperative morbidity and mortality. Dis Colon Rectum 1981;24:181–18.CrossRefGoogle Scholar
  22. 22.
    Thaler K, Baig MK, Berho M, Weiss E, Nogueras JJ, Arnaud JP, Wexner SD, Bergamaschi R. Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis. Dis Colon Rectum 2003;46(3):385–388.PubMedCrossRefGoogle Scholar
  23. 23.
    Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1:144–150.PubMedGoogle Scholar
  24. 24.
    Natarjan S, Ewings EL, Vega RJ. Laparoscopic sigmoid colectomy after acute diverticulitis: when to operate? Surgery 2004;136:725–730.CrossRefGoogle Scholar
  25. 25.
    Eusebio EB, Eisenberg MM. Natural history of diverticular disease of the colon in young patients. Am J Surg 1973;125:308–311.PubMedCrossRefGoogle Scholar
  26. 26.
    Guzzo J, Hyman N. Diverticulitis in young patients: Is resection after a single attack always warranted? Dis Colon Rectum 2004;47:1187–1191.PubMedCrossRefGoogle Scholar
  27. 27.
    Vignati, PV, Welch JP, Cohen JL. Long-term management of diverticulitis in young patients. Dis Colon Rectum 1995;38(6):627–629.PubMedCrossRefGoogle Scholar
  28. 28.
    Chateums RC, Ambrosetti P, Ludwig A, Mermillod B, Morel Ph, Soravia C. Long term follow up after first acute episode of sigmoid diverticulitis: is surgery mandatory? A prospective study of 118 patients. Dis Colon Rectum 2002;45(7):962–966.CrossRefGoogle Scholar
  29. 29.
    Novak L, Hyman N. Surgery for complicated diverticulitis. Semin Colon Rectal Surg 2000;11(4):214–217.Google Scholar
  30. 30.
    Bahadursingh A, Virgo K, Kaminski D, Longo W. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 2003;186:696–701.PubMedCrossRefGoogle Scholar
  31. 31.
    Di Carlo A, Andtbacka R, Shrier I, Belliveau P, Trudel J, Stein B, Gordon P, Vasilevsky C. The value of specialization–is there an outcome difference in the management of fistulas complicating diverticulitis. Dis Colon Rectum 2001;44(10):1456–1463.PubMedCrossRefGoogle Scholar
  32. 32.
    Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Internal fistulas in diverticular disease. Dis Colon Rectum 1988;31:591–596.PubMedCrossRefGoogle Scholar
  33. 33.
    Bartus C, Lipof T, Shahbaz Sarwar C, Vignati P, Johnson K, Sardella W, Cohen J. Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum 2005;48(2):233–236.PubMedCrossRefGoogle Scholar
  34. 34.
    Detry O, Defraigne J, Meurisse M. Acute diverticulitis in heart transplant recipients. Transpl Int 1996;9:376–379.PubMedCrossRefGoogle Scholar
  35. 35.
    Perkins JD, Shield CF, Chang FC, Farha GJ. Acute diverticulitis. Comparison of treatment in immunocompromised and nonimmunocompromised patients. Am J Surg 1984;148:745–748.PubMedCrossRefGoogle Scholar
  36. 36.
    Efron JE, Nogueras JJ. Controversies in diverticular disease. Indications for surgery and surgical options. Semin Colon Rectal Surg 2000;11(4):206–213.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  1. 1.Department of SurgeryMassachusetts General HospitalBostonUSA

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