title: Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance.
abstract: BACKGROUND
  The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease.
  
  
  METHODS
  This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction.
  
  
  RESULTS
  Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention.
  
  
  CONCLUSIONS
  Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance.
authors.affiliation: L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France. Electronic address: auvenara@yahoo.fr.
authors.forename: A
authors.initials: A
authors.lastname: Venara
authors.affiliation: L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
authors.forename: L
authors.initials: L
authors.lastname: Toqué
authors.affiliation: L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
authors.forename: J
authors.initials: J
authors.lastname: Barbieux
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
authors.forename: E
authors.initials: E
authors.lastname: Cesbron
authors.affiliation: Department of medical imaging, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Ridereau-Zins
authors.affiliation: L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
authors.forename: E
authors.initials: E
authors.lastname: Lermite
authors.affiliation: L'UNAM, University of Angers, 49000 Angers, France; Visceral Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Hamy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Diverticulitis; Management; Non-malignant stricture; Quality of life; Sigmoid colon