Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2023; 11(35): 8320-8329
Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8320
Prior abdominal surgery as a potential risk factor for colonic diverticulosis or diverticulitis
Eran Ariam, Vered Richter, Anton Bermont, Yael Sandler, Daniel L Cohen, Haim Shirin
Eran Ariam, Department of Gastroenterology, Kaplan Medical Center, Rehovot 76100, Israel
Vered Richter, Anton Bermont, Daniel L Cohen, Haim Shirin, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin 70300, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Yael Sandler, Department of Surgery Division, Shamir Medical Center, Zerifin 70300, Israel
Author contributions: Shirin H designed the research study; Ariam E, Richter V, Bermont A and Sandler Y performed the research; Ariam E, Cohen DL and Shirin H analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Helsinki Committee of Shamir Medical Center (0107-20-ASF).
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement--checklist of items, and the manuscript was prepared and revised according to the STROBE statement--checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel L Cohen, MD, Gastroenterologist, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir Medical Center, Zerifin 70300, Israel. docdannycohen@yahoo.com
Received: September 18, 2023
Peer-review started: September 18, 2023
First decision: November 13, 2023
Revised: November 15, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: December 16, 2023
Abstract
BACKGROUND

Abnormal colonic pressure profiles have been associated with an increased risk of colonic diverticulosis. A surgical history is a known risk factor for abdominal adhesions and these may lead to increased intraluminal colonic pressure.

AIM

To assess whether previous abdominal surgery is associated with colonic diverticulosis or diverticulitis.

METHODS

We analyzed data from a study of patients undergoing colonoscopy for different indications from 2020 through 2021. Patients completed a structured questionnaire concerning previous abdominal surgeries, dietary and lifestyle exposures including smoking, alcohol use and co-morbidities.

RESULTS

Three hundred and fifty-nine patients were included in the study. The mean age was 67.6 and 46% were females. Diabetes mellitus, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, chronic renal failure, and body mass index were similar in the diverticulosis and control groups. The overall prevalence of colonic diverticulosis was 25% (91/359) and 48% of the patients had previous abdominal surgery. As expected, the prevalence of diverticulosis increased with age. There was no difference in the rate of previous abdominal surgery between patients with or without diverticulosis (49% vs 47%, P = 0.78). In regards to specific surgeries, inguinal hernia repair was significantly associated with diverticulosis (52% vs 20%, P = 0.001), but not diverticulitis. In contrast, appendectomy was not associated with diverticulosis (6% vs 14%, P = 0.048).

CONCLUSION

These findings suggest that post-operative abdominal adhesions inducing high colonic intraluminal pressures do not appear to be the mechanism for diverticula formation. Rather, inguinal hernia and diverticulosis may share similar connective tissue pathologies with no causative relationship between them.

Keywords: Diverticulosis, Diverticulitis, General surgery, Adhesions, Risk factors, Abdomen

Core Tip: Prior abdominal surgery is a risk factor for the development of adhesions. The presence of adhesions may lead to increased intraluminal colonic pressures and, therefore, the formation of diverticula. We sought to evaluate if there was a correlation between a history of abdominal surgery and colonic diverticulosis or diverticulitis. However, we found that a history of prior surgery was not associated with either diverticulosis or diverticulitis. Of the specific surgeries, only inguinal hernia repair was associated with diverticulosis, but this appears to be due to other mechanisms and not adhesions.