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Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis.
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2019-07-15 , DOI: 10.1007/s00464-019-06981-x
Le Huy Luu 1 , Nguyen Lam Vuong 2 , Vo Thi Hong Yen 3 , Do Thi Thu Phuong 3 , Bui Khac Vu 3 , Nguyen Viet Thanh 1 , Nguyen Thien Khanh 4 , Nguyen Van Hai 1
Affiliation  

BACKGROUND Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD. METHODS A single-center, prospective, non-randomized controlled study ran from 2009 to 2017. Patients with first episode of uncomplicated RCD were divided into two treatment arms, LD or NT with bowel rest and broad-spectrum antibiotics, based on their choice. The primary outcome was recurrent diverticulitis during follow-up. Secondary outcomes were treatment success and complications. RESULTS A total of 155 patients were enrolled, with 81 in the NT arm and 74 in the LD arm. Mean follow-up was 49 months. The treatment success rate for the NT arm was 90.1% and for the LD arm, 86.5% (P = 0.480). There was no significant difference in the complication rate between the LD arm, 12.2% and the NT arm, 8.6% (P = 0.472). LD was better than NT in preventing recurrent diverticulitis. Nine patients in the NT arm and none in the LD arm had recurrence (P = 0.003). The number needed to treat to prevent recurrence was nine. CONCLUSION Non-operative management with bowel rest and antibiotics for uncomplicated RCD is safe and effective. Alternatively, LD is also safe and effective, with the added benefit of preventing recurrences. While both treatments could be reasonably offered for uncomplicated RCD, LD is an appealing option when recurrence is a concern.

中文翻译:

腹腔镜憩室切除术与非手术治疗非并发症性右结肠憩室炎。

背景技术右侧结肠憩室炎(RCD)是一种以亚洲人为中心的疾病。急性单纯性RCD的最佳治疗仍是一个有争议的领域。这项研究旨在比较无并发症RCD患者的腹腔镜憩室切除术(LD)与非手术治疗(NT)的安全性和有效性。方法从2009年至2017年进行了一项单中心,前瞻性,非随机对照研究。首发无并发症RCD的患者根据他们的选择分为两组,分别为LD或NT并伴有肠道休息和广谱抗生素。主要结果是随访期间复发性憩室炎。次要结果是治疗成功和并发症。结果共有155例患者入选,其中NT组81例,LD组74例。平均随访49个月。NT组的治疗成功率为90.1%,LD组的治疗成功率为86.5%(P = 0.480)。LD组为12.2%,NT组为8.6%(P = 0.472),并发症发生率无显着差异。在预防复发性憩室炎方面,LD优于NT。NT组有9例患者复发,而LD组无1例复发(P = 0.003)。预防复发所需的治疗数量为9。结论对于简单的RCD进行肠手术和抗生素的非手术治疗是安全有效的。另外,LD也是安全有效的,并具有防止复发的额外好处。虽然可以为简单的RCD合理地提供两种治疗方法,但是当需要考虑复发时,LD是一个有吸引力的选择。LD组为12.2%,NT组为8.6%(P = 0.472),并发症发生率无显着差异。在预防复发性憩室炎方面,LD优于NT。NT组有9例患者复发,而LD组无1例复发(P = 0.003)。预防复发所需的治疗数量为9。结论对于单纯性RCD进行肠手术和抗生素的非手术治疗是安全有效的。另外,LD也是安全有效的,并具有防止复发的额外好处。虽然可以为简单的RCD合理地提供两种治疗方法,但是当需要考虑复发时,LD是一个有吸引力的选择。LD组为12.2%,NT组为8.6%(P = 0.472),并发症发生率无显着差异。在预防复发性憩室炎方面,LD优于NT。NT组有9例患者复发,而LD组无1例复发(P = 0.003)。预防复发所需的治疗数量为9。结论对于单纯性RCD进行肠手术和抗生素的非手术治疗是安全有效的。另外,LD也是安全有效的,具有防止复发的额外好处。虽然可以为简单的RCD合理地提供两种治疗方法,但是当需要考虑复发时,LD是一个有吸引力的选择。NT组有9例患者复发,而LD组无1例复发(P = 0.003)。预防复发所需的治疗数量为9。结论对于单纯性RCD进行肠手术和抗生素的非手术治疗是安全有效的。另外,LD也是安全有效的,并具有防止复发的额外好处。虽然可以为简单的RCD合理地提供两种治疗方法,但是当需要考虑复发时,LD是一个有吸引力的选择。NT组有9例患者复发,而LD组无1例复发(P = 0.003)。预防复发所需的治疗数量为9。结论对于简单的RCD进行肠手术和抗生素的非手术治疗是安全有效的。另外,LD也是安全有效的,并具有防止复发的额外好处。尽管可以为单纯性RCD合理地提供两种治疗方法,但是当需要考虑复发时,LD是一个有吸引力的选择。
更新日期:2020-04-22
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