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Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis.

Abstract

BACKGROUND

Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD.

METHODS

A single-center, prospective, non-randomized controlled study ran from 2009 to 2017. Patients with first episode of uncomplicated RCD were divided into two treatment arms, LD or NT with bowel rest and broad-spectrum antibiotics, based on their choice. The primary outcome was recurrent diverticulitis during follow-up. Secondary outcomes were treatment success and complications.

RESULTS

A total of 155 patients were enrolled, with 81 in the NT arm and 74 in the LD arm. Mean follow-up was 49 months. The treatment success rate for the NT arm was 90.1% and for the LD arm, 86.5% (P = 0.480). There was no significant difference in the complication rate between the LD arm, 12.2% and the NT arm, 8.6% (P = 0.472). LD was better than NT in preventing recurrent diverticulitis. Nine patients in the NT arm and none in the LD arm had recurrence (P = 0.003). The number needed to treat to prevent recurrence was nine.

CONCLUSION

Non-operative management with bowel rest and antibiotics for uncomplicated RCD is safe and effective. Alternatively, LD is also safe and effective, with the added benefit of preventing recurrences. While both treatments could be reasonably offered for uncomplicated RCD, LD is an appealing option when recurrence is a concern.

Authors+Show Affiliations

Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam. lehuyluu@ump.edu.vn.Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam.Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam.Department of General Surgery, People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam.Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.Singapore Health Services, Singapore, Singapore.Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31309310

Citation

Luu, Le Huy, et al. "Laparoscopic Diverticulectomy Versus Non-operative Treatment for Uncomplicated Right Colonic Diverticulitis." Surgical Endoscopy, 2019.
Luu LH, Vuong NL, Yen VTH, et al. Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. Surg Endosc. 2019.
Luu, L. H., Vuong, N. L., Yen, V. T. H., Phuong, D. T. T., Vu, B. K., Thanh, N. V., ... Van Hai, N. (2019). Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. Surgical Endoscopy, doi:10.1007/s00464-019-06981-x.
Luu LH, et al. Laparoscopic Diverticulectomy Versus Non-operative Treatment for Uncomplicated Right Colonic Diverticulitis. Surg Endosc. 2019 Jul 15; PubMed PMID: 31309310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis. AU - Luu,Le Huy, AU - Vuong,Nguyen Lam, AU - Yen,Vo Thi Hong, AU - Phuong,Do Thi Thu, AU - Vu,Bui Khac, AU - Thanh,Nguyen Viet, AU - Khanh,Nguyen Thien, AU - Van Hai,Nguyen, Y1 - 2019/07/15/ PY - 2018/11/19/received PY - 2019/07/11/accepted PY - 2019/7/17/entrez KW - Diverticulectomy KW - Laparoscopy KW - Non-operative treatment KW - Recurrence KW - Right-sided diverticulitis JF - Surgical endoscopy JO - Surg Endosc N2 - BACKGROUND: Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD. METHODS: A single-center, prospective, non-randomized controlled study ran from 2009 to 2017. Patients with first episode of uncomplicated RCD were divided into two treatment arms, LD or NT with bowel rest and broad-spectrum antibiotics, based on their choice. The primary outcome was recurrent diverticulitis during follow-up. Secondary outcomes were treatment success and complications. RESULTS: A total of 155 patients were enrolled, with 81 in the NT arm and 74 in the LD arm. Mean follow-up was 49 months. The treatment success rate for the NT arm was 90.1% and for the LD arm, 86.5% (P = 0.480). There was no significant difference in the complication rate between the LD arm, 12.2% and the NT arm, 8.6% (P = 0.472). LD was better than NT in preventing recurrent diverticulitis. Nine patients in the NT arm and none in the LD arm had recurrence (P = 0.003). The number needed to treat to prevent recurrence was nine. CONCLUSION: Non-operative management with bowel rest and antibiotics for uncomplicated RCD is safe and effective. Alternatively, LD is also safe and effective, with the added benefit of preventing recurrences. While both treatments could be reasonably offered for uncomplicated RCD, LD is an appealing option when recurrence is a concern. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/31309310/Laparoscopic_diverticulectomy_versus_non-operative_treatment_for_uncomplicated_right_colonic_diverticulitis L2 - https://dx.doi.org/10.1007/s00464-019-06981-x DB - PRIME DP - Unbound Medicine ER -