Our Summary

This research paper discusses a clinical trial that aimed to compare the outcomes of two different surgical procedures for patients suffering from diverticular peritonitis, a severe condition involving inflammation of the bowel.

The two surgical procedures assessed were the Hartmann’s procedure (HP), which is the current standard treatment, and primary anastomosis (PA) with a diverting stoma. The study’s main measure of success was the overall mortality rate at 18 months post-surgery.

The trial involved 102 patients and found that there was no significant difference in the mortality rate between the two surgical groups. However, the study did find that significantly more patients who underwent the PA procedure had their stoma reversed (meaning they no longer needed a bag to collect waste from their body) compared to those who underwent the HP procedure.

In simple terms, while both surgeries had similar survival rates, patients who had the PA procedure were more likely to have a better quality of life post-surgery, as they were less likely to need a permanent stoma. This suggests that the PA procedure might be a better option for treating diverticular peritonitis.

FAQs

  1. What were the two surgical procedures compared in the study for treating diverticular peritonitis?
  2. Was there a difference in the mortality rate between the Hartmann’s procedure and primary anastomosis procedure?
  3. How did the primary anastomosis procedure potentially improve the quality of life for patients compared to the Hartmann’s procedure?

Doctor’s Tip

One helpful tip a doctor might tell a patient about diverticulitis surgery is to discuss the possibility of undergoing a primary anastomosis with a diverting stoma procedure, as it may lead to a better quality of life post-surgery compared to the traditional Hartmann’s procedure. Patients should have a thorough discussion with their healthcare provider about the risks and benefits of each surgical option to make an informed decision about their treatment plan.

Suitable For

Overall, patients who are recommended diverticulitis surgery typically have severe symptoms that do not respond to conservative treatments such as antibiotics and dietary changes. They may have complications such as abscesses, perforation, or fistulas, or they may have recurrent episodes of diverticulitis that significantly impact their quality of life.

Patients who are considered for surgery may also have risk factors that make them more likely to develop complications from diverticulitis, such as older age, immunocompromised status, or underlying medical conditions like diabetes or chronic kidney disease.

In general, surgery for diverticulitis is recommended for patients who have:

  1. Severe or recurrent episodes of diverticulitis
  2. Complications such as abscesses, perforation, or fistulas
  3. Ineffective response to conservative treatments
  4. Risk factors that increase the likelihood of complications
  5. Impaired quality of life due to the condition

Ultimately, the decision to undergo surgery for diverticulitis is made on a case-by-case basis, taking into account the patient’s overall health, the severity of their symptoms, and the potential risks and benefits of surgery. It is important for patients to discuss their options with their healthcare provider to determine the best course of treatment for their individual situation.

Timeline

Before surgery, a patient will typically experience symptoms of diverticulitis such as abdominal pain, bloating, fever, and changes in bowel habits. They may undergo diagnostic tests such as a CT scan or colonoscopy to confirm the diagnosis and determine the severity of the condition.

After surgery, the patient will go through a recovery period in the hospital, which can last anywhere from a few days to a few weeks depending on the type of surgery and the patient’s overall health. During this time, the patient will be closely monitored for any signs of complications such as infection or bowel leakage.

Once discharged from the hospital, the patient will need to follow a strict diet and take medications to help with healing and prevent infection. They will also need to gradually increase their activity level and may need physical therapy to regain strength and mobility.

Over time, the patient will gradually resume normal activities and will have follow-up appointments with their healthcare provider to monitor their progress and address any concerns. With proper care and adherence to medical advice, most patients will recover fully from diverticulitis surgery and be able to resume their normal daily activities.

What to Ask Your Doctor

Some questions a patient should ask their doctor about diverticulitis surgery include:

  1. What are the risks and benefits of each type of surgery (Hartmann’s procedure vs. primary anastomosis with a diverting stoma)?
  2. What is the expected recovery time for each type of surgery?
  3. Will I need a permanent stoma after surgery, and if so, for how long?
  4. What are the potential long-term complications or side effects of each type of surgery?
  5. How will the surgery affect my quality of life and daily activities?
  6. Are there any alternative treatments or less invasive procedures available for diverticulitis?
  7. How many times have you performed each type of surgery, and what is your success rate?
  8. What is the expected outcome in terms of symptom relief and recurrence of diverticulitis after surgery?
  9. Will I need to make any lifestyle changes or follow a specific diet after surgery?
  10. What is the follow-up care plan after surgery, including any necessary tests or appointments?

Reference

Authors: Bridoux V, Regimbeau JM, Ouaissi M, Mathonnet M, Mauvais F, Houivet E, Schwarz L, Mege D, Sielezneff I, Sabbagh C, Tuech JJ. Journal: J Am Coll Surg. 2017 Dec;225(6):798-805. doi: 10.1016/j.jamcollsurg.2017.09.004. Epub 2017 Sep 22. PMID: 28943323