[Surgical therapy of diverticulitis].
The prevalence of sigmoid diverticular disease is increasing in western, industrialised countries. Practice parameters recommend surgical treatment for complicated disease or after the second episode of chronic recurrent disease. Surgical intervention should also be considered for younger patients after a first episode severe enough to require treatment. The preferred surgical procedure is elective sigmoid resection with primary anastomosis. Additional resection of the lower colon descendens is necessary when this region is also affected. Two-stage surgery is recommended for patients in emergency situations, i. e. severe or generalized peritonitis or extensive localized abscess formation, especially when the treating hospital is non-specialized. Segmentary resection without anastomosis and Hartmann's procedure is performed first (blind closure of the rectum with terminal colostomy). Restoration of colorectal continuity is performed at the earliest three months postoperatively. The preferred surgical technique is laparoscopy, provided the surgeon has the necessary expertise. Numerous studies have proven significant advantages of laparoscopy, although it is a completely new procedure with a long learning curve of 50-60 operations. Therefore, conversion to the conventional method should not be seen as a personal failure but rather as a responsible decision in favor of the patient's well-being.
Bittner
R
R
Klinik für Allgemein- und Viszeralchirurgie, Marienhospital Stuttgart.
Ulrich
M
M
D018784:Abdominal Abscess / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy; D003113:Colonoscopy; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation