Arshad M. Bachelani , Laura A. Holton , Youssef Soliman
{"title":"分流器脓肿非手术治疗的短期和长期疗效","authors":"Arshad M. Bachelani , Laura A. Holton , Youssef Soliman","doi":"10.1016/j.sipas.2023.100180","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Recommendations for surgery of diverticular abscesses continue to evolve. This study aimed to examine the short- and long-term results of nonoperative management of diverticular abscesses while analyzing granular data to assess for predictive factors for successful treatment.</p></div><div><h3>Materials and methods</h3><p>We analyzed patients admitted with diverticular abscesses at Penn Highlands Mon Valley Hospital from 2010 to 2020 who received initial planned nonoperative management. Short-term failure was defined as requiring surgery within 60 days of diagnosis, whereas long-term failure was defined as requiring surgery beyond 60 days. Successful treatment was defined as treatment that did not require surgery.</p></div><div><h3>Results</h3><p>In total, 857 patient charts were individually analyzed. Sixty-three patients met the inclusion criteria. The median follow-up period was 48 months. Nineteen (30.2%) patients experienced short-term failure of nonoperative management, whereas 6 (9.5%) patients experienced long-term failure. Surgery was successfully avoided in the remaining 41 (60.3%) patients. Abscess size was significantly associated with success rate (< 3 cm, 85.7%; 3–5 cm, 42.3%; > 5 cm, 33.3%; <em>p</em> = 0.001). When corrected for the abscess size, percutaneous drainage did not affect the requirement for eventual surgery.</p></div><div><h3>Conclusions</h3><p>Nonoperative management is a reasonable option for diverticular abscesses and is particularly successful in patients with abscesses < 3 cm in diameter. Although sometimes performed in conjunction with nonoperative management, percutaneous drainage does not decrease the requirement for eventual surgery. Elective surgery should be considered for patients with larger abscesses. Future prospective studies may further clarify the role of the nonoperative management of diverticular abscesses.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"13 ","pages":"Article 100180"},"PeriodicalIF":0.6000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Short- and long-term outcomes in the nonoperative treatment of diverticular abscesses\",\"authors\":\"Arshad M. Bachelani , Laura A. Holton , Youssef Soliman\",\"doi\":\"10.1016/j.sipas.2023.100180\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Recommendations for surgery of diverticular abscesses continue to evolve. This study aimed to examine the short- and long-term results of nonoperative management of diverticular abscesses while analyzing granular data to assess for predictive factors for successful treatment.</p></div><div><h3>Materials and methods</h3><p>We analyzed patients admitted with diverticular abscesses at Penn Highlands Mon Valley Hospital from 2010 to 2020 who received initial planned nonoperative management. Short-term failure was defined as requiring surgery within 60 days of diagnosis, whereas long-term failure was defined as requiring surgery beyond 60 days. Successful treatment was defined as treatment that did not require surgery.</p></div><div><h3>Results</h3><p>In total, 857 patient charts were individually analyzed. Sixty-three patients met the inclusion criteria. The median follow-up period was 48 months. Nineteen (30.2%) patients experienced short-term failure of nonoperative management, whereas 6 (9.5%) patients experienced long-term failure. Surgery was successfully avoided in the remaining 41 (60.3%) patients. Abscess size was significantly associated with success rate (< 3 cm, 85.7%; 3–5 cm, 42.3%; > 5 cm, 33.3%; <em>p</em> = 0.001). When corrected for the abscess size, percutaneous drainage did not affect the requirement for eventual surgery.</p></div><div><h3>Conclusions</h3><p>Nonoperative management is a reasonable option for diverticular abscesses and is particularly successful in patients with abscesses < 3 cm in diameter. Although sometimes performed in conjunction with nonoperative management, percutaneous drainage does not decrease the requirement for eventual surgery. Elective surgery should be considered for patients with larger abscesses. Future prospective studies may further clarify the role of the nonoperative management of diverticular abscesses.</p></div>\",\"PeriodicalId\":74890,\"journal\":{\"name\":\"Surgery in practice and science\",\"volume\":\"13 \",\"pages\":\"Article 100180\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgery in practice and science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666262023000268\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery in practice and science","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666262023000268","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
Short- and long-term outcomes in the nonoperative treatment of diverticular abscesses
Introduction
Recommendations for surgery of diverticular abscesses continue to evolve. This study aimed to examine the short- and long-term results of nonoperative management of diverticular abscesses while analyzing granular data to assess for predictive factors for successful treatment.
Materials and methods
We analyzed patients admitted with diverticular abscesses at Penn Highlands Mon Valley Hospital from 2010 to 2020 who received initial planned nonoperative management. Short-term failure was defined as requiring surgery within 60 days of diagnosis, whereas long-term failure was defined as requiring surgery beyond 60 days. Successful treatment was defined as treatment that did not require surgery.
Results
In total, 857 patient charts were individually analyzed. Sixty-three patients met the inclusion criteria. The median follow-up period was 48 months. Nineteen (30.2%) patients experienced short-term failure of nonoperative management, whereas 6 (9.5%) patients experienced long-term failure. Surgery was successfully avoided in the remaining 41 (60.3%) patients. Abscess size was significantly associated with success rate (< 3 cm, 85.7%; 3–5 cm, 42.3%; > 5 cm, 33.3%; p = 0.001). When corrected for the abscess size, percutaneous drainage did not affect the requirement for eventual surgery.
Conclusions
Nonoperative management is a reasonable option for diverticular abscesses and is particularly successful in patients with abscesses < 3 cm in diameter. Although sometimes performed in conjunction with nonoperative management, percutaneous drainage does not decrease the requirement for eventual surgery. Elective surgery should be considered for patients with larger abscesses. Future prospective studies may further clarify the role of the nonoperative management of diverticular abscesses.