Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 28, 2011; 17(48): 5274-5279
Published online Dec 28, 2011. doi: 10.3748/wjg.v17.i48.5274
Impact of early or delayed elective resection in complicated diverticulitis
Kai Bachmann, Geeske Krause, Tamina Rawnaq, Lena Tomkotter, Yogesh Vashist, Shanly Shahmiri, Jakob R Izbicki, Maximilian Bockhorn
Kai Bachmann, Geeske Krause, Tamina Rawnaq, Lena Tomkotter, Yogesh Vashist, Shanly Shahmiri, Jakob R Izbicki, Maximilian Bockhorn, Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Author contributions: Bachmann K analyzed and interpreted the data, and drafted the manuscript; Krause G and Rawnaq T acquired, analyzed and interpreted the data; Tomkotter L drafted the manuscript; Vashist Y revised the manuscript; Shahmiri S drafted the manuscript and statistical analysis; Izbicki JR studied concept and designed and studied supervision; Bockhorn M studied concept, and designed and drafted the manuscript.
Correspondence to: Kai Bachmann, MD, Department of Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. k.bachmann@uke.de
Telephone: +49-40-741057346 Fax: +49-40-741044995
Received: May 30, 2011
Revised: September 2, 2011
Accepted: September 9, 2011
Published online: December 28, 2011
Abstract

AIM: To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis.

METHODS: The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis (Hinchey classification I-II) at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies.

RESULTS: The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher (80% vs 75%). Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elective resection (9296 €± 694 € vs 8423 €± 968 €; P = 0.001). Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages.

CONCLUSION: Overall, early elective resection for complicated, non-perforated diverticulitis is shown to be a suitable alternative to delayed elective resection after 6-8 wk, with additional beneficial socioeconomic effects.

Keywords: Complicated diverticulitis, Resection of sigmoid, Delayed elective resection, Early elective resection, Socioeconomic effects