Impact of early or delayed elective resection in complicated diverticulitis.
OBJECTIVE
To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis.


METHODS
The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis (Hinchey classification  I-II) at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies.


RESULTS
The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher (80% vs 75%). Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elective resection (9296 € ± 694 € vs 8423 € ± 968 €; P = 0.001). Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages.


CONCLUSIONS
Overall, early elective resection for complicated, non-perforated diverticulitis is shown to be a suitable alternative to delayed elective resection after 6-8 wk, with additional beneficial socioeconomic effects.
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany. k.bachmann@uke.de
Kai
K
Bachmann
Geeske
G
Krause
Tamina
T
Rawnaq
Lena
L
Tomkotter
Yogesh
Y
Vashist
Shanly
S
Shahmiri
Jakob R
JR
Izbicki
Maximilian
M
Bockhorn
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003082:Colectomy / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery; D004239:Diverticulitis, Colonic / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents