Luu H Le, MD1, Vuong L Nguyen1, Yen H Vo2, Phuong T Do2, Vu K Bui2, Thanh V Nguyen1, Hai V Nguyen1. 1University of Medicine and Pharmacy at Ho Chi Minh city, Vietnam, 2People of Gia Dinh Hospital, Ho Chi Minh City, Vietnam
Purpose: Right-sided diverticulitis is a rare clinical entity in Western countries but is more common in some Asian countries. At present, there are only guidelines for patients with acute left-sided diverticulitis. Controversies abound as regards the optimal treatment for those with acute right colonic diverticulitis, ranging from conservative therapy, diverticulectomy to right hemicolectomy. This study aims to establish guidelines for patients with right colon diverticulitis (RCD).
Methods: This prospective non-randomized controlled study ran from December 2009 to May 2014. Patients were enrolled if diagnosed with first attack of uncomplicated RCD by typically clinical symptoms and computerized tomography scan images or diagnosis during surgery. Included patients were divided into two treatment arms, conservative treatment or laparoscopic diverticulectomy, depending on their choice. The outcomes were treatment success, complications and recurrent diverticulitis during follow-up.
Results: 158 patients (male:female ratio: 2:1, median age 35.6 years) were included (81 conservative arm and 74 surgical arm). Median follow-up was 44 months. There were no statistically significant differences found in clinical features and laboratory findings between the two groups. No statistically significant difference was found regarding the overall success rates and the complication rates between the conservative and the surgical arms (success rates: 90.1% and 86.5% (p=0.48) and complication rates: 8.6% and 12.2% (p=0.472), respectively). However, surgical treatment was better than conservative treatment in preventing recurrent diverticulitis (recurrence rates: 0% and 5.4% (p=0.031), respectively).
Conclusion: Conservative management with bowel rest and antibiotics is a safe and effective treatment for right-sided colonic uncomplicated diverticulitis and may be considered as the initial option. On the other hand, laparoscopic diverticulectomy is also safe, effective and adequate. Surgery is advocated to decrease the recurrence rate.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85210
Program Number: P205
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster