Skip to main content
SpringerLink
Log in

Elektive Operationsindikationen bei Sigmadivertikulitis

Elective surgery for sigmoid diverticulitis

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Hintergrund

Im therapeutischen Management der Sigmadivertikulitis hat sich ein Paradigmenwechsel mit einer zunehmenden Zurückhaltung hinsichtlich einer operativen Therapie vollzogen. Während weiterhin eine klare Operationsindikation im Fall von Komplikationen wie Stenosen, Fisteln, Perforationen oder persistierenden Blutungen besteht, so ist eine elektive Indikation zur Sigmaresektion insbesondere bei den chronisch-rezidivierenden Verläufen nicht klar definiert.

Ziel der Arbeit

Die wesentlichen Aspekte der elektiven Operationsindikation bei der Sigmadivertikulitis werden erläutert.

Material und Methoden

Relevante Arbeiten wurden selektioniert und weiterführende Recherchen anhand der Literaturverzeichnisse unternommen.

Ergebnisse

In den unkomplizierten Divertikulitisstadien (Typ 1a/b nach Classification of Diverticular Disease [CDD]) besteht keine Operationsindikation (Ausnahme: immunsupprimierte Patienten). Liegt eine komplizierte Divertikulitis vor (ausgenommen freie Perforation), sollte eine elektive Operation nur im Fall eines Makroabszesses (Typ 2b nach CDD) empfohlen werden. Bei einem chronisch-rezidivierenden Verlauf (Typ 3a/b nach CDD) sollte die Operationsindikation individuell gestellt werden. Treten zusätzlich Komplikationen wie Stenosen oder Fisteln auf (Typ 3c nach CDD), besteht eine elektive Operationsindikation. Aktuelle Daten zeigen, dass Patienten in den Stadien 2b und 3 insbesondere hinsichtlich der Lebensqualität von einer elektiven Operation profitieren.

Schlussfolgerung

Wenngleich die überwiegende Anzahl der Divertikulitispatienten konservativ therapiert werden kann, sollte eine elektive Operation insbesondere auch unter dem Aspekt einer besseren Lebensqualität im Vergleich zur alleinigen konservativen Therapie berücksichtigt werden.

Abstract

Background

A paradigm shift in therapeutic management of sigmoid diverticulitis has occurred with increasing reluctance regarding surgical treatment. While there is still a clear surgical indication in cases of complications such as strictures, fistulas, perforations or persistent bleeding, an elective indication for sigmoid resection is not clearly defined, especially in chronic-recurrent courses.

Objectives

The main aspects of elective surgery for sigmoid diverticulitis are discussed.

Materials and methods

Relevant studies were selected and the reference lists from those studies were also searched.

Results

An uncomplicated form of acute diverticulitis (Classification of Diverticular Disease [CDD] type 1a/b) is not an indication for surgery (exception: immunosuppressed patients). In acute complicated diverticulitis (except free perforation), elective surgery should only be recommended in case of a macroabscess (CDD type 2b). In chronic recurrent, uncomplicated diverticulitis (CDD typ 3a/b), indication for surgery should be individualized. However, indications for elective surgery are complications such as strictures or fistulas (CDD type 3c). Recent data show that patients with type 2b and 3 diverticulitis benefit from elective surgery, especially in terms of quality of life.

Conclusions

Although the majority of patients with diverticulitis can be treated conservatively, elective surgery should also be considered in terms of better quality of life compared to conservative therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Anaya DA, Flum DR (2005) Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 140:681–685

    Article  Google Scholar 

  2. Parks TG (1969) Natural history of diverticular disease of the colon. A review of 521 cases. Br Med J 4:639–642

    Article  CAS  Google Scholar 

  3. Comparato G, Di Mario F (2008) Recurrent diverticulitis. J Clin Gastroenterol 42:1130–1134

    Article  Google Scholar 

  4. Janes S, Meagher A, Frizelle FA (2005) Elective surgery after acute diverticulitis. Br J Surg 92:133–142

    Article  CAS  Google Scholar 

  5. Leifeld L, Germer CT, Böhm S et al (2014) S2k-Leitlinie Divertikelkrankheit/Divertikulitis. Z Gastroenterol 52:663–710

    Article  CAS  Google Scholar 

  6. Chautems RC, Ambrosetti P, Ludwig A et al (2002) Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory?: a prospective study of 118 patients. Dis Colon Rectum 45:962–966

    Article  CAS  Google Scholar 

  7. Sarin S, Boulos PB (1994) Long-term outcome of patients presenting with acute complications of diverticular disease. Ann R Coll Surg Engl 76:117–120

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Shaikh S, Krukowski ZH (2007) Outcome of a conservative policy for managing acute sigmoid diverticulitis. Br J Surg 94:876–879

    Article  CAS  Google Scholar 

  9. Mueller MH, Glatzle J, Kasparek MS et al (2005) Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol 17:649–654

    Article  CAS  Google Scholar 

  10. Kaiser AM, Jiang JK, Lake JP et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917

    Article  Google Scholar 

  11. Hall JF, Roberts PL, Ricciardi R et al (2011) Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum 54:283–288

    Article  Google Scholar 

  12. Ambrosetti P, Grossholz M, Becker C et al (1997) Computed tomography in acute left colonic diverticulitis. Br J Surg 84:532–534

    Article  CAS  Google Scholar 

  13. Ambrosetti P (2008) Acute diverticulitis of the left colon: value of the initial CT and timing of elective colectomy. J Gastrointest Surg 12:1318–1320

    Article  Google Scholar 

  14. Devaraj B, Liu W, Tatum J et al (2016) Medically treated diverticular abscess associated with high risk of recurrence and disease complications. Dis Colon Rectum 59(3):208–215

    Article  Google Scholar 

  15. Holmer C, Lehmann KS, Engelmann S et al (2010) Microscopic findings in sigmoid diverticulitis—changes after conservative therapy. J Gastrointest Surg 14:812–817

    Article  Google Scholar 

  16. Brandlhuber M, Genzinger C, Brandlhuber B et al (2018) Long-term quality of life after conservative treatment versus surgery for different stages of acute sigmoid diverticulitis. Int J Colorectal Dis 33(3):317–326

    Article  Google Scholar 

  17. Zingg U, Pasternak I, Guertler L et al (2007) Early vs. delayed elective laparoscopic-assisted colectomy in sigmoid diverticulitis: timing of surgery in relation to the acute attack. Dis Colon Rectum 50(11):1911–1917

    Article  Google Scholar 

  18. Reissfelder C, Buhr HJ, Ritz J (2006) What isthe optimal time ofsurgical intervention after an acute attack ofsigmoid diverticulitis: early or late elective laparoscopic. Dis Colon Rectum 49(12):1842. https://doi.org/10.1007/s10350-006-0730-z

    Article  PubMed  Google Scholar 

  19. Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363:631–639

    Article  Google Scholar 

  20. Kohler L, Sauerland S, Neugebauer E (1999) Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery. Surg Endosc 13(8):430–436

    Article  CAS  Google Scholar 

  21. Ritz JP, Lehmann KS, Frericks B et al (2011) Outcome of patients with acute sigmoid diverticulitis: multivariate analysis of risk factors for free perforation. Surgery 149:606–613

    Article  Google Scholar 

  22. Colorectal Writing Group for the SCOAP-CERTAIN Collaborative, Simianu VV, Sinanan MN, Bastawrous AL et al (2015) The impact of delaying elective resection of diverticulitis on laparoscopic conversion rate. Am J Surg 209(5):913–918

    Article  Google Scholar 

  23. van de Wall BJM, Stam MAW et al (2017) DIRECT trial collaborators. Surgery versus conservative management for recurrent and ongoing left-sided diverticulitis (DIRECT trial): an open-label, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2(1):13–22

    Article  Google Scholar 

  24. Solkar MH, Forshaw MJ, Sankararajah D et al (2005) Colovesical fistula—is a surgical approach always justified? Colorectal Dis 7:467

    Article  CAS  Google Scholar 

  25. Daniels IR, Bekdash B, Scott HJ et al (2002) Diagnostic lessons learnt from a series of enterovesical fistulae. Colorectal Dis 4:459–462

    Article  CAS  Google Scholar 

  26. Hsieh JH, Chen WS, Jiang JK et al (1997) Enterovesical fistula: 10 years experience. Clin Med J 59:283–288

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    C. Holmer

Authors
  1. C. Holmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Holmer.

Ethics declarations

Interessenkonflikt

C. Holmer gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holmer, C. Elektive Operationsindikationen bei Sigmadivertikulitis. coloproctology 40, 345–348 (2018). https://doi.org/10.1007/s00053-018-0276-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00053-018-0276-2

Schlüsselwörter

Keywords

Search

Navigation