Retrospective Study
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World J Gastroenterol. Jul 7, 2014; 20(25): 8166-8172
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8166
Elective operation after acute complicated diverticulitis: Is it still mandatory?
Valérie Bridoux, Marlène Antor, Lilian Schwarz, Julien Cahais, Haitham Khalil, Francis Michot, Jean-Jacques Tuech
Valérie Bridoux, Marlène Antor, Lilian Schwarz, Julien Cahais, Haitham Khalil, Francis Michot, Jean-Jacques Tuech, Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen Cedex, France
Author contributions: Bridoux V, Michot F and Tuech JJ designed the research; Antor M and Khalil H performed the research; Antor M, Cahais J and Schwarz L analyzed the data; Bridoux V, Tuech JJ and Michot F wrote the paper.
Correspondence to: Jean-Jacques Tuech, MD, PhD, Professor, Department of Digestive Surgery, Rouen University Hospital, 1 rue Germont, 76031 Rouen Cedex, France.
Telephone: +33-2-32888142 Fax: +33-2-32888416
Received: October 16, 2013
Revised: January 4, 2014
Accepted: February 17, 2014
Published online: July 7, 2014

AIM: To investigate recurrence rates, patterns and complications after nonoperatively managed complicated diverticulitis (CD).

METHODS: A retrospective study of patients treated for CD was performed. CD was defined on computed tomography by the presence of a localized abscess, pelvic abscess or extraluminal air. For follow-up, patients were contacted by telephone. Numbers of elective surgeries, recurrences and abdominal pain were analyzed.

RESULTS: A total of 114 patients (median age 57 years (range 29-97)), were admitted for CD. Nine patients required surgical intervention for failure of conservative therapy (Hartmann’s procedure: n = 6; resection and colorectal anastomosis: n = 3). Of the 105 remaining patients, 24 (22.9%) underwent elective sigmoid resection. The 81 (71%) non-operated patients were all contacted after a median follow-up of 32 mo (4-63). Among them, six had developed a recurrent episode of diverticulitis at a median follow-up of 12 mo (6-36); however, no patient required hospitalization. Sixty-eight patients (84%) were asymptomatic and 13 (16%) had recurrent abdominal pain.

CONCLUSION: Conservative policy is feasible and safe in 71% of cases, with a low medium-term recurrence risk.

Keywords: Diverticulosis, Diverticular abscess, Hinchey classification, Percutaneous drainage, Recurrent diverticulitis

Core tip: We sought to determine whether a conservative approach to the sigmoid colon could be proposed after complicated diverticulitis. One hundred and fourteen patients were included in this study, which confirmed that the conservative approach is feasible in 71% of cases after an episode of complicated diverticulitis (CD). Indications for elective sigmoid resection should not be based solely on CD episode. This approach not only has an impact for the patient, but also for the health care system.