Surgical Treatment of Acute Diverticulitis. A Retrospective Multicentre Study
| Autor: | Rodolfo Rodríguez, Rafael García-Calvo, E. García-Granero, Francisco Javier Landete, Matteo Frasson, Javier Aguiló, Zutoia Balciscueta, Miriam Cantos, José V. Roig, Antonio Salvador, Celia Villodre, Juan Hernandis |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Peritonitis 030230 surgery Anastomosis Diverticulitis Colonic Stoma 03 medical and health sciences 0302 clinical medicine Humans Medicine Surgical emergency Abscess Aged Retrospective Studies Aged 80 and over business.industry General surgery General Engineering Retrospective cohort study Immunosuppression Middle Aged medicine.disease Hartmann's operation Surgery 030220 oncology & carcinogenesis Acute Disease Female business |
| Zdroj: | Cirugía Española (English Edition). 94:569-577 |
| ISSN: | 2173-5077 |
| DOI: | 10.1016/j.cireng.2016.10.009 |
| Popis: | Introduction To analyze short and medium-term results of different surgical techniques in the treatment of complicated acute diverticulitis (CAD). Methods Multicentre retrospective study including patients operated on as surgical emergency or deferred-urgency with the diagnosis of CAD. Results A series of 385 patients: 218 men and 167 women, mean age 64.4 ± 15.6 years, operated on in 10 hospitals were included. The median (25th–75th percentile) time from symptoms to surgery was 48 (24–72) h, being peritonitis the main surgical indication in a 66% of cases. Surgical approach was usually open (95.1%), and the commonest findings, a purulent peritonitis (34.8%) or pericolonic abscess (28.6%). Hartmann procedure (HP) was the most used technique in 278 (72.2%) patients, followed by resection and primary anastomosis (RPA) in 69 (17.9%). The overall postoperative morbidity and mortality was 53.2% and 13% respectively. Age, immunosuppression, presence of general risk factors and fecal peritonitis were associated with increased mortality. Laparoscopic peritoneal lavage (LPL) was associated with an increased reoperation rate frequently involving a stoma, and anastomotic leaks presented in 13.7 patients after RPA, without differences in morbimortality when compared with HP. Median postoperative length of stay was 12 days, and was correlated with age, surgical risk, ASA score, hospital and postoperative complications. Conclusions Surgery for CAD has important morbidity and mortality and is frequently associated with an end-stoma. Moreover LPL presented high reoperation rates. It seems better to resect and anastomose in most cases, even with an associated protective stoma. |
| Databáze: | OpenAIRE |
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