[Surgical treatment of sigmoid diverticulitis].
Surgery for diverticulitis is usually discussed in two situations: in emergency to treat a diverticulitis related complication or electively to prevent the risk of diverticulitis recurrence (prophylactic colonic resection). Surgical treatment of complicated diverticulitis has gone to changes during the last decade thanks to advances in laparoscopic surgery and interventional radiology (drainage, embolization). Emergency surgery for diverticulitis is mainly indicated (90%) for infectious related complications and more rarely for bleeding or stenosis. Surgery is the standard treatment of peritonitis complicating diverticulitis (Hinchey 3 or 4) and is recommended in Hinchey 1 or 2 diverticulitis after failure of a well conducted medical treatment with or without radiological drainage (for abscesses >or= 5cm). Indications for prophylactic surgery after an episode of uncomplicated diverticulitis is not systematic and should be discussed case by case according to the baseline characteristics of patients. Prophylactic surgery consists in sigmoid resection including the sigmoido-rectal junction with colorectal anastomosis and should be performed under laparoscopy.
Service de chirurgie digestive et hépato-bilio-pancréatique, AP-HP, groupe hospitalier de La Pitié-Salpêtrière, institut universitaire de cancérologie (Paris-VI), université Pierre-et-Marie-Curie, Paris. mehdi.karoui@psl.aphp.fr
Laurent
L
Genser
Mehdi
M
Karoui
Jean-Christophe
JC
Vaillant
Laurent
L
Hannoun
D003251:Constriction, Pathologic / Q000150:complications / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D055502:Secondary Prevention / Q000379:methods; D012720:Severity of Illness Index; D012810:Sigmoid Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery*