Management of sigmoid diverticulitis: a retrospective study of 268 patients.
OBJECTIVE
The therapeutic management of acute diverticulitis has evolved over the last years in favour of an initial conservative approach with laparoscopy rather than a primary anastomosis. We studied the management of sigmoid diverticulitis in the Digestive Surgical Unit to assess it in comparison to actual practice.


METHODS
A retrospective review of patients admitted to our unit from January 1998 to June 2006 for diverticular disease. We divided the patients into 3 groups (Urgent Medical Group (UM), Urgent Surgical Group (US) and Scheduled Surgical Group (SS)), and analysed demographic data, the severity and recurrence of diverticulitis, pathology results, length of stay, morbidity and mortality.


RESULTS
The mean age was 60.5+/-14.9 years. The overall mortality was 3% (14.5% for the Acute Surgical Group and 0 % for the Elective Surgical Group); overall morbidity 38.4%; the incidence of neoplasm 4.8% in urgent colectomies and 0.9% in scheduled colectomies.


CONCLUSIONS
Based on our study and published reviews, we recommend elective colectomy after 2 recurrent episodes of acute diverticulitis, one episode of complicated acute diverticulitis managed conservatively, or if the patient is younger than 50 years-old. This approach would reduce the number of acute operations, which are associated with high morbidity and mortality.
Boudart
C
C
Department of Digestive, Laparoscopic and Thoracic Surgery, C.H.U. Brugmann, U.L.B., Brussels, Belgium.
Simoens
Ch
Ch
Thill
V
V
Debergh
N
N
Smets
D
D
Mendes da Costa
P
P
D000368:Aged; D003082:Colectomy / Q000379:methods; D004239:Diverticulitis, Colonic / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000401:mortality / Q000601:surgery / Q000628:therapy*