Skip to main content
Log in

Reste-t-il des indications pour la chirurgie à froid ?

Are there still indications for elective sigmoidectomy after diverticulitis?

  • Dossier Thématique / Thematic File
  • Published:
Côlon & Rectum

Résumé

En 2006, l’Association américaine de chirurgie colorectale a publié ses nouvelles recommandations, mettant un terme à la prise en charge chirurgicale de la maladie diverticulaire basée uniquement sur le nombre de crises. Désormais, la décision au cas par cas s’applique. Dix ans après, où en sommes-nous ? Il y a actuellement des pathologies pour lesquelles une indication de chirurgie à froid est claire et évidente comme les patients qui ont présenté une crise compliquée, une fistule, une sténose, lorsqu’une pathologie néoplasique sous-jacente ne peut être éliminée, ou encore chez les patients immunodéprimés. D’autres indications comme les crises non compliquées récidivantes ou la smoldering diverticulitis (diverticulite subintrante sans résolution complète des symptômes) sont plus débattues. Dans ces situations, il est nécessaire de décider en fonction du patient, en pondérant ses symptômes, sa qualité de vie, son style de vie, ainsi que ses attentes de la chirurgie et des risques opératoires et de récidives.

Abstract

In 2006, the American Society of Colon and Rectal Surgeons proposed that the decision of proceeding to elective surgery after diverticulitis should be taken case by case. Ten years later, the question to decide who should be operated on electively is still debated.

It seems clear and evident that for complicated diverticulitis, fistulas, stenosis, immunocompromised patients, or patients in whom a neoplasia cannot be excluded, an elective colonic resection should be proposed. Less clear and evident is the indication for a resection for recurrent uncomplicated and smoldering diverticulitis. However, this decision process should take into account the patient’s wish, general health, number of recurrences, quality of life before to decide if a resection should be proposed.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Rafferty J, Shellito P, Hyman NH, Buie WD, et al (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–44

    Article  PubMed  Google Scholar 

  2. Chapman JR, Dozois EJ, Wolff BG, et al (2006) Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann Surg 243:776–830

    Article  Google Scholar 

  3. Anaya DA, Flum DR (2005) Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 140:681–5

    Article  PubMed  Google Scholar 

  4. Janes S, Meagher A, Frizelle FA (2005) Elective surgery after acute diverticulitis. Br J Surg 92:133–42

    Article  CAS  PubMed  Google Scholar 

  5. Buchs NC, Konrad-Mugnier B, Jannot AS, et al (2013) Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg 100:976–9

    Article  CAS  PubMed  Google Scholar 

  6. Feingold D, Steele SR, Lee S, et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57:284–94

    Article  PubMed  Google Scholar 

  7. Gervaz P, Inan I, Perneger T, et al (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252:3–8

    Article  PubMed  Google Scholar 

  8. Dwivedi A, Chahin F, Agrawal S, et al (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum 45:1309–14

    Article  PubMed  Google Scholar 

  9. Mohammed Ilyas MI, Zangbar B, Nfonsam VN, et al (2016) Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study. Colorectal Dis [in press]

  10. Ambrosetti P, Grossholz M, Becker C, et al (1997) Computed tomography in acute left colonic diverticulitis. Br J Surg 84:532–4

    Article  CAS  PubMed  Google Scholar 

  11. Ambrosetti P, Jenny A, Becker C, et al (2000) Acute left colonic diverticulitis—compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 43:1363–7

    Article  CAS  PubMed  Google Scholar 

  12. Gervaz P, Ambrosetti P (2011) Time for a (re) definition of (recurrent) sigmoid diverticulitis? Ann Surg 254:1076–7

    Article  PubMed  Google Scholar 

  13. Fozard JB, Armitage NC, Schofield JB, et al (2011) ACPGBI position statement on elective resection for diverticulitis. Colorectal Dis 13(Suppl 3):1–11

    Article  PubMed  Google Scholar 

  14. Ambrosetti P, Robert J, Mathey P, Rohner A (1994) Left-sided colon and colorectal anastomoses: Doppler ultrasound as an aid to assess bowel vascularization. A prospective evaluation of 200 consecutive elective cases. Int J Colorectal Dis 9:211–4

    Article  CAS  PubMed  Google Scholar 

  15. Biondo S, Pares D, Marti Rague J, et al (2002) Acute colonic diverticulitis in patients under 50 years of age. Br J Surg 89:1137–41

    Article  CAS  PubMed  Google Scholar 

  16. Buc E, Mabrut JY, Genier F, et al (2007) [Not Available]. Gastroenterol Clin Biol 31:35–46

    Article  PubMed  Google Scholar 

  17. Chautems RC, Ambrosetti P, Ludwig A, et al (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45:962–6

    Article  CAS  PubMed  Google Scholar 

  18. Nelson RS, Ewing BM, Wengert TJ, Thorson AG (2008) Clinical outcomes of complicated diverticulitis managed nonoperatively. Am J Surg 196:969–72

    Article  PubMed  Google Scholar 

  19. Buchs NC, Mortensen NJ, Ris F, et al (2015) Natural history of uncomplicated sigmoid diverticulitis. World J Gastrointest Surg 7:313–8

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lidor AO, Segal JB, Wu AW, et al (2011) Older patients with diverticulitis have low recurrence rates and rarely need surgery. Surgery 150:146–53

    Article  PubMed  Google Scholar 

  21. Dharmarajan S, Hunt SR, Birnbaum EH, et al (2011) The efficacy of nonoperative management of acute complicated diverticulitis. Dis Colon Rectum 54:663–71

    Article  PubMed  Google Scholar 

  22. Kaiser AM, Jiang JK, Lake JP, et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–7

    Article  PubMed  Google Scholar 

  23. Vennix S, Morton DG, Hahnloser D, et al (2014) Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Colorectal Dis 16:866–78

    Article  CAS  PubMed  Google Scholar 

  24. Myers E, Hurley M, O’Sullivan GC, et al (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95:97–101

    Article  CAS  PubMed  Google Scholar 

  25. Schultz JK, Yaqub S, Wallon C, et al (2015) Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: The SCANDIV Randomized Clinical Trial. JAMA 314:1364–75

    Article  CAS  PubMed  Google Scholar 

  26. Angenete E, Bock D, Rosenberg J, Haglind E (2016) Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis-a meta-analysis. Int J Colorectal Dis [in press]

  27. Rade F, Bretagnol F, Auguste M, et al (2014) Determinants of outcome following laparoscopic peritoneal lavage for perforated diverticulitis. Br J Surg 101:1602–6

    Article  CAS  PubMed  Google Scholar 

  28. Brar MS, Roxin G, Yaffe PB, et al (2013) Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted. Dis Colon Rectum 56:1259–64

    Article  PubMed  Google Scholar 

  29. Vennix S, Musters GD, Mulder IM, et al (2015) Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial. Lancet 386:1269–77

    Article  PubMed  Google Scholar 

  30. Meyer J, Thomopoulos T, Usel M, et al (2015) The incidence of colon cancer among patients diagnosed with left colonic or sigmoid acute diverticulitis is higher than in the general population. Surg Endosc 29:3331–7

    Article  PubMed  Google Scholar 

  31. Young-Fadok TM, Roberts PL, Spencer MP, Wolff BG (2000) Colonic diverticular disease. Curr Probl Surg 37:457–514

    Article  CAS  PubMed  Google Scholar 

  32. Colcock BP, Stahmann FD (1972) Fistulas complicating diverticular disease of the sigmoid colon. Ann Surg 175:838–46

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Woods RJ, Lavery IC, Fazio VW, et al (1988) Internal fistulas in diverticular disease. Dis Colon Rectum 31:591–6

    Article  CAS  PubMed  Google Scholar 

  34. Altman D, Forsgren C, Hjern F, et al (2010) Influence of hysterectomy on fistula formation in women with diverticulitis. Br J Surg 97:251–7

    Article  CAS  PubMed  Google Scholar 

  35. Venara A, Toque L, Barbieux J, et al (2015) Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance. J Visc Surg 152:211–5

    Article  CAS  PubMed  Google Scholar 

  36. HAS (2007) Complications de la diverticulose colique: Recommandations. Gastroenterol Clin Biol 31:3S5–3S10

    Article  Google Scholar 

  37. Wolff BG, Boostrom SY (2012) Prophylactic resection, uncomplicated diverticulitis, and recurrent diverticulitis. Dig Dis 30:108–13

    Article  PubMed  Google Scholar 

  38. Eypasch E, Williams JI, Wood-Dauphinee S, et al (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–22

    Article  CAS  PubMed  Google Scholar 

  39. Pasternak I, Wiedemann N, Basilicata G, Melcher GA (2012) Gastrointestinal quality of life after laparoscopic-assisted sigmoidectomy for diverticular disease. Int J Colorectal Dis 27:781–7

    Article  PubMed  Google Scholar 

  40. Andeweg CS, Berg R, Staal JB, et al (2016) Patient-reported Outcomes After Conservative or Surgical Management of Recurrent and Chronic Complaints of Diverticulitis: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 14:183–90

    Article  PubMed  Google Scholar 

  41. Munson KD, Hensien MA, Jacob LN, et al (1996) Diverticulitis. A comprehensive follow-up. Dis Colon Rectum 39:318–22

    Article  CAS  PubMed  Google Scholar 

  42. Egger B, Peter MK, Candinas D (2008) Persistent symptoms after elective sigmoid resection for diverticulitis. Dis Colon Rectum 51:1044–8

    Article  PubMed  Google Scholar 

  43. Regenbogen SE, Hardiman KM, Hendren S, Morris AM (2014) Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg 149:292–303

    Article  PubMed  Google Scholar 

  44. Andersen JC, Bundgaard L, Elbrond H, et al (2012) Danish national guidelines for treatment of diverticular disease. Dan Med J 59:C4453

    Google Scholar 

  45. Klarenbeek BR, Samuels M, van der Wal MA, et al (2010) Indications for elective sigmoid resection in diverticular disease. Ann Surg 251:670–4

    Article  PubMed  Google Scholar 

  46. Klarenbeek BR, Veenhof AA, Bergamaschi R, et al (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg 249:39–44

    Article  PubMed  Google Scholar 

  47. Hwang SS, Cannom RR, Abbas MA, Etzioni D (2010) Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum 53:1699–707

    Article  PubMed  Google Scholar 

  48. Kim TJ, Lee IK, Park JK, et al (2011) Is conservative treatment with antibiotics the correct strategy for management of right colonic diverticulitis?: a prospective study. J Korean Soc Coloproctol 27:188–93

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lee IK (2010) Right colonic diverticulitis. J Korean Soc Coloproctol 26:241–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Fortuny JV, Buchs NC, Morel P, Ris F (2014) [Right-sided colonic diverticular disease: quo vadis?]. Rev Med Suisse 10:1325–30

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. Schiltz.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schiltz, B., Dumont, C., Buchs, N.C. et al. Reste-t-il des indications pour la chirurgie à froid ?. Colon Rectum 11, 25–31 (2017). https://doi.org/10.1007/s11725-017-0692-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11725-017-0692-4

Mots clés

Keywords

Navigation