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Journal of Gastroenterology and... Jan 2018Prevalence of colonic diverticulosis is increasing worldwide with age, and up to 25% of patients who have colonic diverticulosis might experience diverticulitis.... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIM
Prevalence of colonic diverticulosis is increasing worldwide with age, and up to 25% of patients who have colonic diverticulosis might experience diverticulitis. However, a definitive approach of preventing recurrent diverticulitis remains unknown. 5-aminosalicylic acid (5-ASA) agents are anti-inflammatory agents and have been used to prevent recurrent diverticulitis, and there have been some randomized clinical trials (RCTs). However, the efficacy results for secondary prevention in uncomplicated diverticulitis differed across studies. Our aim was to clarify the efficacy and safety of 5-ASA agents in the prevention of recurrent diverticulitis.
METHODS
We searched MEDLINE, EMBASE, Web of Science, and the Cochrane library with no language restrictions. Two reviewers independently assessed and selected RCTs. The data were pooled using a random effect model and were presented in the pooled risk ratio (RR) and 95% confidence interval (CI). Cochrane's Q and I-squared statistics were used to assess heterogeneity. The protocol was registered at PROSPERO.
RESULTS
Seven articles with eight RCTs from 329 potentially relevant articles were included. 5-ASA agents were not superior to controls in preventing recurrent diverticulitis (RR 0.86, 95% CI 0.63 to 1.17, I = 60%) and the incidence of adverse events was not different between 5-ASA agents and controls (RR 0.97, 95% CI 0.84 to 1.11, I = 45%). However, some included studies were few in number of participants and substantial risk of bias.
CONCLUSIONS
5-aminosalicylic acid agents were not associated with prevention of recurrent diverticulitis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aminosalicylic Acids; Anti-Inflammatory Agents; Databases, Bibliographic; Diverticulitis; Female; Humans; Male; Mesalamine; Middle Aged; Phenylhydrazines; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention; Sulfasalazine; Treatment Outcome; Young Adult
PubMed: 28623877
DOI: 10.1111/jgh.13846 -
Diagnostics (Basel, Switzerland) Jan 2023Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can... (Review)
Review
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were (25%), spp. (17%), and spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
PubMed: 36766534
DOI: 10.3390/diagnostics13030429 -
Colorectal Disease : the Official... Jan 2012This paper addresses the current status of the treatment of acute colonic diverticulitis by an evidence-based review. (Review)
Review
AIM
This paper addresses the current status of the treatment of acute colonic diverticulitis by an evidence-based review.
METHOD
A systematic search in PUBMED, MEDLINE, EMBASE and Google scholar on colonic diverticulitis was performed. Diagnostic tools, randomized controlled trials, non-randomized comparative studies, observational epidemiological studies, national and international guidelines, reviews of observational studies on elective and emergency surgical treatment of diverticulitis, and studies of prognostic significance were reviewed. Criteria for eligibility of the studies were diagnosis and classification, medical treatment, inpatients and outpatients, diverticulitis in young patients, immunosuppression, recurrence, elective resection, emergency surgery, and predictive factors.
RESULTS
Some 92 publications were selected for comprehensive review. The review highlighted that computed tomography is the most effective test in the diagnosis and staging of acute diverticulitis; outpatient treatment can be performed for uncomplicated diverticulitis in patients without associated comorbidities; conservative treatment is aimed at those patients with uncomplicated acute diverticulitis; elective surgery must be done on an individual basis; laparoscopic approach for elective treatment of diverticulitis is appropriate but may be technically complex; in perforated diverticulitis, resection with primary anastomosis is a safe procedure that requires experience and should take into account strict exclusion criteria.
CONCLUSION
The heterogeneity of patients with colonic diverticular disease means that both elective and urgent treatment should be tailored on an individual basis.
Topics: Acute Disease; Clinical Trials as Topic; Diagnostic Imaging; Diverticulitis, Colonic; Humans
PubMed: 21848896
DOI: 10.1111/j.1463-1318.2011.02766.x -
Scandinavian Journal of Surgery : SJS :... 2022The aim of this systematic review was to evaluate the risk of parastomal (PSH) and incisional hernias (IH) after emergency surgery for Hinchey III-IV diverticulitis,...
PURPOSE
The aim of this systematic review was to evaluate the risk of parastomal (PSH) and incisional hernias (IH) after emergency surgery for Hinchey III-IV diverticulitis, with comparison between the Hartmann procedure and other surgical techniques.
METHODS
The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence.
RESULTS
Five studies (four randomized controlled trials and one retrospective cohort) with a total of 699 patients were eligible for inclusion. The PSH rate was 15%-46% for Hartmann procedure, 0%-85% for primary anastomosis, 4% for resection, and 2% for laparoscopic lavage. The IH rates were 5%-38% for Hartmann procedure, 5%-27% for primary anastomosis, 9%-12% for primary resection, and 3%-11% for laparoscopic lavage.
CONCLUSIONS
Both the parastomal and incisional hernia incidences are poorly evaluated and reported, and varied greatly between the studies.
Topics: Anastomosis, Surgical; Diverticulitis; Humans; Incidence; Incisional Hernia; Laparoscopy; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 35748305
DOI: 10.1177/14574969221107276 -
Diseases of the Colon and Rectum Oct 2020There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis.
OBJECTIVE
The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management.
DATA SOURCES
PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019.
STUDY SELECTION
Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available.
INTERVENTIONS
Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered.
MAIN OUTCOME MEASURES
The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model.
RESULTS
There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%-15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%-15%)) or heterogeneity. Funnel plot assessment revealed no publication bias.
LIMITATIONS
There were no randomized controlled trials available. The statistical heterogeneity was moderate (I = 46%).
CONCLUSIONS
Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon.
PROSPERO
CRD42019131673.
Topics: Anti-Bacterial Agents; Diverticulitis, Colonic; Drainage; Humans; Recurrence
PubMed: 32969890
DOI: 10.1097/DCR.0000000000001787 -
European Journal of Nutrition Dec 2017We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease risk.
METHODS
PubMed and Embase databases were searched up to February 7, 2017. Summary relative risks and 95% confidence intervals (95% CIs) were calculated using a random effects model and nonlinear associations were modeled using fractional polynomial models.
RESULTS
Six cohort studies of BMI and diverticular disease risk (28,915 cases, 1,636,777 participants) and five cohort studies of physical activity and diverticular disease risk (2080 cases, 147,869 participants) were included. The summary relative risk (RR) of incident diverticular disease for a 5 unit BMI increment was 1.28 (95% CI: 1.18-1.40, I = 77%, n = 6) for diverticular disease, 1.31 (95% CI: 1.09-1.56, I = 74%, n = 2) for diverticulitis, and 1.20 (95% CI: 1.04-1.40, I = 56%, n = 3) for diverticular disease complications. There was no evidence of a nonlinear association between BMI and diverticular disease risk (p = 0.22), and risk increased even within the normal weight range. Compared to a BMI of 20, the summary RR for a BMI of 22.5, 25.0, 27.5, 30.0, 32.5, 35.0, 37.5, and 40.0 was 1.15 (1.07-1.23), 1.31 (1.17-1.47), 1.50 (1.31-1.71), 1.71 (1.52-1.94), 1.96 (1.77-2.18), 2.26 (2.00-2.54), 2.60 (2.11-3.21), and 3.01 (2.06-4.39), respectively. The summary RR was 0.76 (95% CI: 0.63-0.93, I = 54%, n = 5) for high vs. low physical activity and 0.74 (95% CI: 0.57-0.97, I = 39.5%, p = 0.20, n = 2) for high vs. low vigorous physical activity.
CONCLUSIONS
These results suggest that even moderate increases in BMI may increase the risk of diverticular disease as well as diverticular disease complications and that a higher level of physical activity may reduce the risk.
Topics: Body Mass Index; Diverticular Diseases; Exercise; Humans; Incidence; Obesity; Risk Factors; Sensitivity and Specificity; Waist Circumference; Waist-Hip Ratio
PubMed: 28393286
DOI: 10.1007/s00394-017-1443-x -
International Journal of Colorectal... Dec 2022Hartmann's procedure is traditionally performed in emergency situations where single-step procedures with immediate anastomosis may be unsafe. However, it can be... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Hartmann's procedure is traditionally performed in emergency situations where single-step procedures with immediate anastomosis may be unsafe. However, it can be associated with significant morbidity and low colostomy reversal rate. Whilst randomised controlled trials and a Cochrane review have reported strong evidence of laparoscopic over open colectomies, no such reviews have been performed for Hartmann's procedure. Hence, this paper aims to summarise the existing evidence to determine the efficacy of laparoscopic Hartmann's procedure over its open counterpart.
METHODS
Embase, Medline and Cochrane databases were searched from inception to 15 November 2020 for keywords relating to 'laparoscopy' and 'Hartmann' using strict inclusion and exclusion criteria. Odds ratio was estimated for dichotomous outcomes and weighted mean difference was estimated for continuous outcomes.
RESULTS
From the 836 articles yielded from the search strategy, 12 articles were selected for meta-analysis. Pooled analysis revealed that laparoscopic Hartmann's procedure (LHP) allows for a shorter length of stay, and a lower risk of overall surgical site infections and superficial surgical site infections. There was no significant difference in other outcomes. Single-arm analysis of LHP also showed an unprecedented high colostomy reversal rate of over 80%.
CONCLUSION
In clinically suitable patients, laparoscopic Hartmann's procedure has benefits over open Hartmann's procedure. Despite the selection bias of single-arm studies, LHP has reported a high stoma reversal rate of over 80%. Future well-controlled studies should be done to affirm the findings.
Topics: Humans; Surgical Wound Infection; Colostomy; Laparoscopy; Colectomy; Rectum; Anastomosis, Surgical; Retrospective Studies; Treatment Outcome; Postoperative Complications
PubMed: 36416926
DOI: 10.1007/s00384-022-04285-6 -
Annals of Surgery Apr 2017To compare the outcomes of laparoscopic lavage and sigmoid resection in perforated diverticulitis with purulent peritonitis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the outcomes of laparoscopic lavage and sigmoid resection in perforated diverticulitis with purulent peritonitis.
BACKGROUND
Peritonitis secondary to perforated diverticulitis has conventionally been managed by resection and stoma formation. Case series have suggested that patients can be safely managed with laparoscopic lavage, resulting in reduced mortality and stoma formation. Recently, 3 randomized controlled trials have published contradictory conclusions.
METHODS
MEDLINE from 1946 to present, Cochrane Database of Systematic Reviews, and Cochrane database of Registered clinical trials and EMBASE (all via OVID) were searched using the terms "laparoscopy" AND ("primary resection" OR "Hartmann procedure", OR "sigmoidectomy"), AND "Diverticulitis", AND "Peritonitis" AND "therapeutic irrigation" or "lavage" AND randomized controlled trial and any derivatives of those terms. We included all randomized controlled trials. Data were extracted from each study using a purpose-designed template. Statistical analysis was undertaken using Revman 5.
RESULTS
Three randomized controlled trials were identified from 48 potential studies. The analysis included 307 patients of whom 159 underwent laparoscopic lavage. Overall, the rate of reintervention within 30 days postoperatively was 45/159 (28.3%) in the lavage group and 13/148 (8.8%) in the resection group (relative risk 3.01, 95% confidence interval 1.15-7.90). There was no significant difference in Intensive Care Unit admissions, 30 and 90-day mortality, or stoma rates at 12 months.
CONCLUSION
Laparoscopic lavage used in the management of Hinchey grade III diverticulitis leads to more reinterventions within 30 days postoperatively, but does not increase the 30 or 90-day mortality rates compared with sigmoid resection.
Topics: Diverticulitis; Diverticulum, Colon; Female; Hospital Mortality; Humans; Laparoscopy; Male; Peritoneal Lavage; Peritonitis; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Survival Rate; Treatment Outcome
PubMed: 27631772
DOI: 10.1097/SLA.0000000000002005 -
Digestive Surgery 2017Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management... (Comparative Study)
Comparative Study Review
BACKGROUND
Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice.
AIM
To assess outcomes of out-patient management of acute UD.
METHODS
A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings.
RESULTS
The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria.
CONCLUSION
Ambulatory management of acute UD is reasonable in selected patients.
Topics: Acute Disease; Ambulatory Care; Analgesics; Anti-Bacterial Agents; Cost Savings; Diet; Diverticulitis; Health Care Costs; Hospitalization; Humans; Recurrence; Severity of Illness Index; Treatment Failure
PubMed: 27701164
DOI: 10.1159/000450865 -
Scandinavian Journal of Gastroenterology Jul 2024Recurrences or persistent symptoms after an initial episode of diverticulitis are common, yet surgical treatment is rarely performed. Current guidelines lack clear... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recurrences or persistent symptoms after an initial episode of diverticulitis are common, yet surgical treatment is rarely performed. Current guidelines lack clear recommendations on whether or not to operate, even though recent studies suggest an improved quality of life following surgery. The aim of this study is therefore to compare quality of life in patients with recurrent or ongoing diverticulitis treated conservatively versus surgically, giving a more definitive answer to the question of whether or not to operate on these patients.
METHODS
A systematic literature search was conducted in EMBASE, MEDLINE and Cochrane. Only comparative studies reporting on quality of life were included. Statistical analysis included calculation of weighted mean differences and pooled odds ratios.
RESULTS
Five studies were included; two RCT's and three retrospective observational studies. Compared to conservative treatment, the SF-36 scores were higher in the surgically treated group at each follow-up moment but only the difference in SF-36 physical scores at six months follow-up was statistically significant (MD 6.02, 95%CI 2.62-9.42). GIQLI scores were also higher in the surgical group with a MD of 14.01 (95%CI 8.15-19.87) at six months follow-up and 7.42 (95%CI 1.23-12.85) at last available follow-up. Also, at last available follow-up, significantly fewer recurrences occurred in the surgery group (OR 0.10, 95%CI 0.05-0.23, < 0.001).
CONCLUSION
Although surgery for recurrent diverticulitis is not without risk, it might improve long-term quality of life in patients suffering from recurrent- or ongoing diverticulitis when compared to conservative treatment. Therefore, it should be considered in this patient group.
Topics: Humans; Quality of Life; Recurrence; Conservative Treatment; Diverticulitis; Diverticulitis, Colonic; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38613245
DOI: 10.1080/00365521.2024.2337833