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[Surgical strategies in the treatment of acute diverticular disease--a retrospective analysis of surgical patients at the hospital "Städtisches Klinikum Brandenburg an der Havel"].
Zentralbl Chir. 2008 Feb; 133(1):61-7.ZC

Abstract

BACKGROUND

Depending on the degree of severity of acute diverticular disease, operative therapy is performed as an emergency, urgent or elective resection. A challenge is posed not only by the decision on whether to opt for conservative therapy or speedy resection, but also, when resection is indicated, by choosing the most suitable procedure (primary anastomosis or discontinuity resection). The frequency of use of the various therapeutic concepts and their success rates were studied in our clinic.

METHODS

All cases of acute sigmoid diverticulitis (108) surgically treated in the Klinikum Brandenburg from 2003 to 2005 were analysed retrospectively.

RESULTS

17 patients (15.7 %) underwent emergency resection with primary anastomosis (8) (of these, 4 were with additional protective stoma) or Hartmann procedure (9). 17 patients (15.7 %) required urgent laparotomy, 11 needed primary anastomosis (protective stoma in 8 patients) and the Hartmann procedure was performed in 3 patients. In 2 patients the laparotomy was limited to colostomy with drainage without resection because of the high cardiac risk under anaesthesia. Of 49 patients (45.4 %), 25 underwent elective resection via laparotomy, and 24 via laparoscopy, with protective stomas in 4 and 3 patients, respectively. 25 patients (23.1 %) were treated conservatively: in 8 cases a later resection was recommended. Revision was necessary in 10 cases due to anastomosis dehiscence (4), bleeding (1), stoma necrosis (2), ileus (1), wound dehiscence (1) or for programmed lavage after free perforation with faecal peritonitis (2). 3 multimorbid patients died after emergency laparotomy.

CONCLUSION

A concept of staged treatment can reduce the number of emergency laparotomies; it provides for early focus removal in cases which cannot be managed adequately with conservative treatment and aims for the largest possible number of elective resections.

Authors+Show Affiliations

Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Brandenburg a. d. Havel, Brandenburg. kautzsch@klinikum-brandenburg.deNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

18278705

Citation

Kautzsch, M, et al. "[Surgical Strategies in the Treatment of Acute Diverticular Disease--a Retrospective Analysis of Surgical Patients at the Hospital "Städtisches Klinikum Brandenburg an Der Havel"]." Zentralblatt Fur Chirurgie, vol. 133, no. 1, 2008, pp. 61-7.
Kautzsch M, Niemann T, Mantke R. [Surgical strategies in the treatment of acute diverticular disease--a retrospective analysis of surgical patients at the hospital "Städtisches Klinikum Brandenburg an der Havel"]. Zentralbl Chir. 2008;133(1):61-7.
Kautzsch, M., Niemann, T., & Mantke, R. (2008). [Surgical strategies in the treatment of acute diverticular disease--a retrospective analysis of surgical patients at the hospital "Städtisches Klinikum Brandenburg an der Havel"]. Zentralblatt Fur Chirurgie, 133(1), 61-7. https://doi.org/10.1055/s-2008-1004656
Kautzsch M, Niemann T, Mantke R. [Surgical Strategies in the Treatment of Acute Diverticular Disease--a Retrospective Analysis of Surgical Patients at the Hospital "Städtisches Klinikum Brandenburg an Der Havel"]. Zentralbl Chir. 2008;133(1):61-7. PubMed PMID: 18278705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Surgical strategies in the treatment of acute diverticular disease--a retrospective analysis of surgical patients at the hospital "Städtisches Klinikum Brandenburg an der Havel"]. AU - Kautzsch,M, AU - Niemann,T, AU - Mantke,R, PY - 2008/2/19/pubmed PY - 2008/5/28/medline PY - 2008/2/19/entrez SP - 61 EP - 7 JF - Zentralblatt fur Chirurgie JO - Zentralbl Chir VL - 133 IS - 1 N2 - BACKGROUND: Depending on the degree of severity of acute diverticular disease, operative therapy is performed as an emergency, urgent or elective resection. A challenge is posed not only by the decision on whether to opt for conservative therapy or speedy resection, but also, when resection is indicated, by choosing the most suitable procedure (primary anastomosis or discontinuity resection). The frequency of use of the various therapeutic concepts and their success rates were studied in our clinic. METHODS: All cases of acute sigmoid diverticulitis (108) surgically treated in the Klinikum Brandenburg from 2003 to 2005 were analysed retrospectively. RESULTS: 17 patients (15.7 %) underwent emergency resection with primary anastomosis (8) (of these, 4 were with additional protective stoma) or Hartmann procedure (9). 17 patients (15.7 %) required urgent laparotomy, 11 needed primary anastomosis (protective stoma in 8 patients) and the Hartmann procedure was performed in 3 patients. In 2 patients the laparotomy was limited to colostomy with drainage without resection because of the high cardiac risk under anaesthesia. Of 49 patients (45.4 %), 25 underwent elective resection via laparotomy, and 24 via laparoscopy, with protective stomas in 4 and 3 patients, respectively. 25 patients (23.1 %) were treated conservatively: in 8 cases a later resection was recommended. Revision was necessary in 10 cases due to anastomosis dehiscence (4), bleeding (1), stoma necrosis (2), ileus (1), wound dehiscence (1) or for programmed lavage after free perforation with faecal peritonitis (2). 3 multimorbid patients died after emergency laparotomy. CONCLUSION: A concept of staged treatment can reduce the number of emergency laparotomies; it provides for early focus removal in cases which cannot be managed adequately with conservative treatment and aims for the largest possible number of elective resections. SN - 0044-409X UR - https://www.unboundmedicine.com/medline/citation/18278705/[Surgical_strategies_in_the_treatment_of_acute_diverticular_disease__a_retrospective_analysis_of_surgical_patients_at_the_hospital_"Städtisches_Klinikum_Brandenburg_an_der_Havel"]_ DB - PRIME DP - Unbound Medicine ER -