Clin Colon Rectal Surg 2021; 34(02): 091-095
DOI: 10.1055/s-0040-1716700
Review Article

Surgical Management of Recurrent Uncomplicated Diverticulitis

Vinay Rai
1   Department of Surgery, University of New Mexico, Albuquerque, New Mexico
,
Nitin Mishra
2   Department of Surgery, Mayo Clinic College of Medicine, Phoenix, Arizona
› Author Affiliations

Abstract

Sigmoid diverticulitis represents a most common gastroenterological diagnosis in the western world. There has been a significant change in the management of recurrent uncomplicated diverticulitis in the last 10 to 15 years. The absolute number of previous episodes is not used as criteria to recommend surgery anymore. Young age is no longer considered to be an indication for more aggressive surgical treatment. It is accepted that subsequent episodes of diverticulitis are not significantly worse than the first episode. Laparoscopic surgery is now the standard of care for elective surgery for diverticulitis where expertise is available. There is a consensus that decision to perform sigmoid colectomy should be individualized, after careful risk benefit assessment.



Publication History

Article published online:
02 November 2020

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  • References

  • 1 Schneider EB, Singh A, Sung J. et al. Emergency department presentation, admission, and surgical intervention for colonic diverticulitis in the United States. Am J Surg 2015; 210 (02) 404-407
  • 2 Buchs NC, Mortensen NJ, Ris F, Morel P, Gervaz P. Natural history of uncomplicated sigmoid diverticulitis. World J Gastrointest Surg 2015; 7 (11) 313-318
  • 3 Anaya DA, Flum DR. Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 2005; 140 (07) 681-685
  • 4 Strate LL, Modi R, Cohen E, Spiegel BM. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol 2012; 107 (10) 1486-1493
  • 5 Etzioni DA, Mack TM, Beart Jr. RW, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg 2009; 249 (02) 210-217
  • 6 Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis?. Dis Colon Rectum 2009; 52 (09) 1558-1563
  • 7 Horesh N, Wasserberg N, Zbar AP. et al. Changing paradigms in the management of diverticulitis. Int J Surg 2016; 33 (Pt A): 146-150
  • 8 Unlü C, de Korte N, Daniels L. et al. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg 2020; 10: 23
  • 9 Daniels L, Ünlü Ç, de Korte N. et al. Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg 2017; 104 (01) 52-61
  • 10 Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K. AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 2012; 99 (04) 532-539
  • 11 Simianu VV, Flum DR. Rethinking elective colectomy for diverticulitis: a strategic approach to population health. World J Gastroenterol 2014; 20 (44) 16609-16614
  • 12 Morris AM, Regenbogen SE, Hardiman KM, Hendren S. Sigmoid diverticulitis: a systematic review. JAMA 2014; 311 (03) 287-297
  • 13 Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI. Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 2005; 140 (06) 576-581 , discussion 581–583
  • 14 Binda GA, Arezzo A, Serventi A. et al. Italian Study Group on Complicated Diverticulosis (GISDIC). Multicentre observational study of the natural history of left-sided acute diverticulitis. Br J Surg 2012; 99 (02) 276-285
  • 15 Hall JF, Roberts PL, Ricciardi R. et al. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence?. Dis Colon Rectum 2011; 54 (03) 283-288
  • 16 Feingold D, Steele SR, Lee S. et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 2014; 57 (03) 284-294
  • 17 Klarenbeek BR, Samuels M, van der Wal MA, van der Peet DL, Meijerink WJ, Cuesta MA. Indications for elective sigmoid resection in diverticular disease. Ann Surg 2010; 251 (04) 670-674
  • 18 Vennix S, Morton DG, Hahnloser D, Lange JF, Bemelman WA. Research Committee of the European Society of Coloproctocology. Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Colorectal Dis 2014; 16 (11) 866-878
  • 19 Boostrom SY, Wolff BG, Cima RR, Merchea A, Dozois EJ, Larson DW. Uncomplicated diverticulitis, more complicated than we thought. J Gastrointest Surg 2012; 16 (09) 1744-1749
  • 20 Bar-Meir S, Lahat A, Melzer E. Role of endoscopy in patients with diverticular disease. Dig Dis 2012; 30 (01) 60-63
  • 21 Lam TJ, Meurs-Szojda MM, Gundlach L. et al. There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study. Colorectal Dis 2010; 12 (11) 1122-1126
  • 22 Schmilovitz-Weiss H, Yalunin E, Boaz M. et al. Does a colonoscopy after acute diverticulitis affect its management?: a single center experience. J Clin Gastroenterol 2012; 46 (04) 317-320
  • 23 Westwood DA, Eglinton TW, Frizelle FA. Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg 2011; 98 (11) 1630-1634
  • 24 Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg 2014; 149 (03) 292-303
  • 25 Jurowich CF, Germer CT. Elective surgery for sigmoid diverticulitis - indications, techniques, and results. Viszeralmedizin 2015; 31 (02) 112-116
  • 26 Bellows CF, Mills KT, Kelly TN, Gagliardi G. Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials. Tech Coloproctol 2011; 15 (04) 385-395
  • 27 Moghadamyeghaneh Z, Hanna MH, Carmichael JC. et al. Nationwide analysis of outcomes of bowel preparation in colon surgery. J Am Coll Surg 2015; 220 (05) 912-920
  • 28 Thaler K, Baig MK, Berho M. et al. Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis. Dis Colon Rectum 2003; 46 (03) 385-388
  • 29 Bergamaschi R, Arnaud JP. Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid. Surg Endosc 1998; 12 (09) 1149-1151
  • 30 Cirocchi R, Farinella E, Trastulli S, Sciannameo F, Audisio RA. Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review. Colorectal Dis 2012; 14 (06) 671-683
  • 31 Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK. Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. Am J Surg 2010; 200 (01) 144-161
  • 32 Gervaz P, Inan I, Perneger T, Schiffer E, Morel P. A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 2010; 252 (01) 3-8
  • 33 Anderson J, Luchtefeld M, Dujovny N, Hoedema R, Kim D, Butcher J. A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease. Am J Surg 2007; 193 (03) 400-403 , discussion 403
  • 34 Mahmoud NN, Riddle EW. Minimally invasive surgery for complicated diverticulitis. J Gastrointest Surg 2017; 21 (04) 731-738
  • 35 Park JS, Kang SB, Kim DW, Lee KH, Kim YH. Laparoscopic versus open resection without splenic flexure mobilization for the treatment of rectum and sigmoid cancer: a study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech 2009; 19 (01) 62-68
  • 36 Chand M, Miskovic D, Parvaiz AC. Is splenic flexure mobilization necessary in laparoscopic anterior resection?. Dis Colon Rectum 2012; 55 (11) 1195-1197
  • 37 Ludwig KA, Kosinski L. Is splenic flexure mobilization necessary in laparoscopic anterior resection? Another view. Dis Colon Rectum 2012; 55 (11) 1198-1200
  • 38 Tocchi A, Mazzoni G, Fornasari V, Miccini M, Daddi G, Tagliacozzo S. Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease. Am J Surg 2001; 182 (02) 162-167
  • 39 Masoni L, Mari FS, Nigri G. et al. Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc 2013; 27 (01) 199-206
  • 40 da Silva G, Boutros M, Wexner SD. Role of prophylactic ureteric stents in colorectal surgery. Asian J Endosc Surg 2012; 5 (03) 105-110
  • 41 Halabi WJ, Jafari MD, Nguyen VQ. et al. Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 2014; 57 (02) 179-186
  • 42 Kamal T, Pai A, Velchuru VR. et al. Should anastomotic assessment with flexible sigmoidoscopy be routine following laparoscopic restorative left colorectal resection?. Colorectal Dis 2015; 17 (02) 160-164
  • 43 Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary?. Langenbecks Arch Surg 2015; 400 (02) 145-152
  • 44 Jafari MD, Wexner SD, Martz JE. et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 2015; 220 (01) 82-92.e1
  • 45 Kin C, Vo H, Welton L, Welton M. Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 2015; 58 (06) 582-587
  • 46 Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc 2014; 28 (05) 1695-1702
  • 47 Ricciardi R, Roberts PL, Marcello PW, Hall JF, Read TE, Schoetz DJ. Anastomotic leak testing after colorectal resection: what are the data?. Arch Surg 2009; 144 (05) 407-411 , discussion 411–412
  • 48 Longstreth GF, Tieu RS. Clinically diagnosed acute diverticulitis in outpatients: misdiagnosis in patients with irritable bowel syndrome. Dig Dis Sci 2016; 61 (02) 578-588
  • 49 Haas JM, Singh M, Vakil N. Mortality and complications following surgery for diverticulitis: Systematic review and meta-analysis. United European Gastroenterol J 2016; 4 (05) 706-713