Surgical treatment of diverticulitis: Twenty years' experience

doi:10.1016/0002-9610(68)90037-8

The American Journal of Surgery

Volume 115, Issue 2, February 1968, Pages 264-270

https://doi.org/10.1016/0002-9610(68)90037-8 Get rights and content

Abstract

During the last twenty years, 294 patients have been operated on at the Lahey Clinic for diverticulitis. The indications for surgery were perforation, obstruction, fistula, recurrent attacks of the disease, and occasionally the inability to rule out carcinoma. Of this group, 61.2 per cent had one stage resection. There were seven deaths and the over-all mortality was 2.38 per cent. The mortality for 180 patients who had primary one stage resection was 1.6 per cent. There were no deaths in the fifty-seven patients who had a three stage resection. This mortality is reasonable, but it could have been less. Much of the remaining morbidity associated with the surgical treatment of diverticulitis is caused not by the too frequent use of a three stage procedure but by complications occurring after one stage resection for patients with perforation or obstruction.

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There are more references available in the full text version of this article.

Cited by (33)

What Are the Indications for Resection After an Episode of Sigmoid Diverticulitis?
2015, Advances in Surgery
Citation Excerpt :
Subsequent articles called for a more aggressive surgical mentality, arguing that surgery should not be reserved only for cases with complications but rather should be used to intervene before complications ensued [5]. Over the decades that followed, surgical progress was steady: 3-stage surgery for complicated disease was replaced by 1-stage and 2-stage resections [6,7], and elective resection for recurrent uncomplicated diverticulitis was routinely performed because of the belief that recurrence was common and increasingly likely to result in complicated disease if allowed to continue unchecked. However, over the past decade, every aspect of colonic diverticulitis has been examined, challenging long-held beliefs.
Diverticular disease: Historical review and current situation
2001, Cirugia Espanola
La enfermedad diverticular del colon presenta una incidencia elevada en los países occidentales. El presente trabajo se propone llevar a cabo tanto una revisión histórica como del estado actual de las actuaciones diagnósticas y del tratamiento en sus diferentes estadios.
Para la revisión bibliográfica se ha recurrido a la búsqueda a través de Medline de las publicaciones previas.
La enfermedad diverticular presenta una clara relación con la dieta pobre en fibra. En el diagnóstico de diverticulitis aguda no deben emplearse métodos invasivos (enema opaco, fibrocolonoscopia) por el riesgo de complicaciones que conllevan, siendo preferible los métodos de imagen (tomografía axial computarizada; ecografía abdominal). El enema opaco y la fibrocolonoscopia son útiles en el estudio de la enfermedad en fase no aguda y para el diagnóstico diferencial. El tratamiento de la diverticulitis aguda no complicada es médico en los primeros episodios y quirúrgico en los casos recidivantes, siendo preferible la cirugía programada en un solo tiempo. Los abscesos abdominales pueden tratarse mediante punción guiada por ecografía o TAC, permitiendo así realizar la cirugía en un segundo tiempo, cuando ha remitido la fase aguda. La cirugía laparoscópica puede suponer una vía de abordaje en el tratamiento de la diverticulitis aguda no complicada.
Diverticular disease of the colon is very frequent in the occidental countries. In this paper we review the diagnosis and treatment in different stages of the disease.
We performed a sistematic review of the Medline data base.
Diverticular disease is related to poor fibre diet. Aggressive methods of diagnosis should not be used in the management due to the increased risk of complications. CT and ultrasonography should be prefered. However, colonoscopy and barium enema is the best diagnostic method in not acute cases. The treatment of diverticular disease should be preferably medical. But surgery may be necessary in acute relapsing cases. Abdominal absess should be treated by percutaneous drainage, and elective surgery performed in a elective phase. The laparoscopic approach in non complicated case is promising.
Uncomplicated diverticulitis: Indications for surgery and surgical management
1993, Surgical Clinics of North America
Acquired diverticulosis of the colon represents a significant disease of twentieth-century Western society. Acute diverticulitis is the most common complication of the disorder. About one quarter of patients require operative intervention at the time of initial presentation. A better understanding of the natural history of diverticulosis will define subgroups of patients who will benefit from more aggressive elective surgery to reduce the overall morbidity and mortality of operative treatment.
Reassessment of primary resection of the perforated segment for severe colonic diverticulitis
1990, The American Journal of Surgery
Primary resection with colostomy has been widely adopted during the past decade for the treatment of patients with severe complications of diverticulitis. Because of this, a retrospective review was performed of all patients undergoing surgery for colonic diverticular disease during the two time periods 1974 to 1978 (n=196) and 1982 to 1986 (n=230). Forty-three patients had abscess or peritonitis from 1974 to 1978, whereas 52 had these complications from 1982 to 1986. Colostomy and drainage alone were used for 31 of 43 patients (72%) from 1974 to 1978, while primary resection with colostomy was used for 39 of 52 patients (75%) from 1982 to 1986 (p<-0.5). Despite this shift in treatment method, mortality increased from 14% in 1974 to 1978 to 19% in 1982 to 1986 (p=NS). Patients with peritonitis had identical mortalities (22%) during both intervals. Patients with abscess experienced an increase in mortality from 8% in 1974 to 1978 to 15% in 1982 to 1986 (p=NS). The widespread use of primary resection for patients with severe complications of diverticulitis appears not to have altered mortality for those with diffuse peritonitis and may have worsened the outcome for those with abscess.
Diverticular disease of the colon: Current concepts and management
1985, Surgical Clinics of North America
Surgical management of perforated diverticulitis
1981, The American Journal of Surgery
The surgical management of perforated diverticulitis remains a subject of controversy, with some workers advocating initial drainage with decompressive colostomy and others favoring primary resection of the perforated colon. To evaluate this problem, we reviewed our experience from January 1, 1960 through December 31, 1978. This retrospective study included 25 patients treated by primary resection and 32 patients treated by staged resection. The duration of postoperative fever and ileus and the incidence and type of postoperative complications were similar in the two groups. Hospital stay and the period of disability were significantly shortened when primary resection with primary anastomosis was carried out initially. Overall, the total cumulative hospital stay was longer (p < 0.05) for staged resection (48 days) than for primary resection (39 days). The period of disability was also longer (p < 0.001) for staged (134 days) than for primary resection (75 days). Finally, all patients in the primary resection group left the hospital cured, that is, restored to their premorbid condition, while in the staged resection group only 75 percent were cured; 16 percent were finally discharged with colostomies and 9 percent died. These data suggest that whenever technically feasible, primary resection is the treatment of choice for perforated colonic diverticulitis.

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^☆: Presented at the Eighth Annual Meeting of the Society for Surgery of the Alimentary Tract, Atlantic City, New Jersey, June 17 and 18, 1967.

¹: From the Department of Surgery, The Lahey Clinic Foundation, Boston, Massachusetts.

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Surgical treatment of diverticulitis: Twenty years' experience☆

Abstract

Am. J. Surg.

Appraisal of resection of colon for diverticulitis of sigmoid colon

Ann. Surg.

Diverticulitis and carcinoma of the colon; differential diagnosis

Surg. Gynec. & Obst.

Recent experiences in the surgical treatment of diverticulitis

Surg. Gynec. & Obst.