Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD.

Methods

A single-center, prospective, non-randomized controlled study ran from 2009 to 2017. Patients with first episode of uncomplicated RCD were divided into two treatment arms, LD or NT with bowel rest and broad-spectrum antibiotics, based on their choice. The primary outcome was recurrent diverticulitis during follow-up. Secondary outcomes were treatment success and complications.

Results

A total of 155 patients were enrolled, with 81 in the NT arm and 74 in the LD arm. Mean follow-up was 49 months. The treatment success rate for the NT arm was 90.1% and for the LD arm, 86.5% (P = 0.480). There was no significant difference in the complication rate between the LD arm, 12.2% and the NT arm, 8.6% (P = 0.472). LD was better than NT in preventing recurrent diverticulitis. Nine patients in the NT arm and none in the LD arm had recurrence (P = 0.003). The number needed to treat to prevent recurrence was nine.

Conclusion

Non-operative management with bowel rest and antibiotics for uncomplicated RCD is safe and effective. Alternatively, LD is also safe and effective, with the added benefit of preventing recurrences. While both treatments could be reasonably offered for uncomplicated RCD, LD is an appealing option when recurrence is a concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sardi A, Gokli A, Singer JA (1987) Diverticular disease of the cecum and ascending colon. A review of 881 cases. Am Surg 53:41–45

    CAS  PubMed  Google Scholar 

  2. Jacobs DO (2007) Clinical practice. Diverticulitis. N Engl J Med 357:2057–2066

    Article  CAS  Google Scholar 

  3. Manabe N, Haruma K, Nakajima A, Yamada M, Maruyama Y, Gushimiyagi M, Yamamoto T (2015) Characteristics of colonic diverticulitis and factors associated with complications: a Japanese Multicenter, retrospective, cross-sectional study. Dis Colon Rectum 58:1174–1181

    Article  Google Scholar 

  4. Tanase I, Paun S, Stoica B, Negoi I, Gaspar B, Beuran M (2015) Epidemiology of diverticular disease—systematic review of the literature. Chirurgia (Bucur) 110:9–14

    CAS  Google Scholar 

  5. Paik PS, Yun JA (2017) Clinical features and factors associated with surgical treatment in patients with complicated colonic diverticulitis. Ann Coloproctol 33:178–183

    Article  Google Scholar 

  6. Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, Shiogama T, Furui J, Kanematsu T (2004) Toward therapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg 187:233–237

    Article  Google Scholar 

  7. Yang HR, Huang HH, Wang YC, Hsieh CH, Chung PK, Jeng LB, Chen RJ (2006) Management of right colon diverticulitis: a 10-year experience. World J Surg 30:1929–1934

    Article  Google Scholar 

  8. Kim MR, Kye BH, Kim HJ, Cho HM, Oh ST, Kim JG (2010) Treatment of right colonic diverticulitis: the role of nonoperative treatment. J Korean Soc Coloproctol 26:402–406

    Article  Google Scholar 

  9. Tan KK, Wong J, Sim R (2013) Non-operative treatment of right-sided colonic diverticulitis has good long-term outcome: a review of 226 patients. Int J Colorectal Dis 28:849–854

    Article  Google Scholar 

  10. Park HC, Kim BS, Lee K, Kim MJ, Lee BH (2014) Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack. Int J Colorectal Dis 29:1217–1222

    Article  Google Scholar 

  11. Lane JS, Sarkar R, Schmit PJ, Chandler CF, Thompson JE Jr (1999) Surgical approach to cecal diverticulitis. J Am Coll Surg 188:629–634 discussion 634–635

    Article  CAS  Google Scholar 

  12. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF (2003) Aggressive resection is indicated for cecal diverticulitis. Am J Surg 185:135–140

    Article  Google Scholar 

  13. Papaziogas B, Makris J, Koutelidakis I, Paraskevas G, Oikonomou B, Papadopoulos E, Atmatzidis K (2005) Surgical management of cecal diverticulitis: is diverticulectomy enough? Int J Colorectal Dis 20:24–27

    Article  CAS  Google Scholar 

  14. Lee IK, Kim SH, Lee YS, Kim HJ, Lee SK, Kang WK, Ahn CH, Oh ST, Jeon HM, Kim J-G (2007) Diverticulitis of the right colon: tips for preoperative diagnosis and treatment strategy. J Korean Soc Coloproctol 23:223–231

    Article  Google Scholar 

  15. Lee IK, Lee YS, Kim SJ, Gorden DL, Won DY, Kim HJ, Cho HM, Jeon HM, Kim JG, Oh ST (2010) Laparoscopic and open surgery for right colonic diverticulitis. Am Surg 76:486–491

    PubMed  Google Scholar 

  16. Kwon JW, Kim BS, Park HC, Oh HK, Shin R, Ryoo SB, Park KJ, Lee BH (2012) Surgical treatment of complicated right colonic diverticulitis: laparoscopic versus open surgery. Surg Endosc 26:2926–2930

    Article  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  18. Core Team R (2017) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  19. Shyung L-R, Lin S-C, Shih S-C, Kao C-R, Chou S-Y (2003) Decision making in right-sided diverticulitis. World J Gastroenterol 9:606

    Article  Google Scholar 

  20. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564

    Article  CAS  Google Scholar 

  21. Lee IK (2010) Right colonic diverticulitis. J Korean Soc Coloproctol 26:241–245

    Article  CAS  Google Scholar 

  22. Cole M, Ayantunde AA, Payne J (2009) Caecal diverticulitis presenting as acute appendicitis: a case report. World J Emerg Surg 4:29

    Article  Google Scholar 

  23. Chou Y-H, Chiou H-J, Tiu C-M, Chen J-D, Hsu C-C, Lee C-H, Lui W-Y, Hung G-S, Yu C (2001) Sonography of acute right side colonic diverticulitis. Am J Surg 181:122–127

    Article  CAS  Google Scholar 

  24. Kim TJ, Lee IK, Park JK, Lee YS, Si Y, Jung H, Kim HJ, Lee SC, Cheung DY, Gorden LD, Oh ST (2011) Is conservative treatment with antibiotics the correct strategy for management of right colonic diverticulitis?: a prospective study. J Korean Soc Coloproctol 27:188–193

    Article  Google Scholar 

  25. Park SM, Kwon TS, Kim DJ, Lee YS, Cheung DY, Oh ST, Kim JG, Lee IK (2014) Prediction and management of recurrent right colon diverticulitis. Int J Colorectal Dis 29:1355–1360

    Article  Google Scholar 

  26. Ha GW, Lee MR, Kim JH (2017) Efficacy of conservative management in patients with right colonic diverticulitis. ANZ J Surg 87:467–470

    Article  Google Scholar 

  27. Lee IK, Jung SE, Gorden DL, Lee YS, Jung DY, Oh ST, Kim JG, Jeon HM, Chang SK (2008) The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients. Int J Colorectal Dis 23:1151–1157

    Article  Google Scholar 

  28. Monari F, Cervellera M, Pirrera B, D’Errico U, Vaccari S, Alberici L, Tonini V (2017) Right-sided acute diverticulitis: a single Western center experience. Int J Surg 44:128–131

    Article  Google Scholar 

  29. Hildebrand P, Kropp M, Stellmacher F, Roblick UJ, Bruch HP, Schwandner O (2007) Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period. Langenbecks Arch Surg 392:143–147

    Article  CAS  Google Scholar 

  30. Park HC, Kim BS, Lee BH (2011) Management of right colonic uncomplicated diverticulitis: outpatient versus inpatient management. World J Surg 35:1118–1122

    Article  Google Scholar 

  31. Chan DKH, Tan KK (2017) There is no role for colonoscopy after diverticulitis among Asian patients less than 50 years of age. Gastrointest Tumors 3:136–140

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam

    Le Huy Luu, Nguyen Viet Thanh & Nguyen Van Hai

  2. Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Nguyen Lam Vuong

  3. Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam

    Vo Thi Hong Yen, Do Thi Thu Phuong & Bui Khac Vu

  4. Singapore Health Services, Singapore, Singapore

    Nguyen Thien Khanh

Authors
  1. Le Huy Luu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nguyen Lam Vuong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vo Thi Hong Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Do Thi Thu Phuong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bui Khac Vu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nguyen Viet Thanh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nguyen Thien Khanh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nguyen Van Hai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Le Huy Luu.

Ethics declarations

Disclosures

Dr. Le Huy Luu, Dr. Nguyen Lam Vuong, Dr. Vo Thi Hong Yen, Dr. Do Thi Thu Phuong, Dr. Bui Khac Vu, Dr. Nguyen Viet Thanh, Dr. Nguyen Thien Khanh, and Dr. Nguyen Van Hai have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luu, L.H., Vuong, N.L., Yen, V.T.H. et al. Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. Surg Endosc 34, 2019–2027 (2020). https://doi.org/10.1007/s00464-019-06981-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06981-x

Keywords

Search

Navigation