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 24 November 2017

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News

Hospitalization for diverticulitis does not mandate colectomy

A study in the latest Archives of Surgery shows successful nonoperative management of acute diverticulitis with low recurrence, arguing against routine elective colectomy.

News image

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Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis.

Dr Gregory Broderick-Villa and colleagues from California hypothesized that acute diverticulitis initially treated nonoperatively does not require elective colectomy.

The researchers conducted a retrospective cohort study in 12 Kaiser Permanente hospitals in Southern California.

The research team included 3165 patients with acute diverticulitis.

The team undertook colectomy or nonoperative treatment with or without percutaneous abscess drainage.

The researchers' main outcome measure was recurrent diverticulitis.

The risk of rerecurrence is higher than a first recurrence in patients treated nonoperatively
Archives of Surgery

The team performed emergency colectomy in 614 patients.

Nonoperative treatment was initially used in 2551 patients.

The team reported that of these, 185 patients had an elective colectomy and the remaining 2366 patients did not.

The researchers found that factors associated with undergoing elective colectomy compared with nonoperative treatment were younger age of the patient.

In addition, the team noted that fewer comorbidities, and percutaneous abscess drainage were associated with undergoing elective colectomy.

The patients were followed up for a mean of 9 years, to a maximum of 12 years.

The researchers observed that after nonoperative treatment, 314 patients had recurrence.

Single recurrence occurred in 222 patients and 92 patients had a rerecurrence.

After adjusting for other variables, the team noted that older age was associated with a lower recurrence.

Higher comorbidity was associated with higher recurrence.

The researchers found that gender and percutaneous abscess drainage had no influence on recurrence.

All 92 rerecurrences were treated nonoperatively, and the risk of a rerecurrence was significantly higher than a first recurrence.

Furthermore, the team observed that age, gender, Charlson comorbidity index, and percutaneous abscess drainage did not predict rerecurrence.

Dr Broderick-Villa's team concluded, “Very few patients with acute diverticulitis treated nonoperatively have recurrence.”

“Younger age was associated with recurrence and a first recurrence was the only factor that predicted rerecurrences.”

“The low recurrence rate argues against routine elective colectomy after successful nonoperative management of acute diverticulitis.”

Arch Surg 2005: 140(6): 576-83
24 June 2005

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