Timing e risultati della terapia chirurgica della malattia diverticolare del colon

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Giuseppe P. Ferulano, Saverio Dilillo, Michele D’Ambra, Cecilia Saviano, Rossella Brunaccino, Ruggero Lionetti, Domenico Fico

Ann. Ital. Chir., 2006; 77: 497-502

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AIMS: To evaluate retrospectively the outcome of the curative open and laparoscopic surgical approach to the diverticular
disease according to timed steps based on the pathologic stage.
PATIENT AND MATERIAL: From 1989 83 out of 242 outpatients underwent surgery in emergency or after medical failure
and at least two acute attacks requiring hospital admittance, or complicated diverticulitis. Modified Hinchey classification
staged the disease. Clinic and instrumental criteria, surgical procedures, early and late complications were statistically
evaluated (Student’s t-test and exact Fischer test, p<0.05) in comparison with the different steps of therapeutic strategy. RESULTS: Twenty nine patients were classified as Hinchey 0, 26 as I, 14 as II, 11 as III, 3 as IV. Clinical characteristics of the lap and open groups overlapped, with higher rate of earlier age in first and advanced stages in the second group. 16 patients (19.3%) underwent surgery at the first attack in emergency or in delayed emergency (5 TC-guided drainages). 30 open and 53 lap procedures were done: 21 two-stage: 18 primary resections + ileostomy and 3 Hartmann; 61 single stage: 49 sigmoidectomy, 12 left colectomy. 4 conversions (7.5%), 12 early (14.5%) and 10 late (12.1%) complications were observed. DISCUSSION: Complications rate was higher in the open group including more advanced stages. Elective surgery performed following conservative therapy, 4 weeks from the first acute attack in younger people (age<55yrs.) and after two attacks in elder (age >55yrs.) showed a significant lower complications’ incidence (p<0.05) compared to the 8 weeks delayed operations. CONCLUSION: Surgery of diverticulitis must follow standardized criteria. The laparoscopic approach could be performed in more severe stages, provided that conditions of delayed emergency were achieved.

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