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

Autor: Luu LH; 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. lehuyluu@ump.edu.vn., Vuong NL; 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., Yen VTH; Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam., Phuong DTT; Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam., Vu BK; Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam., Thanh NV; 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., Khanh NT; Singapore Health Services, Singapore, Singapore., Van Hai N; 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.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2020 May; Vol. 34 (5), pp. 2019-2027. Date of Electronic Publication: 2019 Jul 15.
DOI: 10.1007/s00464-019-06981-x
Abstrakt: 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.
Databáze: MEDLINE
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