Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.
Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Surg Endosc. 2020 May;34(5):2019-2027. doi: 10.1007/s00464-019-06981-x. Epub 2019 Jul 15.
Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD.
A single-center, prospective, non-randomized controlled study ran from 2009 to 2017. Patients with first episode of uncomplicated RCD were divided into two treatment arms, LD or NT with bowel rest and broad-spectrum antibiotics, based on their choice. The primary outcome was recurrent diverticulitis during follow-up. Secondary outcomes were treatment success and complications.
A total of 155 patients were enrolled, with 81 in the NT arm and 74 in the LD arm. Mean follow-up was 49 months. The treatment success rate for the NT arm was 90.1% and for the LD arm, 86.5% (P = 0.480). There was no significant difference in the complication rate between the LD arm, 12.2% and the NT arm, 8.6% (P = 0.472). LD was better than NT in preventing recurrent diverticulitis. Nine patients in the NT arm and none in the LD arm had recurrence (P = 0.003). The number needed to treat to prevent recurrence was nine.
Non-operative management with bowel rest and antibiotics for uncomplicated RCD is safe and effective. Alternatively, LD is also safe and effective, with the added benefit of preventing recurrences. While both treatments could be reasonably offered for uncomplicated RCD, LD is an appealing option when recurrence is a concern.
右半结肠憩室炎（RCD）是一种以亚洲为中心的疾病。急性单纯性 RCD 的最佳治疗方法仍然存在争议。本研究旨在比较腹腔镜憩室切除术（LD）与非手术治疗（NT）在单纯性 RCD 患者中的安全性和疗效。
这是一项于 2009 年至 2017 年进行的单中心前瞻性非随机对照研究。根据患者的选择，将首次发生单纯性 RCD 的患者分为 LD 或 NT 治疗组，即 LD 或 NT 加肠道休息和广谱抗生素治疗。主要结局是随访期间复发性憩室炎。次要结局是治疗成功率和并发症。
共纳入 155 例患者，其中 NT 组 81 例，LD 组 74 例。平均随访时间为 49 个月。NT 组的治疗成功率为 90.1%，LD 组为 86.5%（P=0.480）。LD 组和 NT 组的并发症发生率分别为 12.2%和 8.6%，差异无统计学意义（P=0.472）。LD 组在预防复发性憩室炎方面优于 NT 组。NT 组有 9 例患者复发，LD 组无患者复发（P=0.003）。预防复发的 NNT 为 9。
肠道休息和抗生素治疗单纯性 RCD 是安全有效的。LD 也是安全有效的，并且可以预防复发。虽然这两种治疗方法都可以合理地用于单纯性 RCD，但当复发是一个问题时，LD 是一个有吸引力的选择。
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