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Journal of Gastrointestinal Surgery :... Nov 2014Immunosuppression could increase the complication rate in patients with acute diverticulitis. This would justify a low threshold for elective sigmoid resection in these... (Review)
Review
BACKGROUND
Immunosuppression could increase the complication rate in patients with acute diverticulitis. This would justify a low threshold for elective sigmoid resection in these patients after an episode of diverticulitis. Well-documented groups of immunocompromised patients are transplant patients, in which many prospective studies have been conducted.
OBJECTIVES
The aim of this systematic review is to assess the incidence of complicated diverticulitis in post-transplant patients.
DATA SOURCE
We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases for papers published between January 1966 and January 2014.
STUDY SELECTION AND INTERVENTION
Publications dealing with post-transplant patients and left-sided diverticulitis were eligible for inclusion. The following exclusion criteria were used for study selection: abstracts, case-series and non-English articles.
MAIN OUTCOME MEASURES
Primary outcome measure was the incidence of complicated diverticulitis. Secondary outcome was the incidence of acute diverticulitis and the proportion of complicated diverticulitis. Pooling of data was only performed when more than five reported on the outcome of interest with comparable cohorts. Only studies describing proportion of complicated diverticulitis and renal transplant studies were eligible for pooling data.
RESULTS
Seventeen articles met the inclusion criteria. Nine renal transplant cohorts, four mixed lung-heart-heart lung transplant cohorts, two heart transplant cohorts, and two lung cohorts. A total of 11,966 post-transplant patients were included in the present review. Overall incidence of complicated diverticulitis in all transplantation studies ranged from 0.1 to 3.5%. Nine studies only included renal transplant patients. Pooled incidence of complicated diverticulitis in these patients was 1.0% (95% CI 0.6 to 1.5%). Ten studies provided proportion of complicated diverticulitis. Pooled incidence of acute diverticulitis in these studies was 1.7% (95% CI 1.0 to 2.7%). Pooled proportion of complicated diverticulitis among these patients was 40.1% (95% CI 32.2 to 49.7%). All studies were of moderate quality using the MINORS scoring scale.
CONCLUSION
The incidence of complicated diverticulitis is about one in 100 transplant patients. Additionally when a transplant patient develops an episode of acute diverticulitis, a high proportion of patients have a complicated disease course.
Topics: Diverticulitis; Female; Graft Rejection; Graft Survival; Heart Transplantation; Humans; Incidence; Kidney Transplantation; Lung Transplantation; Male; Organ Transplantation; Postoperative Complications; Prognosis; Risk Assessment; Severity of Illness Index; Survival Analysis; Treatment Outcome
PubMed: 25127673
DOI: 10.1007/s11605-014-2593-2 -
International Journal of Colorectal... Apr 2024To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis.
METHODS
A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters.
RESULTS
The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61).
CONCLUSION
Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.
Topics: Humans; Neoplasm Recurrence, Local; Diverticulitis; Outcome Assessment, Health Care; Treatment Failure; Patient Readmission; Diverticulitis, Colonic; Acute Disease; Treatment Outcome
PubMed: 38578433
DOI: 10.1007/s00384-024-04618-7 -
International Journal of Colorectal... Aug 2021Right-sided diverticulitis has different epidemiologic features compared to left-sided diverticulitis. However, data on the appropriate treatment of right-sided... (Meta-Analysis)
Meta-Analysis
PURPOSE
Right-sided diverticulitis has different epidemiologic features compared to left-sided diverticulitis. However, data on the appropriate treatment of right-sided diverticulitis are lacking. This systematic review aimed to examine the outcomes of conservative treatment for uncomplicated right-sided diverticulitis.
METHODS
MEDLINE, Embase, and the Cochrane Library were searched for articles published from January 1, 1990, to May 31, 2020. A total of 21 studies were included in the systematic review. We calculated proportions and 95% confidence intervals (CIs) to assess the outcomes of individual studies and pooled the results using a random effects model.
RESULTS
A total of 2811 patients (59.1% men; mean and median age, 37-54 years) with right-sided diverticulitis were included. The pooled rate of treatment failure was 2.5% (95% CI 1.2-4.3%; p <0.01; I = 64.0%). The recurrence rate ranged from 0 to 26.9%, and the pooled recurrence rate was 10.9% (95% CI 8.1-14.1%; p <0.01; I = 78.2%). The pooled rate of complicated diverticulitis at recurrence was 4.4% (95% CI 1.4-9.0%; p = 0.84; I = 0%). The pooled rate of emergency surgery at recurrence was 9.0% (95% CI 4.6-14.7%; p = 0.12; I = 30.3%).
CONCLUSIONS
Conservative treatment of uncomplicated right-sided diverticulitis results in a low rate of recurrence and complicated diverticulitis at recurrence. Based on these results, unnecessary surgery may be avoided and a new treatment paradigm for uncomplicated right-sided diverticulitis may be introduced.
Topics: Adult; Conservative Treatment; Diverticulitis; Diverticulitis, Colonic; Female; Humans; Male; Middle Aged; Recurrence; Treatment Outcome
PubMed: 33765173
DOI: 10.1007/s00384-021-03913-x -
Digestive Surgery 2017The study aimed to perform a meta-analysis comparing laparoscopic and open surgery for diverticulitis. (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND/AIMS
The study aimed to perform a meta-analysis comparing laparoscopic and open surgery for diverticulitis.
METHODS
Studies comparing the outcomes of laparoscopic surgery versus open surgery for diverticulitis that reported quantitative data were included. Outcome measures were mortality and morbidity rates and length of hospital stay.
RESULTS
Four randomized controlled trials - 3 prospective and 21 retrospective - were included in the analysis. The total numbers of patients ranged from 5 to 14,562 in the laparoscopic groups and from 4 to 110,172 in the open surgery groups, and the mean patient age ranged from 38.9 to 78 years. Overall analysis revealed that laparoscopic surgery was associated with lower mortality (pooled OR 0.40, 95% CI 0.25-0.63, p < 0.001) and a lower overall morbidity rate (pooled OR 0.65, 95% CI 0.51-0.82, p < 0.001) than open surgery. Laparoscopic surgery was associated with a higher anastomotic bleeding rate, but lower rates of ileus, anastomotic leakage, small bowel obstruction, wound infection, fascial dehiscence and intra-abdominal abscesses. Length of hospital stay was less with laparoscopic surgery.
CONCLUSIONS
The current meta-analysis supports the use of laparoscopy for the treatment of diverticulitis. The results, however, should be interpreted with caution.
Topics: Abdominal Abscess; Anastomosis, Surgical; Anastomotic Leak; Colectomy; Colon; Diverticulitis, Colonic; Humans; Ileus; Laparoscopy; Length of Stay; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 27941315
DOI: 10.1159/000450683 -
International Journal of Colorectal... Jun 2023Our aim was to determine the incidence of diverticulitis recurrence after sigmoid colectomy for diverticular disease. (Review)
Review
INTRODUCTION
Our aim was to determine the incidence of diverticulitis recurrence after sigmoid colectomy for diverticular disease.
METHODS
Consecutive patients who benefited from sigmoid colectomy for diverticular disease from January 2007 to June 2021 were identified based on operative codes. Recurrent episodes were identified based on hospitalization codes and reviewed. Survival analysis was performed and was reported using a Kaplan-Meier curve. Follow-up was censored for last hospital visit and diverticulitis recurrence. The systematic review of the literature was performed according to the PRISMA statement. Medline, Embase, CENTRAL, and Web of Science were searched for studies reporting on the incidence of diverticulitis after sigmoid colectomy. The review was registered into PROSPERO (CRD42021237003, 25/06/2021).
RESULTS
One thousand three-hundred and fifty-six patients benefited from sigmoid colectomy. Four hundred and three were excluded, leaving 953 patients for inclusion. The mean age at time of sigmoid colectomy was 64.0 + / - 14.7 years. Four hundred and fifty-eight patients (48.1%) were males. Six hundred and twenty-two sigmoid colectomies (65.3%) were performed in the elective setting and 331 (34.7%) as emergency surgery. The mean duration of follow-up was 4.8 + / - 4.1 years. During this period, 10 patients (1.1%) developed reccurent diverticulitis. Nine of these episodes were classified as Hinchey 1a, and one as Hinchey 1b. The incidence of diverticulitis recurrence (95% CI) was as follows: at 1 year: 0.37% (0.12-1.13%), at 5 years: 1.07% (0.50-2.28%), at 10 years: 2.14% (1.07-4.25%) and at 15 years: 2.14% (1.07-4.25%). Risk factors for recurrence could not be assessed by logistic regression due to the low number of incidental cases. The systematic review of the literature identified 15 observational studies reporting on the incidence of diverticulitis recurrence after sigmoid colectomy, which ranged from 0 to 15% for a follow-up period ranging between 2 months and over 10 years.
CONCLUSION
The incidence of diverticulitis recurrence after sigmoid colectomy is of 2.14% at 15 years, and is mostly composed of Hinchey 1a episodes. The incidences reported in the literature are heterogeneous.
Topics: Male; Humans; Middle Aged; Aged; Female; Incidence; Diverticulitis, Colonic; Retrospective Studies; Colectomy; Diverticulitis; Colon, Sigmoid; Diverticular Diseases; Sigmoid Diseases
PubMed: 37261498
DOI: 10.1007/s00384-023-04454-1 -
Diseases (Basel, Switzerland) Oct 2023Probiotics have been widely used in gastroenteritis due to acute and chronic illnesses. However, evidence supporting the effectiveness of probiotics in different health... (Review)
Review
Probiotics have been widely used in gastroenteritis due to acute and chronic illnesses. However, evidence supporting the effectiveness of probiotics in different health conditions is inconclusive and conflicting. The aim of this study was to review the existing literature on the effects of probiotics on gastroenteritis among adults. Only original articles on clinical trials that demonstrated the effects of probiotics in adults with gastroenteritis were used for this analysis. Multiple databases, such as PubMed, Google Scholar, MEDLINE and Scopus databases, were searched for the data. The study followed standard procedures for data extraction using a PRISMA flow chart. A quality appraisal of the selected studies was conducted using CADIMA. Finally, a meta-analysis was performed. Thirty-five articles met the selection criteria; of them, probiotics were found effective in the treatment and/or prevention of chronic inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease in 17 (49%), and the treatment of in 4 (11.4%), antibiotic-induced diarrhea in 3 (8.6%), infection in 2 (5.7%) and diverticulitis in 1 (2.9%), while the remaining 7 (20%) were ineffective, and 1 study's results were inconclusive. The meta-analysis did not demonstrate any significant protective effects of probiotics. Having a τ value of zero and I of 6%, the studies were homogeneous and had minimum variances. Further studies are suggested to evaluate the beneficial effects of probiotics in IBDs and other chronic bowel diseases.
PubMed: 37873782
DOI: 10.3390/diseases11040138 -
Journal of Digestive Diseases Feb 2022There is no consensus on the optimal treatment for patients with complicated diverticulitis. In this systematic review and meta-analysis we aimed to determine the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
There is no consensus on the optimal treatment for patients with complicated diverticulitis. In this systematic review and meta-analysis we aimed to determine the indications for elective surgery in complicated diverticulitis by comparing conservative treatment with elective surgery.
METHODS
A meta-analysis of recurrence, morbidity and stoma rates was performed using a random effects model. Patient-reported quality of life (QoL) and cost-effectiveness outcomes were synthesized qualitatively.
RESULTS
Eleven randomized controlled trials and non-randomized studies with a total of 7415 patients were included. In statistical terms, the recurrence of diverticulitis was significantly higher in the conservatively treated group than in the elective surgery group (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.12-0.51). The stoma rate (OR 2.34, 95% CI 1.88-2.92) and the morbidity rate (OR 4.29, 95% CI 2.24-8.23) were significantly higher in the elective surgery group than in the conservatively treated group. There was some evidence for a significant increase in QoL and long-term cost-effectiveness in the elective surgery group than in the conservatively treated group.
CONCLUSIONS
Indications for elective surgery should not include the prevention of emergency colostomy or complications. Elective surgical resection may be considered in patients with complicated diverticulitis with the goal of improving their QoL and long-term cost-effectiveness.
Topics: Conservative Treatment; Diverticulitis; Elective Surgical Procedures; Humans; Quality of Life; Randomized Controlled Trials as Topic; Recurrence
PubMed: 34965017
DOI: 10.1111/1751-2980.13076 -
Surgery Aug 2023The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of this study was to compare the clinical outcomes of sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with a proximal diversion in perforated diverticulitis with diffuse peritonitis.
METHOD
A systematic literature search on sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with proximal diversion for diverticulitis with diffuse peritonitis was conducted in the Medline and EMBASE databases. Randomized clinical trials and observational studies reporting the primary outcome of interest (30-day mortality) were included. Secondary outcomes were major morbidity, anastomotic leak, reoperation, stoma nonreversal rates, and length of hospital stay. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes.
RESULTS
A total of 17 studies involving 544 patients (sigmoid resection and primary anastomosis: 287 versus sigmoid resection and primary anastomosis with proximal diversion: 257) were included. Thirty-day mortality (odds ratio 1.12, 95% confidence interval 0.53-2.40, P = .76), major morbidity (odds ratio 1.40, 95% confidence interval 0.80-2.44, P = .24), anastomotic leak (odds ratio 0.34, 95% confidence interval 0.099-1.20, P = .10), reoperation (odds ratio 0.49, 95% confidence interval 0.17-1.46, P = .20), and length of stay (sigmoid resection and primary anastomosis: 12.1 vs resection and primary anastomosis with diverting ileostomy: 15 days, P = .44) were similar between groups. The risk of definitive stoma was significantly lower after sigmoid resection and primary anastomosis (odds ratio 0.05, 95% confidence interval 0.006-0.35, P = .003).
CONCLUSION
Sigmoid resection and primary anastomosis with or without proximal diversion have similar postoperative outcomes in selected patients with diverticulitis and diffuse peritonitis. However, further randomized controlled trials are needed to confirm these results.
Topics: Humans; Diverticulitis, Colonic; Anastomotic Leak; Colostomy; Intestinal Perforation; Diverticulitis; Anastomosis, Surgical; Peritonitis; Treatment Outcome
PubMed: 37258308
DOI: 10.1016/j.surg.2023.04.035 -
Diseases of the Colon and Rectum Dec 2018The traditional approach for perforated diverticulitis, the Hartmann procedure, has considerable morbidity and the challenge of stoma reversal. Alternative procedures,... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The traditional approach for perforated diverticulitis, the Hartmann procedure, has considerable morbidity and the challenge of stoma reversal. Alternative procedures, including primary resection and anastomosis and laparoscopic lavage, have been proposed but remain controversial.
OBJECTIVE
The purpose of this study was to compare operative strategies for perforated diverticulitis.
DATA SOURCES
MEDLINE, Embase, Cochrane Library, and the grey literature were searched from inception to October 2017.
STUDY SELECTION
We included randomized clinical trials evaluating operative strategies for perforated diverticulitis.
INTERVENTIONS
Hartmann procedure, primary resection and anastomosis, and laparoscopic lavage were included.
MAIN OUTCOME MEASURES
Data were independently extracted by 2 investigators. Risk of bias was evaluated using the Cochrane risk-of-bias tool. Pooled risk ratios for major complications, reoperation, and mortality were determined using random-effects models.
RESULTS
Six trials including 626 patients with perforated diverticulitis were identified. Laparoscopic lavage and sigmoidectomy had comparable rates of early reoperation and postoperative mortality; major complications (Clavien-Dindo >IIIa) were more frequent after laparoscopic lavage (RR = 1.68 (95% CI, 1.10-2.56); 3 trials, 305 patients). Comparing approaches for sigmoidectomy, primary resection and anastomosis had similar rates of major complications (RR = 0.88 (95% CI, 0.49-1.55); 3 trials, 255 patients) and postoperative mortality (RR = 0.58 (95% CI, 0.20-1.70); 3 trials, 254 patients) compared with the Hartmann procedure. However, patients who underwent primary resection and anastomosis were more likely to be stoma free at 12 months compared with the Hartmann procedure (RR = 1.40 (95% CI, 1.18-1.67); 4 trials, 283 patients) and to experience fewer major complications related to the stoma reversal procedure (RR = 0.26 (95% CI, 0.07-0.89); 4 trials, 186 patients).
LIMITATIONS
There were no limitations to this study.
CONCLUSIONS
Laparoscopic lavage is associated with increased risk of major complications versus primary resection for Hinchey III diverticulitis. The lower rate of stoma reversal and higher rate of complications after the Hartmann procedure suggest primary resection and anastomosis as the optimal management of perforated diverticulitis.
Topics: Anastomosis, Surgical; Colon, Sigmoid; Digestive System Surgical Procedures; Diverticulitis, Colonic; Humans; Intestinal Perforation; Laparoscopy; Postoperative Complications; Therapeutic Irrigation
PubMed: 30371549
DOI: 10.1097/DCR.0000000000001149 -
International Journal of Colorectal... Sep 2022The aim of this review was to examine if diverticulitis increases the long-term risk (> 6 months) of developing colon cancer. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this review was to examine if diverticulitis increases the long-term risk (> 6 months) of developing colon cancer.
METHODS
A systematic search was conducted in PubMed, Embase, and Cochrane CENTRAL. Google Scholar was also searched. We included studies with human adults of 18 years of age and above. Studies that included only patients with diverticulitis as well as studies comparing groups with and without diverticulitis were included. The primary outcome was the incidence of colon cancer 6 months or more after an episode of diverticulitis.
RESULTS
Twelve records were included with 38,621 patients with diverticulitis. The crude rate of colon cancer among the prospectively followed populations with diverticulitis was by meta-analysis found to be 0.6% (95% CI 0.5-0.6%). The limitations of this review include heterogeneous reporting of outcomes across studies, specifically regarding population and outcome as well as variations in the design and reporting of the studies.
CONCLUSION
We found that the long-term risk of colon cancer after diverticulitis is not increased. The results of our review support current practice on follow-up after an episode of diverticulitis with short-term follow-up being the primary focus.
Topics: Adult; Colonic Neoplasms; Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 36042030
DOI: 10.1007/s00384-022-04246-z