Advances and Dilemmas in Diverticular Disease: Surgery for Recurrent Diverticulitis


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Abstract

CME Learning Objectives:On completion of this educational activity, learners should be better able to: (1) Appropriately counsel patients after an episode of uncomplicated diverticulitis about the risks of further episodes. (2) Evaluate the rationale for treatment of diverticular abscesses with antibiotics, percutaneous drainage, or surgery.Increasing recognition, over the past decade, that patients frequently present with complicated diverticular disease as the first episode combined with a reduction in morbidity and mortality of elective and emergency surgery has resulted in a change in the surgical management of recurrent uncomplicated diverticulitis. Patients with an episode of uncomplicated diverticular disease have an 80% chance of experiencing no further episodes. Therefore, elective sigmoid colectomy for recurrent uncomplicated disease is no longer recommended after 2 episodes. There are some high-risk patient groups including those with immunosuppression or collagen vascular diseases in whom earlier surgery is recommended. In contrast, sigmoid colectomy after an episode of complicated diverticular disease is usually recommended; although it may be safe to nonoperatively treat patients with small diverticular abscesses. To prevent recurrence after surgery it is important to ensure removal of the entire sigmoid colon and to perform an anastomosis to the upper rectum.

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