Strategy of stage treatment for patients with perforated diverticulitis: first experience

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BACKGROUND: The results of surgical treatment of patients with perforative diverticulitis of the colon are still unsatisfactory today. Since the majority of patients undergo Hartmann surgery, the main problem is a large number of stoma patients. Three quarters of them live with a stoma for a long time, which negatively affects their quality of life and increases the cost of treatment.

AIM: The purpose of this research work is to improve the immediate results of treating patients with perforative diverticulitis and peritonitis by using staged surgical tactics.

MATERIALS AND METHODS: The reaserach included 14 patients with perforative diverticulitis Hinchey grade II-III. The average value of the Mannheim peritoneal index is 18.9 ± 6.3 points. At the first stage of surgical treatment, all the patients underwent colon resection with a zone of perforation of the diverticulum and leaving its muffled ends in the abdominal cavity. After lavage and drainage, temporary closure of the anterior abdominal wall was performed. After 24–48 hours, all the patients underwent colon reconstraction.

RESULTS: The average age of the patients was 52.3 ± 12.4 years with 4 women (28.6%) and 10 men (71.4%). The average duration of the first stage was 105.7 ± 27.2 minutes, the second one — 113.2 ± 40.5 minutes. The average hospital-stays were 16.4 ± 7.2 days. There were no anastomosis failures and no lethal outcomes. Complications were noted in 9 patients (64.3%), grade I according to Clavien – Dindo — 83.4%.

CONCLUSIONS: The tactics of early surgical treatment is a promising concept for patients with perforative diverticulitis. It provides rapid elimination of the septic focus during the first surgical operation, assumes early reconstruction of the intestine without increasing the number of complications and mortality, and can be used in patients with peritonitis.

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作者简介

Boris Bezmozgin

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

编辑信件的主要联系方式.
Email: bezkard@mail.ru

MD

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242

Evita Poryvaeva

North-Western State Medical University named after I.I. Mechnikov

Email: eeporyvaeva@gmail.com

MD

俄罗斯联邦, Saint Petersburg

Ekaterina Pirozhkova

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

Email: ekaterina.pirozhkova93@mail.ru

MD

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242

Oleg Babkov

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

Email: oleg.babckov@yandex.ru
SPIN 代码: 3214-7704

MD, Cand. Sci. (Med.)

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242

Ivan Yastrebov

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

Email: ipyastreb@gmail.com

MD

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242

Ildar Batyrshin

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

Email: onrush@mail.ru
ORCID iD: 0000-0003-0241-7902
SPIN 代码: 5287-7599

MD, Dr. Sci. (Med.)

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242

Dmitry Surov

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze; Kirov Military Medical Academy

Email: sda120675@mail.ru
SPIN 代码: 5346-1613
Scopus 作者 ID: 445844

MD, Dr. Sci. (Med.), Assistant Professor

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242; Saint Petersburg

Andrey Demko

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze; Kirov Military Medical Academy

Email: demko@emergency.spb.ru
ORCID iD: 0000-0002-5606-288X
SPIN 代码: 3399-8762

MD, Dr. Sci. (Med.), Professor, Honored Doctor of the Russian Federation

俄罗斯联邦, 3A Budapeshtskaya St., Saint Petersburg, 192242; Saint Petersburg

参考

  1. Bolikhov KV. Ostrye vospalitel’nye oslozhneniya divertikulyarnoi bolezni obodochnoi kishki. Klinika, diagnostika, lechenie: dissertation. Moscow; 2006. 238 p. (In Russ.)
  2. Belov DM, Zarodnyuk IV, Mikhalchenko VA. Computed tomography diagnostics of inflammatory complications of colon diverticulitis (review). Koloproktologia. 2016;(4(58)):60–68. (In Russ.)
  3. Timerbulatov VM, Timerbulatov MV, Mekhdiev DI, et al. Modern issues of treatment complicated diverticular colon disease. Clinical and Experimental Surgery. Petrovsky journal. 2013;(3):6–11. (In Russ.)
  4. Timerbulatov VM. Divertikulyarnaya bolezn’ tolstoi kishki. Moscow: Dzhangar; 2016. 190 p. (In Russ.)
  5. Cirocchi R, Grassi V, Cavaliere D, et al. New trends in acute management of colonic diverticular bleeding: a systematic review. Medicine (Baltimore). 2015;94(44): e1710. doi: 10.1097/MD.0000000000001710
  6. Novik AA, Ionova TI. Rukovodstvo po issledovaniyu kachestva zhizni v meditsine. Ed. by Yu.L. Shevchenko. 2nd ed. Moscow: OLMA Media Grupp; 2007. 320 p. (In Russ.)
  7. Klinicheskie rekomendatsii po diagnostike i lecheniyu vzroslykh patsientov divertikulyarnoi bolezn’yu obodochnoi kishki / Ekspertnaya komissiya Obshcherossiiskoi obshchestvennoi organizatsii “Assotsiatsiya koloproktologov RossiI. Ed. by Yu.A. Shelygin, S.I. Achkasov, L.A. Blagodarnyi. Moscow; 2013. 22 p. (In Russ.)
  8. Binda GA, Prandi M. Storia naturale della diverticolite del colon. UCP News. 1999;3(S1):14–16. doi: 10.5962/bhl.title.61536
  9. Dmitriev OV, Sinenchenko GI, Vashetko RV, et al. Oslozhnennye formy divertikulyarnoi bolezni tolstoi kishki v praktike khirurga otdeleniya ehkstrennoi meditsinskoi pomoshchi. Skoraya meditsinskaya pomoshch’. 2013;14(4):071–075. (In Russ.)
  10. Komarova LA, Zhukov BA, Isaev VR, Chernov AA. Operativnoe lechenie patsientov s divertikulyarnoi bolezn’yu tolstoi kishki v stadii ostrykh i khronicheskikh oslozhnenii. Vrach-aspirant. 2013;61(6(2)):342–348. (In Russ.)
  11. Jafferji MS, Hyman N. Surgeon, not disease severity, often determines the operation for acute complicated diverticulitis. J Am Coll Surg. 2014;218:1156–1161. doi: 10.1016/j.jamcollsurg.2013.12.06
  12. Gaponov IV, Kudryavtseva VE. Dinamika izmenenii fekal’nogo kal’protektina u bol’nykh s oslozhneniyami divertikulyarnoi bolezni obodochnoi kishki. Meditsina transporta Ukrainy. 2014;(2(50)):47–52. (In Russ.)
  13. Dalimaeva DA. Surgical treatment of perforation of a colonic diverticulum. Proceedings of the “Studenty i molodye uchenye Belorusskogo gosudarstvennogo meditsinskogo universiteta — meditsinskoi nauke i zdravookhraneniyu Respubliki Belarus’”. Ed. by A.V. Sikorskiy, O.K. Doronina. Minsk; 2016. P. 99–102. (In Russ.)
  14. Timerbulatov MV, Kulyapin AV, Lopatin DV, Aitova LR. Diagnostic tactics in the management of patients with diverticular disease complicated by a perforated diverticulitis in 15 years. Koloproktologia. 2018;(2(64)):85–88. (In Russ.) doi: 10.33878/2073-7556-2018-0-2-85-88
  15. Shelygin YuA, Blagodarnyi LA. Spravochnik po koloproktologii. Moscow: Litterra; 2012. 608 p. (In Russ.)
  16. Timerbulatov MV, Ibatullin AA, Gainutdinov FM, et al. Khirurgiya divertikulyarnoi bolezni tolstoi kishki. Koloproktologiya. 2014;(S3):108–108a. (In Russ.)
  17. Roque-Castellano C, Marchena-Gomez J, Hemmersbach-Miller M, et al. Analysis of the factors related to the decision of restoring intestinal continuity after Hartmann’s procedure. Int J Colorectal Dis. 2007;22(9):1091–1096. doi: 10.1007/s00384-007-0272-4
  18. Keck JO, Collopy BT, Ryan PJ, et al. Reversal of Hartmann’s procedure: effect of timingand technique on ease and safety. Dis Colon Rectum. 1994;37(3):243–248. doi: 10.1007/BF02048162
  19. Penna M, Markar SR. Mackenzie H. et al. Laparoscopic lavage versus primary resection for acute perforated diverticulitis: review and meta-analysis. Ann Surg. 2018;267(2):252–258. doi: 10.1097/SLA.0000000000002236
  20. Lambrichts DPV, Vennix S, Musters GD, et al. Hartmann’s procedure versus sigmoidectomy with primaryanastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superioritytrial. Lancet Gastroenterol Hepatol. 2019;4:599–610. doi: 10.1016/j.ijsu.2021.106221
  21. Kafka-Ritsch R, Zitt M, Perathoner A, et al. prospectively randomized controlled trial on damage control surgery for perforated diverticulitis with generalized peritonitis. World J Surg. 2020;44:4098–4105. doi: 10.1007/s00268-020-05762-1
  22. Antolovic D, Reissfelder C, Özkan T, et al. Restoration of intestinal continuity after Hartmann’s procedure — not a benign operation. Are there predictors for morbidity? Langenbecks Arch Surg. 2011;396(7):989–996. doi: 10.1007/s00423-011-0763-1
  23. Skvortsova TE, Mamedli SAK, Mikolaichuk VA, et al. Divertikulyarnaya bolezn’ tolstoi kishki: faktory riska, vozrastnaya struktura, lokalizatsiya porazhenii, chastota i struktura oslozhnenii v raznorodnykh gruppakh patsientov. Gastroehnterologiya Sankt-Peterburga. 2018;(2):119–120. (In Russ.)
  24. Torba AV, Borota AV, Khodyrev VN, Startseva LN. Lechenie ostrogo divertikulita: ot Lokkhart-Mammeri do ehry dokazatel’noi meditsiny. Ukraїns’kii morfologіchnii al’manakh. 2015;13(3-4):101–115. (In Russ.)
  25. Etzioni DA, Mack TM, Beart RW, Kaiser AM. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg. 2009;249(2):210–217. doi: 10.1097/SLA.0b013e3181952888

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2. Fig. 1. Perforated diverticulitis of the sigmoid colon Hinchey type II (a). Pelvic abscess. View after the removal of the autopsied specimen (b)

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3. Fig. 2. The second phase. Regression of the inflammatory process in the abdominal cavity (a). Colon before an anastomosis is formed (b)

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4. Fig. 3. Results of microbiological studies at the first (a) and second (b) stages of surgical treatment. LIF, left iliac fossa; RIF, right iliac fossa

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5. Fig. 4. Quality of life of the patients at the time of discharge (a) and one month after discharge (b). МН, mental health; RE, role-emotional; SF, social functioning; VT, vitality; GH, general health; BP, bodily pain; RP, role-physical functioning; PF, physical functioning

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