title: [Acute sigmoid diverticulitis. Are operations more frequent since the introduction of laparoscopy and CT scanning?].
abstract: BACKGROUND
  Sigmoid resection is now considered as a standard procedure for acute and recurrent sigmoid diverticulitis (SD). In the last decade significant changes in preoperative diagnosis with computed tomography (CT) scanning and surgical access (laparoscopy) have been implemented. The aim of this study was to examine whether this has led to changes in the indications for surgical therapy.
  
  
  METHODS
  Consecutive admissions of 1,154 patients from January 1995 to December 2009 with acute SD were prospectively included. In terms of pre-operative and intraoperative findings and postoperative course 3 treatment periods (TP) were distinguished: TP I 1995-1999, TP II 2000-2004 and TP III 2005-2009.
  
  
  RESULTS
  CT scanning was used in more than 90% of cases since TP II compared to 51% during TP I (p<0.001). The ratio of emergency versus elective surgery significantly increased in favor of elective surgery (p<0.001). The rate of laparoscopy-assisted sigmoid resections showed a continuous increase from 53% in TP I to 71% in TP III (p<0.001) while the rate of Hartmann's procedures decreased over time (p<0.001). Overall, the rate of surgically treated patients decreased during the time periods studied despite an increase in the total number of patients with SD (TP III versus TP I +41%.) The rate of conservatively treated patients increased significantly (p<0.001). The morbidity rate decreased (p<0,001) whereas mortality rates remained at a constantly low level (p=0.175).
  
  
  CONCLUSIONS
  The increasing use of CT diagnosis and the laparoscopic approach led to a shift from emergency surgery with a high complication rate to elective surgery with a high rate of primary restoration of continuity and low morbidity. However, the indications for surgery and therefore the overall rate of patients who underwent surgery did not increase due to these changes.
authors.affiliation: Chirurgische Klinik I, Klinik für Allgemein-, Gefäss- und Thoraxchirurgie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany.
authors.forename: J-P
authors.initials: JP
authors.lastname: Ritz
authors.forename: K S
authors.initials: KS
authors.lastname: Lehmann
authors.forename: A J
authors.initials: AJ
authors.lastname: Kroesen
authors.forename: H J
authors.initials: HJ
authors.lastname: Buhr
authors.forename: C
authors.initials: C
authors.lastname: Holmer
mesh_terms: D000208:Acute Disease; D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014600:Utilization Review