Tags

Type your tag names separated by a space and hit enter

[Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons].
Ann Ital Chir 2009 Jan-Feb; 80(1):3-8AI

Abstract

Diverticular disease (DD) is one of the most common disorders of the colon with an increased prevalence in Western populations. There are still many unsolved issues about indications, timing of surgery and modality of surgical treatment. These topics were discussed during the Consensus Conference (CC). There is still common agreement indicating surgery after the second acute episode of diverticular disease; however, patients younger than 50 years should undergo surgery after the first acute episode, because of a higher risk of recurrence compared to older patients. It is not clear though how to uniformly classify an acute episode (severe, moderate or mild): an accurate clinical and instrumental valuation (based on CT scan) is recommended to establish the real severity of the acute episode before recommending a surgical procedure. In presence of septic complications (abscess or peritonitis) of DD, colonic resection is indicated, but a primary anastomosis could be at risk of failure due to sepsis. Therefore a Hartmann's procedure or protective stoma could be preferable. However, instead of a staged procedure, an appropriate strategy should be to resolve sepsis and perform resection and anastomosis in election. Abscesses smaller than 5 cm intra-meso-colic or para-colic can be successfully treated medically; vice versa larger or pelvic abscesses should undergo percutaneous or laparoscopic drainage, postponing colonic resection in elective conditions. Limited purulent peritonitis can be favourably treated by means of laparoscopic approach and simple lavage and drainage of peritoneal cavity. Diffuse purulent or faecal peritonitis is the most dramatic complication which still has a high risk of mortality and morbidity. Surgical risk is related to clinical conditions, duration of peritonitis, age of patient and comorbidities. Thus it is not possible to state a univocal approach, although Hartmann's procedure keeps being the first choice. On this matter farther randomized studies are required to compare Hartmann's procedure with other techniques (such as primary anastomosis with or without diverting colostomy). A wide left colonic resection (with splenic flexure mobilization) extended beneath sigmoid-rectal junction is recommended to avoid immediate or late complications. Laparoscopic approach is feasible, even for management of complicated diverticular disease, if strict patient selection criteria are followed, duration of the procedure is comparable to open surgery and conversion rate is under 10%.

Authors+Show Affiliations

Dipartimento di Fisiopatologia Clinica, Unità di Chirurgia, Università degli Studi di Firenze, Viale G.B. Morgagni 85, 50134 Firenze. f.tonelli@dfc.unifi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Consensus Development Conference
English Abstract
Journal Article

Language

ita

PubMed ID

19537116

Citation

Tonelli, Francesco, et al. "[Diverticular Disease of the Colon: Diagnosis and Treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons]." Annali Italiani Di Chirurgia, vol. 80, no. 1, 2009, pp. 3-8.
Tonelli F, Di Carlo V, Liscia G, et al. [Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons]. Ann Ital Chir. 2009;80(1):3-8.
Tonelli, F., Di Carlo, V., Liscia, G., Liscia, G., & Serventi, A. (2009). [Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons]. Annali Italiani Di Chirurgia, 80(1), pp. 3-8.
Tonelli F, et al. [Diverticular Disease of the Colon: Diagnosis and Treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons]. Ann Ital Chir. 2009;80(1):3-8. PubMed PMID: 19537116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Diverticular disease of the colon: diagnosis and treatment. Consensus Conference, 5th National Congress of the Italian Society of Academic Surgeons]. AU - Tonelli,Francesco, AU - Di Carlo,Valerio, AU - Liscia,Gadiel, AU - Liscia,Gabriel, AU - Serventi,Alberto, PY - 2009/6/20/entrez PY - 2009/6/20/pubmed PY - 2009/8/1/medline SP - 3 EP - 8 JF - Annali italiani di chirurgia JO - Ann Ital Chir VL - 80 IS - 1 N2 - Diverticular disease (DD) is one of the most common disorders of the colon with an increased prevalence in Western populations. There are still many unsolved issues about indications, timing of surgery and modality of surgical treatment. These topics were discussed during the Consensus Conference (CC). There is still common agreement indicating surgery after the second acute episode of diverticular disease; however, patients younger than 50 years should undergo surgery after the first acute episode, because of a higher risk of recurrence compared to older patients. It is not clear though how to uniformly classify an acute episode (severe, moderate or mild): an accurate clinical and instrumental valuation (based on CT scan) is recommended to establish the real severity of the acute episode before recommending a surgical procedure. In presence of septic complications (abscess or peritonitis) of DD, colonic resection is indicated, but a primary anastomosis could be at risk of failure due to sepsis. Therefore a Hartmann's procedure or protective stoma could be preferable. However, instead of a staged procedure, an appropriate strategy should be to resolve sepsis and perform resection and anastomosis in election. Abscesses smaller than 5 cm intra-meso-colic or para-colic can be successfully treated medically; vice versa larger or pelvic abscesses should undergo percutaneous or laparoscopic drainage, postponing colonic resection in elective conditions. Limited purulent peritonitis can be favourably treated by means of laparoscopic approach and simple lavage and drainage of peritoneal cavity. Diffuse purulent or faecal peritonitis is the most dramatic complication which still has a high risk of mortality and morbidity. Surgical risk is related to clinical conditions, duration of peritonitis, age of patient and comorbidities. Thus it is not possible to state a univocal approach, although Hartmann's procedure keeps being the first choice. On this matter farther randomized studies are required to compare Hartmann's procedure with other techniques (such as primary anastomosis with or without diverting colostomy). A wide left colonic resection (with splenic flexure mobilization) extended beneath sigmoid-rectal junction is recommended to avoid immediate or late complications. Laparoscopic approach is feasible, even for management of complicated diverticular disease, if strict patient selection criteria are followed, duration of the procedure is comparable to open surgery and conversion rate is under 10%. SN - 0003-469X UR - https://www.unboundmedicine.com/medline/citation/19537116/[Diverticular_disease_of_the_colon:_diagnosis_and_treatment__Consensus_Conference_5th_National_Congress_of_the_Italian_Society_of_Academic_Surgeons]_ L2 - http://www.diseaseinfosearch.org/result/2310 DB - PRIME DP - Unbound Medicine ER -