Fulltext

Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

Hoffmann, Henry ; Dell-Kuster, Salome ; Genstorfer, Jörg ; Kettelhack, Christoph ; Langer, Igor ; Rosenthal, Rachel ; Oertli, Daniel ; Heizmann, Oleg

In: World Journal of Surgery, 2012, vol. 36, no. 4, p. 898-907

Ajouter à la liste personnelle
    Titre
    • Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients
    Auteur
    • Hoffmann, Henry. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Dell-Kuster, Salome. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Genstorfer, Jörg. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Kettelhack, Christoph. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Langer, Igor. Department of Surgery, Cantonal Hospital Bruderholz, 4101, Bruderholz, Switzerland
    • Rosenthal, Rachel. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Oertli, Daniel. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Heizmann, Oleg. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    Type de document
    • Postprint
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:310741
    Summary
    Background: The optimal timing of elective surgery in diverticulitis remains unclear. We attempted to investigate early elective versus late elective laparoscopic surgery in acute recurrent diverticulitis in a retrospective study. Method: Data of patients undergoing elective laparoscopic surgery for diverticulitis were retrospectively gathered, including Hinchey stages I-II a/b. the primary endpoint was in-hospital complications according to the Clavien-Dindo classification. Secondary endpoints were surgical complications, operative time, conversion rate, and length of hospital stay. Results: Of 237 patients, 81 (34%) underwent early elective operation (group A) and 156 (66%) underwent late elective operation (group B). In-hospital complications developed in 32% in group A and in 34% in group B (risk difference 2%, 95% Confidence Interval (95% CI): −11%, 14%). Higher age (p=0.048) and borderline higher American Society of Anesthesiologists score (p=0.056) were risk factors for in-hospital complications. Severe surgical complications occurred in 9% of patients in group A and 10% in group B (risk difference 2%, 95% CI: −6%, 9%). Conversion rate was 9% in group A and 3% in group B (p=0.070). Severity of disease did not seem to have an impact on complications or length of hospital stay. The median postoperative hospital stay was 8days in both groups (interquartile range 6-10). Mean operative time was 220min (SD 64) in group A and 202min (SD 48) in group B. Conclusions: This is the first study comparing early versus late elective surgery for diverticulitis in terms of the postoperative outcome using a validated classification. Although the retrospective setting and large confidence intervals don't allow definitive recommendations, these results are of utmost importance for the design of future prospective, randomized controlled trials