Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review.

IF 2.3 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2024-08-01 Epub Date: 2024-06-06 DOI:10.1002/wjs.12244

Andrea Morini, Maurizio Zizzo, David Tumiati, Federica Mereu, Diego Bernini, Massimiliano Fabozzi

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引用次数: 0

Abstract

Introduction: Colonic Diverticular Disease (CDD) is a multifactorial inflammatory disease. Acute diverticulitis (AD), with extraluminal free air (both pericolic and distant), represents about 15% of radiological scenarios and remains a therapeutic challenge for surgeons. Currently, the WSES guidelines suggest trying a conservative strategy both in the presence of pericolic and distant free extraluminal air, even if both have respectively weak recommendation based on low/very low-quality evidence.

Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Embase databases were used to identify articles of interest.

Results: A total of 2380 patients with AD and extraluminal free air (both pericolic and distant) who underwent nonoperative management (NOM) were analyzed. Of the 2380 patients, 2095(88%) were successfully treated with NOM, while 285 (12%) patients failed. A total of 1574 (93.1%) patients with pericolic extraluminal free air had a successful NOM with 6.9% (117) failure rates, while 135 (71.1%) patients with distant extraluminal free air had a successful NOM with 28.9% (55) failure rates. Regarding distant recurrence, we recorded a rate of 18.3% (261/1430), while a rate of 11.3% (167/1472) was recorded for patients undergoing elective surgery.

Conclusion: NOM for patients with AD and extraluminal free air (both pericolic and distant) seems to be feasible and safe despite a higher failure rate in the distant subgroup, which remains the most challenging clinical scenario to deal with through conservative treatment.

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急性复杂性憩室炎伴有包膜和/或远端腔外积气的非手术治疗：系统性综述。

简介结肠憩室疾病（CDD）是一种多因素炎症性疾病。急性憩室炎（AD）伴有腔外游离空气（包括结肠周围和远处），约占放射学病例的 15%，仍是外科医生面临的治疗难题。目前，WSES 指南建议在出现结肠周围和远处游离腔外空气时均应尝试保守治疗，尽管这两种治疗方法都是基于低/极低质量的证据提出的微弱建议：我们按照《系统综述和元分析首选报告项目》指南进行了系统综述。我们使用 PubMed/MEDLINE、Scopus、Web of Science 和 Embase 数据库来确定感兴趣的文章：结果：共分析了2380例接受非手术治疗（NOM）的AD和腔外游离气体（包括包膜和远处游离气体）患者。在 2380 例患者中，2095 例（88%）成功接受了非手术治疗，285 例（12%）治疗失败。共有 1574 名（93.1%）患有结肠周围腔外游离气体的患者成功接受了非手术治疗，失败率为 6.9%（117 例）；135 名（71.1%）患有远处腔外游离气体的患者成功接受了非手术治疗，失败率为 28.9%（55 例）。关于远处复发，我们记录的复发率为 18.3%（261/1430），而接受择期手术的患者的复发率为 11.3%（167/1472）：结论：对患有 AD 和腔外游离气体（包括结肠周围和远处）的患者进行 NOM 似乎是可行和安全的，尽管远处亚组的失败率较高，但这仍然是通过保守治疗应对的最具挑战性的临床情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.