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2011, Number 4

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Cir Gen 2011; 33 (4)

Complicated diverticular disease. Surgical management at the Hospital Español de Veracruz

Pérez-Morales AG, Roesch-Dietlen F, Martínez-Fernández S, Gómez Delgado JA, Remes-Troche JM, Jiménez-García VA, GRomero-Sierra G

Language: Spanish
References: 30
Page: 243-247
PDF size: 67.25 Kb.


ABSTRACT

Objective: To assess the results of surgical treatment of patients with complicated diverticular disease in a 9-year period.
Setting: Hospital Español de Veracruz (third level health care).
Design: Observational, descriptive, cross-sectional, retrospective study.
Statistical analysis: Relative frequency and central tendency measures.
Patients and methods: We studied 41 patients with complicated colonic diverticular disease. Analyzed variables were: sociodemographic characteristics, risk factors, surgical indications, surgical technique used, complications, and postoperative evolution.
Results: Average age was of 66 ± 12.3 years, predominating women (51.22%). The main surgical indications were: perforation (43.90%), recurring diverticulitis (21.95%), hemorrhage (19.51%), colon fistula toward the bladder and vagina (9.76%), and obstruction (4.88%). Obesity was the most frequent risk factor (24.39%). Surgery was elective in 56.10% cases. Primary resection with anastomoses was performed in 92.69% of the cases and Hartman’s procedure in 7.31%. Evolution of patients was satisfactory in 78.05%, and mortality in the group was of 2.44%.
Conclusions: Our experience in the management of complicated diverticular disease reveals a high morbidity, with mortality similar to that reported in the worldwide literature. It is advisable that management be performed by experienced surgeons and at concentration hospitals.


REFERENCES

  1. Sheth AA, Longo W, Floch MH. Diverticular disease and diverticulitis. Am J Gastroenterol 2008; 103: 1550-1556.

  2. Pérez MJ, Raña GJ. Enfermedad diverticular en Gastroenterología Clínica. 2ª. Ed. 2008, México D.F. Edit. Alfil, pp. 229-237.

  3. Petruzziello L, Iacopini F, Bulajic M, Shah S, Costamagna G. Review article: uncomplicated diverticular disease of the colon. Aliment Pharmacol Ther 2006; 23: 1379-1391.

  4. Ye H, Losada M, West AB. Diverticulosis coli update on a “western” disease. Adv Anat Pathol 2005; 12: 74-80.

  5. Rafferty J, Shellito P, Hyman NH, Buie WD. Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006; 49: 939-944.

  6. Heise CP. Epidemiology and pathogenesis of diverticular disease. J Gastrointest Surg 2008; 12: 1309-1311.

  7. Ritz JP, Lehmann KS, Stroux A, Buhr HJ, Holmer C. Sigmoid diverticulitis in young patients -a more aggressive disease than in older patients? J Gastrointest Sur 2011; 15: 667-674.

  8. Raña Garibay RH, Méndez Gutiérrez TH, Sanjurjo García JL, Huerta Iga F, Amaya Echanova T. Guías clínicas de diagnóstico y tratamiento de la enfermedad diverticular del colon. Etiología, fisiopatología, epidemiología: en México y el mundo. Rev Gastroenterol Mex 2008; 73: 255-257.

  9. Floch MH., White JA. Management of diverticular disease is changing. World J Gastroenterol 2006; 12: 3225-3228.

  10. Janes S, Meagher A, Frizelle FA. Elective surgery after acute diverticulitis. Brit J Surg 2005; 92: 133-142.

  11. Bordeianou L, Hodin R. Controversies in the surgical management of the sigmoid diverticulitis. J Gastrointest Surg 2007; 11: 542-548.

  12. Bretagnol F, Pautrat K, Mor C, Benchellal Z, Hutten N, de Calan L. Emergency laparoscopic management of perforated sigmoid diverticulitis: a promissing alternative to more radical procedures. J Am Coll Surg 2008: 206: 654-657.

  13. Peppas G, Bliziotis A, Oikonomaki D, Falagas ME. Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol 2007; 22: 1360-1366.

  14. Strate LL, Liu YL, Aldoori WH, Sungal S, Giovannucci EL. Obesity increases the risk of diverticulitis and diverticular bleeding. Gastroenterology 2009; 138: 115-122.

  15. Chen CY, Wu CC, Jao SW, Hsiao CW. Colonic diverticular bleeding with comorbid diseases may need elective colectomy. J Gastrointest Surg 2009; 13: 516-520.

  16. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12: 85-109.

  17. Richter S, Lindermann W, Kollmar O. Pistorius GA, Maurer CA, Schilling MK. One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV). World J Surg 2006; 30: 1027-1032.

  18. Aydin HN, Remzi FH, Tekkis PP, Fazio VW. Hartmann’s reversal is associated with high postoperative adverse events. Dis Col Rectum 2005; 48: 2117-2126.

  19. Regenet N, Pessaux P, Hennekinne S, Lermite E, Tuech JJ, Brehant O, et al. Primary anastomosis after intraoperative colonic lavage vs Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 2003; 18: 503-507.

  20. Fleming FJ, Gillen P. Reversal of Hartmann´s procedure following acute diverticulitis: is timing everything? Int J Colorectal Dis 2009; 24: 1219-1225.

  21. Hussain A, Mahmood H, Subhas G, El-Hasani S. Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 cases in south east England. World J Emerg Surg 2008; 3: 5-10.

  22. Rafferty F, Sellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006; 49: 939-944.

  23. Constantinides VA, Tekkis PP, Senapati A. Association of Coloproctology of Great Britain Ireland. Prospective multicenter evaluation of adverse outcomes following treatment for complicated diverticular disease. Brit J Sug 2006; 93: 1503-1509.

  24. Charúa Guindic L, Mazza Olmos D, Orduña Téllez D, Orozco Zepeda H, Peniche Gallares LF, Reed San Román G, et al. Guías clínicas de diagnóstico y tratamiento de la enfermedad diverticular del colon. Trtamiento. Rev Gastroenterol Mex 2008; 73: 261-264.

  25. Alves A, Panis Y, Slim K, Heyd B, Kwiaatowski F, Mantion G. Association Français de Chirurgie. French multicenter observational study of laparoscopic vs open colectomy for sigmoid diverticular disease. Br J Surg 2005; 92: 1520-1525.

  26. Zdichavsky M, Königsrainer A, Granderath FA, Laparoscopic rectosigmoid resection for acute sigmoid diverticulitis. J Gastrointest Surg 2009; 13: 804-805.

  27. Farthmann EH, Rückauer KD, Häring RU. Evidence-based surgery: diverticulitis —a surgical disease? Langenbeck’s. Arch Surg 2000; 385: 143-151.

  28. Gómez López JM, Pichardo Uribe A, Baqueiro Cendon A, Terrazas Espitia F, Fernández Alvárez J. Lavado y drenaje laparoscópico de la cavidad abdominal en diverticulitis aguda. Cir Gral 2009; 31: 169-174.

  29. Belmonte Montes C, Guerrero Guerrero VH, Pérez Aguirre J. Cosme Reyes C, Fernández Domínguez P. Sigmoideotomía laparoscópica manualmente asistida en el manejo de fístulas secundarias a enfermedad diverticular complicada. Una alternativa segura. Cir Gral 2009; 31: 175-179.

  30. Roesch Dietlen F. Avances en Cirugía Colorrectal. Rev Gastroenterol Mex 2011; 76 (Supl 1): 84-87.




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