The role of elective surgery following acute colonic diverticulitis
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://revista.spcir.com/index.php/spcir/article/view/347 |
Resumo: | The surgical treatment following acute diverticulitis (DV) has been an ongoing subject of debate. During the first half of the 20th century, only complicated cases of acute DV were surgically treated. During the second half, some studies suggested that patients with recurrent episodes of uncomplicated DV had an increased risk of complicated disease, morbidity, and mortality, and, for that reason, surgery was indicated also for these patients. In 1995, the ASCRS recommended elective bowel resection after two episodes of uncomplicated acute DV (or one episode for patients younger than 50), or after one episode of complicated DV. Recent studies have questioned these three recommendations. First, although acute DV is particularly aggressive during its first episode, subsequent episodes tend to be significantly more benign and successfully manageable with non-operative treatment. Elective surgery decreases neither the likelihood of emergency surgery nor the overall mortality due to DV complications. Moreover, elective surgery is not risk free, and some patients still experience acute DV episodes post-operatively. Second, in patients under 50, the disease does not seem to be as aggressive as previously implied. The response to medical treatment and post-operative morbidity and mortality remain similar to older patients. Third, regarding episodes of complicated DV, whether surgery is always necessary after successful percutaneous abscess drainage has also been a matter of debate. International guidelines are consensual when indicating precocious surgical resection for patients chronically immunosuppressed, who have collagen-vascular disease, or chronic renal disease. While waiting for the results of the first randomised clinical trials comparing different treatment strategies for acute DV, the present paper reviews the debate regarding the indications for elective surgery. |
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The role of elective surgery following acute colonic diverticulitisO papel da cirurgia electiva na diverticulite aguda do cólonDiverticulitisElective Surgical ProcedureGuidelinesDiverticuliteCirurgia ElectivaGuidelinesThe surgical treatment following acute diverticulitis (DV) has been an ongoing subject of debate. During the first half of the 20th century, only complicated cases of acute DV were surgically treated. During the second half, some studies suggested that patients with recurrent episodes of uncomplicated DV had an increased risk of complicated disease, morbidity, and mortality, and, for that reason, surgery was indicated also for these patients. In 1995, the ASCRS recommended elective bowel resection after two episodes of uncomplicated acute DV (or one episode for patients younger than 50), or after one episode of complicated DV. Recent studies have questioned these three recommendations. First, although acute DV is particularly aggressive during its first episode, subsequent episodes tend to be significantly more benign and successfully manageable with non-operative treatment. Elective surgery decreases neither the likelihood of emergency surgery nor the overall mortality due to DV complications. Moreover, elective surgery is not risk free, and some patients still experience acute DV episodes post-operatively. Second, in patients under 50, the disease does not seem to be as aggressive as previously implied. The response to medical treatment and post-operative morbidity and mortality remain similar to older patients. Third, regarding episodes of complicated DV, whether surgery is always necessary after successful percutaneous abscess drainage has also been a matter of debate. International guidelines are consensual when indicating precocious surgical resection for patients chronically immunosuppressed, who have collagen-vascular disease, or chronic renal disease. While waiting for the results of the first randomised clinical trials comparing different treatment strategies for acute DV, the present paper reviews the debate regarding the indications for elective surgery.O tratamento cirúrgico de doentes com antecedentes de diverticulite (DV) aguda tem sido alvo de debate ao longo dos últimos anos. Na primeira metade do século XX, apenas os casos de DV aguda complicada eram submetidos a intervenção cirúrgica. Na segunda metade, alguns estudos sugeriram que doentes com episódios de DV aguda não complicada teriam um risco acrescido de desenvolver doença complicada, com morbilidade e mortalidade significativas, estando assim o tratamento cirúrgico indicado. Em 1995 a ASCRS recomendou a sigmoidectomia eletiva após dois episódios de DV não complicada (ou um episódio se o doente tivesse menos de 50 anos) ou após um episódio de DV complicada. Estudos recentes colocaram em causa estas recomendações. Em primeiro lugar, apesar de a DV aguda ser uma doença particularmente agressiva aquando do primeiro episódio, os episódios subsequentes tendem a ser significativamente mais benignos e passíveis de tratamento conservador eficaz. Nestes casos, a cirurgia eletiva não reduz o risco de cirurgia urgente nem a mortalidade global devido a complicações da DV. Aliás, a cirurgia eletiva não é desprovida de riscos e alguns doentes poderão ainda desenvolver episódios de DV aguda após a intervenção. Em segundo lugar, nos doentes com menos de 50 anos, a doença não aparenta ser tão agressiva como previamente sugerido. Por último, relativamente aos episódios de DV complicada, é questionável se a sigmoidectomia eletiva será sempre necessária após uma drenagem percutânea eficaz de um abcesso. As guidelines internacionais são no entanto consensuais ao recomendarem a cirurgia eletiva precoce em doentes cronicamente imunodeprimidos, com doença do colagénio ou doença renal crónica. Enquanto aguardamos pelos resultados dos primeiros ensaios clínicos randomizados que comparam abordagens de tratamento distintas em doentes com episódios de DV aguda, o presente artigo visa resumir o debate relativo às indicações para realizar cirurgia eletiva.Sociedade Portuguesa de Cirurgia2017-03-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spcir.com/index.php/spcir/article/view/347Revista Portuguesa de Cirurgia; No. 40 (2017): Number 40 - March 2017; 21-34Revista Portuguesa de Cirurgia; N.º 40 (2017): Número 40 - Março 2017; 21-342183-11651646-6918reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://revista.spcir.com/index.php/spcir/article/view/347https://revista.spcir.com/index.php/spcir/article/view/347/459Copyright (c) 2017 Revista Portuguesa de Cirurgiainfo:eu-repo/semantics/openAccessMachado, Catarina TavaresMalheiro, Luís Sá2024-10-24T16:52:18Zoai:revista.spcir.com:article/347Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-10-24T16:52:18Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
The role of elective surgery following acute colonic diverticulitis O papel da cirurgia electiva na diverticulite aguda do cólon |
title |
The role of elective surgery following acute colonic diverticulitis |
spellingShingle |
The role of elective surgery following acute colonic diverticulitis Machado, Catarina Tavares Diverticulitis Elective Surgical Procedure Guidelines Diverticulite Cirurgia Electiva Guidelines |
title_short |
The role of elective surgery following acute colonic diverticulitis |
title_full |
The role of elective surgery following acute colonic diverticulitis |
title_fullStr |
The role of elective surgery following acute colonic diverticulitis |
title_full_unstemmed |
The role of elective surgery following acute colonic diverticulitis |
title_sort |
The role of elective surgery following acute colonic diverticulitis |
author |
Machado, Catarina Tavares |
author_facet |
Machado, Catarina Tavares Malheiro, Luís Sá |
author_role |
author |
author2 |
Malheiro, Luís Sá |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Machado, Catarina Tavares Malheiro, Luís Sá |
dc.subject.por.fl_str_mv |
Diverticulitis Elective Surgical Procedure Guidelines Diverticulite Cirurgia Electiva Guidelines |
topic |
Diverticulitis Elective Surgical Procedure Guidelines Diverticulite Cirurgia Electiva Guidelines |
description |
The surgical treatment following acute diverticulitis (DV) has been an ongoing subject of debate. During the first half of the 20th century, only complicated cases of acute DV were surgically treated. During the second half, some studies suggested that patients with recurrent episodes of uncomplicated DV had an increased risk of complicated disease, morbidity, and mortality, and, for that reason, surgery was indicated also for these patients. In 1995, the ASCRS recommended elective bowel resection after two episodes of uncomplicated acute DV (or one episode for patients younger than 50), or after one episode of complicated DV. Recent studies have questioned these three recommendations. First, although acute DV is particularly aggressive during its first episode, subsequent episodes tend to be significantly more benign and successfully manageable with non-operative treatment. Elective surgery decreases neither the likelihood of emergency surgery nor the overall mortality due to DV complications. Moreover, elective surgery is not risk free, and some patients still experience acute DV episodes post-operatively. Second, in patients under 50, the disease does not seem to be as aggressive as previously implied. The response to medical treatment and post-operative morbidity and mortality remain similar to older patients. Third, regarding episodes of complicated DV, whether surgery is always necessary after successful percutaneous abscess drainage has also been a matter of debate. International guidelines are consensual when indicating precocious surgical resection for patients chronically immunosuppressed, who have collagen-vascular disease, or chronic renal disease. While waiting for the results of the first randomised clinical trials comparing different treatment strategies for acute DV, the present paper reviews the debate regarding the indications for elective surgery. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-03-30 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/347 |
url |
https://revista.spcir.com/index.php/spcir/article/view/347 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/347 https://revista.spcir.com/index.php/spcir/article/view/347/459 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Revista Portuguesa de Cirurgia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Revista Portuguesa de Cirurgia |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
dc.source.none.fl_str_mv |
Revista Portuguesa de Cirurgia; No. 40 (2017): Number 40 - March 2017; 21-34 Revista Portuguesa de Cirurgia; N.º 40 (2017): Número 40 - Março 2017; 21-34 2183-1165 1646-6918 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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mluisa.alvim@gmail.com |
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