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Intestinal Research Oct 2023Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the...
BACKGROUND/AIMS
Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis.
METHODS
A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included.
RESULTS
A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31-2.38 and RR, 3.05; 95% CI, 1.70-5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95-1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73-7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease.
CONCLUSIONS
Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.
PubMed: 37248174
DOI: 10.5217/ir.2023.00005 -
Journal of Robotic Surgery May 2024Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have...
Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24 h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89 years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; Ambulatory Surgical Procedures; Colectomy; Colorectal Neoplasms; Laparoscopy; Length of Stay; Postoperative Complications; Robotic Surgical Procedures
PubMed: 38713324
DOI: 10.1007/s11701-024-01961-3 -
Colorectal Disease : the Official... Jul 2023Elective stoma formation has a negative effect on patient quality of life (QoL), with a potential detrimental impact on body image, confidence and social functioning... (Review)
Review
AIM
Elective stoma formation has a negative effect on patient quality of life (QoL), with a potential detrimental impact on body image, confidence and social functioning being shown previously. However, the impact of emergency stoma formation on QoL has been explored less frequently. This systematic review aims to synthesize all available literature exploring QoL via patient-reported outcome measures.
METHODS
A search strategy was implemented on 24 November 2022 across Embase, MEDLINE, PsycInfo and the Cochrane Library database after registration on PROSPERO (CRD42022370606). Studies were included if they used a standardized patient-reported outcome measure, had more than five emergency stoma patients, age > 18 years and were fully published in English. Two of three independent researchers screened articles, extracted data and performed quality assessment using the Newcastle-Ottawa Scale and the Cochrane risk of bias tool.
RESULTS
In all, 1775 articles were screened, with 16 included in the systematic review. This included 1868 emergency stoma patients (men:women 0.53; median age 64.6 years) followed up for a median of 12 months. Patients who had a Hartmann's procedure for perforated diverticulitis had poorer QoL than those who underwent primary anastomosis. There was a negligible difference in QoL between those who had a colonic stent for obstructing colorectal cancer compared with those who underwent emergency stoma formation. Female sex, end stoma formation and ileostomy formation were all identified as risk factors for poorer QoL.
CONCLUSION
Patients undergoing emergency stoma surgery have marginally poorer QoL compared with those undergoing similar procedures without stoma formation. Further work is required to identify risk factors associated with this and also to compare QoL after stoma reversal.
Topics: Male; Humans; Female; Adult; Middle Aged; Quality of Life; Diverticulitis; Surgical Stomas; Colostomy; Ileostomy; Anastomosis, Surgical
PubMed: 37208806
DOI: 10.1111/codi.16603 -
BJS Open May 2024Diverticulosis is a normal anatomical variant of the colon present in more than 70% of the westernized population over the age of 80. Approximately 3% will develop...
BACKGROUND
Diverticulosis is a normal anatomical variant of the colon present in more than 70% of the westernized population over the age of 80. Approximately 3% will develop diverticulitis in their lifetime. Many patients present emergently, suffer high morbidity rates and require substantial healthcare resources. Diverticulosis is the most common finding at colonoscopy and has the potential for causing a significant morbidity rate and burden on healthcare. There is a need to better understand the aetiology and pathogenesis of diverticular disease. Research suggests a genetic susceptibility of 40-50% in the formation of diverticular disease. The aim of this review is to present the hypothesized functional effects of the identified gene loci and environmental factors.
METHODS
A systematic literature review was performed using PubMed, MEDLINE and Embase. Medical subject headings terms used were: 'diverticular disease, diverticulosis, diverticulitis, genomics, genetics and epigenetics'. A review of grey literature identified environmental factors.
RESULTS
Of 995 articles identified, 59 articles met the inclusion criteria. Age, obesity and smoking are strongly associated environmental risk factors. Intrinsic factors of the colonic wall are associated with the presence of diverticula. Genetic pathways of interest and environmental risk factors were identified. The COLQ, FAM155A, PHGR1, ARHGAP15, S100A10, and TNFSF15 genes are the strongest candidates for further research.
CONCLUSION
There is increasing evidence to support the role of genomics in the spectrum of diverticular disease. Genomic, epigenetic and omic research with demographic context will help improve the understanding and management of this complex disease.
Topics: Humans; Risk Factors; Epigenesis, Genetic; Genetic Predisposition to Disease; Diverticular Diseases; Gene-Environment Interaction; Obesity
PubMed: 38831715
DOI: 10.1093/bjsopen/zrae032 -
Updates in Surgery Apr 2024To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and... (Meta-Analysis)
Meta-Analysis
The influence of preoperative e intraoperative factors in predicting postoperative morbidity and mortality in perforated diverticulitis: a systematic review and meta-analysis.
To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.
Topics: Humans; Diverticulitis, Colonic; Surgical Wound Infection; Intestinal Perforation; Diverticulitis; Peritonitis; Anastomosis, Surgical; Morbidity; Colostomy; Treatment Outcome
PubMed: 38282071
DOI: 10.1007/s13304-023-01738-7 -
Clinical and Experimental Vaccine... Jan 2024Conduct a systematic review of case reports and case series regarding the development of acute abdomen following coronavirus disease 2019 (COVID-19) vaccination, to...
PURPOSE
Conduct a systematic review of case reports and case series regarding the development of acute abdomen following coronavirus disease 2019 (COVID-19) vaccination, to describe the possible association and the clinical and demographic characteristics in detail.
MATERIALS AND METHODS
This study included case report studies and case series that focused on the development of acute abdomen following COVID-19 vaccination. Systematic review studies, literature, letters to the editor, brief comments, and so forth were excluded. PubMed, Scopus, EMBASE, and Web of Science databases were searched until June 15, 2023. The Joanna Briggs Institute tool was used to assess the risk of bias and the quality of the study. Descriptive data were presented as frequency, median, mean, and standard deviation.
RESULTS
Seventeen clinical case studies were identified, evaluating 17 patients with acute abdomen associated with COVID-19 vaccination, which included acute appendicitis (n=3), acute pancreatitis (n=9), diverticulitis (n=1), cholecystitis (n=2), and colitis (n=2). The COVID-19 vaccine most commonly linked to acute abdomen was Pfizer-BioNTech (messenger RNA), accounting for 64.71% of cases. Acute abdomen predominantly occurred after the first vaccine dose (52.94%). All patients responded objectively to medical (88.34%) and surgical (11.76%) treatment and were discharged within a few weeks. No cases of death were reported.
CONCLUSION
Acute abdomen is a rare complication of great interest in the medical and surgical practice of COVID-19 vaccination. Our study is based on a small sample of patients; therefore, it is recommended to conduct future observational studies to fully elucidate the underlying mechanisms of this association.
PubMed: 38362368
DOI: 10.7774/cevr.2024.13.1.42 -
Family Practice Feb 2024Recognition of acute diverticulitis is important to determine an adequate management strategy. Differentiating it from other gastrointestinal disorders is challenging as... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recognition of acute diverticulitis is important to determine an adequate management strategy. Differentiating it from other gastrointestinal disorders is challenging as symptoms overlap. Clinical tests might assist the clinician with this diagnostic challenge. Previous reviews have focussed on prognostic questions and imaging examinations in secondary care.
OBJECTIVE
To evaluate the diagnostic accuracy of clinical tests feasible in primary care for acute diverticulitis in suspected patients.
METHOD
We have systematically searched multiple databases for diagnostic accuracy studies of tests feasible in primary care compared to a reference standard in suspected patients. Two reviewers independently selected studies, extracted data, and assessed study quality with the QUADAS-2 tool. We have meta-analysed the results in the case of more than four studies per index test.
RESULTS
Seventeen studies were included, all studies were performed in secondary care (median prevalence 48%). Individual signs and symptoms showed a wide range in sensitivity (range 0.00-0.98) and specificity (range 0.08-1.00). Of the four laboratory tests evaluated, CRP >10 mg/l had the highest sensitivity (range 0.89-0.96) with specificity ranging from 0.28 to 0.61. Ultrasound had the highest pooled sensitivity and specificity of 0.92 (95% CI 0.86-0.96) and 0.94 (95% CI 0.88-0.97), respectively.
CONCLUSION
None of the studies were performed in primary care. Individual signs and symptoms alone are insufficiently informative for acute diverticulitis diagnosis. CRP showed potential for ruling out and ultrasound had a high diagnostic accuracy. More research is needed about the diagnostic accuracy of these tests in primary care.
PROSPERO REGISTRATION NUMBER
CRD42021230622.
Topics: Humans; Sensitivity and Specificity; Ultrasonography; Diagnostic Tests, Routine; Primary Health Care
PubMed: 38271592
DOI: 10.1093/fampra/cmad118 -
Surgical Laparoscopy, Endoscopy &... Aug 2023Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is... (Meta-Analysis)
Meta-Analysis
Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery.
BACKGROUND
Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is still mainly approached by conventional celiotomy.
MATERIALS AND METHODS
A video vignette is presented showing the details of an emergent laparoscopic right colectomy as performed to treat a 59-year-old woman who presented with clinical signs of peritonitis, and radiologic findings suggestive of acute right-colon diverticulitis complicated by perforation of the hepatic flexure and periduodenal abscess. We also aimed to evaluate the relative outcomes of laparoscopic versus conventional surgery by meta-analyzing the currently available comparative evidence on the argument.
RESULTS
A total of 2848 patients were included in the analysis, of which 979 patients received minimally invasive surgery and 1869 had conventional surgery. Laparoscopic surgery had a longer operating time and resulted in an abbreviated hospital stay. Overall, patients receiving laparoscopy had significantly lower morbidity than those whose surgery was undertaken by laparotomy, while there was no statistically significant difference in terms of postoperative mortality.
CONCLUSIONS
According to the existing literature, minimally invasive surgery improves the postoperative outcomes of patients receiving surgery for right-sided colonic diverticulitis.
Topics: Female; Humans; Middle Aged; Diverticulitis; Diverticulitis, Colonic; Laparoscopy; Colectomy; Treatment Outcome; Postoperative Complications
PubMed: 37311024
DOI: 10.1097/SLE.0000000000001186 -
Langenbeck's Archives of Surgery Jan 2024Although laparoscopic lavage for perforated diverticulitis with peritonitis has been grabbing the headlines, it is known that the clinical presentation of peritonitis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although laparoscopic lavage for perforated diverticulitis with peritonitis has been grabbing the headlines, it is known that the clinical presentation of peritonitis can also be caused by an underlying perforated carcinoma. The aim of this study was to determine the incidence of patients undergoing inadvertent laparoscopic lavage of perforated colon cancer as well as the delay in cancer diagnosis.
METHODS
The PubMed database was systematically searched to include all studies meeting inclusion criteria. Studies were screened through titles and abstracts with potentially eligible studies undergoing full-text screening. The primary endpoints of this meta-analysis were the rates of perforated colon cancer patients having undergone inadvertent laparoscopic lavage as well as the delay in cancer diagnosis. This was expressed in pooled rate % and 95% confidence intervals.
RESULTS
Eleven studies (three randomized, two prospective, six retrospective) totaling 642 patients met inclusion criteria. Eight studies reported how patients were screened for cancer and the number of patients who completed follow-up. The pooled cancer rate was 3.4% (0.9%, 5.8%) with low heterogeneity (Isquare2 = 34.02%) in eight studies. Cancer rates were 8.2% (0%, 3%) (Isquare2 = 58.2%) and 1.7% (0%, 4.5%) (Isquare2 = 0%) in prospective and retrospective studies, respectively. Randomized trials reported a cancer rate of 7.2% (3.1%, 11.2%) with low among-study heterogeneity (Isquare2 = 0%) and a median delay to diagnosis of 2 (1.5-5) months.
CONCLUSIONS
This systematic review found that 7% of patients undergoing laparoscopic lavage for peritonitis had perforated colon cancer with a delay to diagnosis of up to 5 months.
Topics: Humans; Prospective Studies; Retrospective Studies; Therapeutic Irrigation; Colonic Neoplasms; Colonic Diseases; Intestinal Perforation; Laparoscopy; Peritonitis
PubMed: 38197963
DOI: 10.1007/s00423-023-03224-5 -
The American Surgeon Jun 2024Acute uncomplicated diverticulitis (AUD) is a common cause of acute abdominal pain. Recent guidelines advise selective use of antibiotics in AUD patients. This... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Acute uncomplicated diverticulitis (AUD) is a common cause of acute abdominal pain. Recent guidelines advise selective use of antibiotics in AUD patients. This meta-analysis aimed to compare the effectiveness of no antibiotics vs antibiotics in AUD patients.
METHODS
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify randomized controlled trials (RCTs) involving AUD patients which compared the use of antibiotics with no antibiotics. Pooled outcome data was calculated using random effects modeling with 95% confidence intervals (CIs).
RESULTS
5 RCTs with 1934 AUD patients were included. 979 patients were managed without antibiotics (50.6%). Patients in the no antibiotic and antibiotic groups had comparable demographics (age, sex, and body mass index) and presenting features (temperature, pain score, and C-reactive protein levels). There was no significant difference in rates of complicated diverticulitis (OR: .61, 95% CI: 0.27-1.36, = .23), abscess (OR: .51, 95% CI: .08-3.25, = .47) or fistula (OR: .33, 95% CI: .03-3.15, = .33) formation, perforation (OR: .98, 95% CI: .32-3.07, = .98), recurrence (OR: .96, 95% CI: .66-1.41, = .85), need for surgery (OR: 1.36, 95% CI: .47-3.95, = .37), mortality (OR: 1.27, 95% CI: .14-11.76, = .82), or length of stay (MD: .215, 95% CI: -.43-.73, = .61) between the 2 groups. However, the likelihood of readmission was higher in the antibiotics group (OR: 2.13, 95% CI: 1.43-3.18, = .0002).
CONCLUSION
There is no significant difference in baseline characteristics, clinical presentation, and adverse health outcomes between AUD patients treated without antibiotics compared to with antibiotics.
Topics: Humans; Anti-Bacterial Agents; Acute Disease; Diverticulitis, Colonic; Randomized Controlled Trials as Topic; Treatment Outcome; Diverticulitis
PubMed: 38205505
DOI: 10.1177/00031348241227183