Skip to main content
SpringerLink
Log in

Welchen Erfolg bringt die Sigmaresektion bei der akuten Sigmadivertikulitis tatsächlich?

Funktionelle Ergebnisse nach operativer und konservativer Therapie

What is the actual benefit of sigmoid resection for acute diverticulitis?

Functional outcome after surgical and conservative treatment

  • Originalien
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Nach wie vor gibt es eine kontroverse Diskussion über das korrekte therapeutische Management bei der akuten Sigmadivertikulitis (SD). Wesentlich für den Therapieerfolg ist vor allem die langfristige Beschwerdefreiheit der Patienten nach operativer bzw. konservativer Therapie. Ziel dieser Studie war es daher, das Langzeitoutcome von Patienten mit einer akuten SD nach konservativer und operativer Therapie zu vergleichen.

Patienten und Methoden

Von Januar 2005 bis Juni 2008 wurden alle Patienten mit einer akuten SD mit Ausnahme einer freien Perforation prospektiv in die Studie eingeschlossen. Verglichen wurden Alter, Geschlecht, SD-Ereignis (Erstereignis/rezidivierende SD), CT-Stadium, Infektparameter (CRP, Leukozyten), persistierende Beschwerden sowie Rezidivrate nach konservativer und operativer Therapie. Ferner wurde die Rate an postoperativen Sexual- und Blasenfunktionsstörungen erhoben. Das Langzeitoutcome wurde mittels Fragebogen evaluiert.

Ergebnisse

Insgesamt wurden 153 (86 weiblich, 67 männlich, mittleres Alter 62,46 Jahre) Patienten eingeschlossen. 70 (45,8 %) Patienten hatten ein Erstereignis und 83 (54,2 %) eine rezidivierende SD. 40 (26,1 %) Patienten wurden initial konservativ und 113 (73,9 %) mittels Sigmakontinuitätsresektion operativ behandelt. Bei 16 Patienten (konservativ: 4; operativ 12, p = 0,961) lag ein Stadium I nach Hansen/Stock, bei 88 (konservativ 29; operativ 59, p = 0,026) ein Stadium IIa und bei 49 (konservativ: 7; operativ: 42, p = 0,022) ein Stadium IIb vor. Das mediane Follow-up lag bei 32 (Range 12–52) Monaten. Zum Zeitpunkt der Follow-up-Untersuchung klagten 25 % der konservativ und 8,8 % der operativ behandelten Patienten über persistierende Beschwerden (p = 0,009). Dabei traten auf (konservativ vs. operativ): schmerzhafte Defäkation (22,5 % vs. 8,8 %, p = 0,024), Obstipation (25 % vs. 8,8 %, p = 0,009), Bauchkrämpfe (22,5 % vs. 4,4 %, p = 0,001) und schmerzhafte Blähungen (25 % vs. 8,8 %, p = 0,009). Postoperativ traten in 7 % der Fälle Sexual- und in 9 % Blasenfunktionsstörungen auf. Ein Rezidiv der SD trat bei 32,5 % der konservativ und 3,5 % der operativ behandelten Patienten auf (p < 0,001).

Schlussfolgerung

Die chirurgische Therapie der akuten SD ist in Hinblick auf die Vermeidung persistierender Beschwerden sowie die Prophylaxe eines etwaigen Rezidivs effektiver als die konservative Therapie.

Abstract

Introduction

The correct therapeutic management of acute sigmoid diverticulitis (SD) is still controversially discussed. Essential to the success of therapy is primarily the long-term resolution of Patient symptoms after surgical or conservative therapy. The aim of this study was to compare the long-term outcome after conservative and surgical treatment of Patients with acute SD.

Patients and methods

Consecutive admissions of all Patients with acute SD were prospectively recruited from January 2005 to June 2008 with the exception of a free perforation. The following data were recorded: age, sex, first or recurrent episode of SD, computed tomography (CT) stage, white blood cell count, C-reactive protein, persistent symptoms and recurrence after conservative and surgical therapy. Furthermore, information on the rates of postoperative sexual and bladder dysfunction was collected. The long-term outcome was evaluated by a standardized questionnaire. In June 2008 all Patients were contacted using a standardized questionnaire.

Results

A total of 153 Patients were included in the study of whom 70 (45.8  %) presented with the first episode, 83 (54.2  %) had a prior history of SD and 40 Patients were treated conservatively whereas 113 Patients were surgically treated by sigmoid resection. Uncomplicated SD was seen in 16 Patients (conservative 4, surgical 12, p = 0.961), phlegmonous SD was seen in 88 cases (conservative 29, surgical 59, p = 0.026) and covered perforated SD in 49 cases (conservative 7, surgical 42, p = 0.022). The median follow-up was 32 months (range 12–52 months). At follow-up 25  % of conservative and 8.8  % of Patients treated surgically complained about persistent symptoms (p = 0.009). The following symptoms occurred (conservative vs. surgery): painful defecation (22.5  % versus 8.8  %, p = 0.024.), constipation (25  % versus 8.8  %, p = 0.009), abdominal cramp (22.5 % versus 4.4  %, p = 0.001) and painful flatulence (25  % versus 8.8  %, p = 0.009). Sexual or bladder dysfunction occurred postoperatively in 7  % and 9  %, respectively. Of the conservatively treated Patients 32.5  % had a recurrence of SD during follow-up compared to 3.5 % of surgically treated Patients (p < 0.001).

Conclusions

Surgical treatment of acute SD is more effective than conservative therapy for the prophylaxis of recurrent SD and avoidance of persistent symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1

Literatur

  1. Jun S, Stollmann N (2002) Epidemiology of diverticular disease. Best Pract Res Clin Gastroenterol 16:529–542

    Article  PubMed  Google Scholar 

  2. Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69

    PubMed  CAS  Google Scholar 

  3. Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217

    Article  PubMed  Google Scholar 

  4. Roberts P, Abel M, Rosen L et al (1995) Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum 38:125–132

    Article  PubMed  CAS  Google Scholar 

  5. Lee YS (1986) Diverticular disease of the large bowel in Singapore. An autopsy survey. Dis Colon Rectum 29:330–335

    Article  PubMed  CAS  Google Scholar 

  6. Antolovic D, Reissfelder C, Koch M et al (2009) Surgical treatment of sigmoid diverticulitis – analysis of predictive risk factors for postoperative infections, surgical complications, and mortality. Int J Colorectal Dis 24:577–584

    Article  PubMed  CAS  Google Scholar 

  7. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150

    PubMed  CAS  Google Scholar 

  8. Janes S, Meagher A, Frizelle FA (2005) Elective surgery after acute diverticulitis. Br J Surg 92:133–142

    Article  PubMed  CAS  Google Scholar 

  9. Rafferty J, Shellito P, Hyman NH, Buie WD (2006) Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 49:939–944

    Article  PubMed  Google Scholar 

  10. Chapman JRM, Dozois EJM, Wolff BGM et al (2006) Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann Surg 243:876–883

    Article  PubMed  Google Scholar 

  11. Holmer C, Lehmann KS, Engelmann S et al (2010) Microscopic findings in sigmoid diverticulitis – changes after conservative therapy. J Gastrointest Surg 14(5):812–817

    Article  PubMed  Google Scholar 

  12. Hansen O, Stock W (1999) Prophylaktische Operation bei der Divertikelkrankheit des Kolons – Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir Suppl II:1257

    Google Scholar 

  13. Rothenberger DA, Wiltz O (1993) Surgery for complicated diverticulitis. Surg Clin North Am 73:975–992

    PubMed  CAS  Google Scholar 

  14. Antolovic D, Reissfelder C, Koch M et al (2009) Surgical treatment of sigmoid diverticulitis – analysis of predictive risk factors for postoperative infections, surgical complications, and mortality. Int J Colorectal Dis 24:577–584

    Article  PubMed  CAS  Google Scholar 

  15. Al-Sahaf O, Al-Azawi D, Fauzi MZ et al (2008) Early discharge policy of Patients with acute colonic diverticulitis following initial CT scan. Int J Colorectal Dis 23:979–984

    Article  Google Scholar 

  16. Reissfelder C, Buhr HJ, Ritz JP (2006) Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis? Surg Endosc 20(7):1055–1059

    Article  PubMed  CAS  Google Scholar 

  17. Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME (2007) Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol 22(9):1360–1368

    Article  PubMed  Google Scholar 

  18. Greenberg AS, Gal R, Coben RM et al (2005) A retrospective analysis of medical or surgical therapy in young Patients with diverticulitis. Aliment Pharmacol Ther 21:1225–1229

    Article  PubMed  CAS  Google Scholar 

  19. Ritz JP, Lehmann KS, Frericks B et al (2011) Outcome of Patients with acute sigmoid diverticulitis – multivariate analysis of risk factors for free perforation. Surgery 149(5):606–613

    Article  PubMed  Google Scholar 

  20. Reissfelder C, Buhr HJ, Ritz JP (2006) What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection. Dis Colon Rectum 49:1842–1848

    Article  PubMed  Google Scholar 

  21. Ritz JP, Reissfelder C, Holmer C, Buhr HJ (2008) Results of sigma resection in acute complicated diverticulitis: method and time of surgical intervention. Chirurg 79(8):753–758

    Article  PubMed  Google Scholar 

  22. Ritz JP, Lehmann KS, Loddenkemper C et al (2010) Preoperative CT staging in sigmoid diverticulitis-does it correlate with intraoperative and histological findings? Langenbecks Arch Surg 395(8):1009–1015

    Article  PubMed  Google Scholar 

  23. Ritz JP, Lehmann KS, Stroux A et al (2011) Sigmoid diverticulitis in young Patients–a more aggressive disease than in older Patients? J Gastrointest Surg 15(4):667–674 (Epub 12 Feb 2011)

    Article  PubMed  Google Scholar 

  24. Moreaux J, Vons C (1990) Elective resection for diverticular disease of the sigmoid colon. Br J Surg 77:1036–1038

    Article  PubMed  CAS  Google Scholar 

  25. Breen RE, Corman ML, Robertson WG, Prager ED (1986) Are we really operating on diverticulitis? Dis Colon Rectum 29:174–176

    Article  PubMed  CAS  Google Scholar 

  26. Munson KD, Hensien MA, Jacob LN et al (1996) Diverticulitis: a comprehensive follow-up. Dis Colon Rectum 39:318–322

    Article  PubMed  CAS  Google Scholar 

  27. Thorn M, Graf W, Stefansson T, Pahlman L (2002) Clinical and functional results after elective colonic resection in 75 consecutive Patients with diverticular disease. Am J Surg 183:7–11

    Article  PubMed  Google Scholar 

  28. Simpson J, Neal KR, Scholefield JH, Spiller RC (2003) Patterns of pain in diverticular disease and the influence of acute diverticulitis. Eur J Gastroenterol Hepatol 15:1005–1010

    Article  PubMed  Google Scholar 

  29. Holmer C, Lehmann KS, Engelmann S et al (2011) Long-term outcome after conservative and surgical treatment of acute sigmoid diverticulitis. Langenbecks Arch Surg 396(6):825–832

    Article  PubMed  Google Scholar 

  30. Egger B, Peter MK, Candinas D (2008) Persistent symptoms after elective sigmoid resection for diverticulitis. Dis Colon Rectum 51(7):1044–1048

    Article  PubMed  Google Scholar 

  31. Müller MH, Glatzle J, Kasparek MS et al (2005) Long-term outcome of conservative treatment in Patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol 17(6):649–654

    Article  Google Scholar 

  32. Asoglu O, Matlim T, Karanlik H et al (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23(2):296–303

    Article  PubMed  Google Scholar 

  33. Jones OM, Stevenson AR, Stitz RW, Lumley JW (2009) Preservation of sexual and bladder function after laparoscopic rectal surgery. Colorectal Dis 11(5):489–495

    Article  PubMed  CAS  Google Scholar 

  34. Panjari M, Bell RJ, Burney S et al (2012) Sexual function, incontinence, and wellbeing in women after rectal cancer–a review of the evidence. J Sex Med 9(11):2749–2758

    Article  PubMed  Google Scholar 

  35. Gallina A, Briganti A, Suardi N et al (2010) Surgery and erectile dysfunction. Arch Esp Urol 63(8):640–648

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, Chirurgische Klinik I, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    J.-P. Ritz MD, J. Gröne MD, S. Engelmann MD, K.S. Lehmann, H.J. Buhr & C. Holmer MD

  2. Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Deutschland

    J.-P. Ritz MD

Authors
  1. J.-P. Ritz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Gröne MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Engelmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K.S. Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H.J. Buhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Holmer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Holmer MD .

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ritz, JP., Gröne, J., Engelmann, S. et al. Welchen Erfolg bringt die Sigmaresektion bei der akuten Sigmadivertikulitis tatsächlich?. Chirurg 84, 673–680 (2013). https://doi.org/10.1007/s00104-013-2485-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-013-2485-0

Schlüsselwörter

Keywords

Search

Navigation