Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
Int J Colorectal Dis. 2023 Jul 15;38(1):195. doi: 10.1007/s00384-023-04479-6.
Previously considered a disease of old age, diverticular disease is increasingly prevalent in younger populations. Guidelines on surgical resection have shifted from recommending resection for all young onset patients to an individualized approach. Therefore, we aim to determine demographics and outcomes including radiographic and surgical recurrence rates in patients < 40 years old undergoing resection for diverticular disease.
A retrospective, single center study was performed. All patients ≤ 39 years undergoing operative intervention for left-sided diverticular disease between Jan 2010 and July 2017 were included. Recurrence was determined by individual review of imaging and operative reports.
Overall, 147 (n = 107/72.8% male, mean age = 34.93 ± 4.12 years) patients were included. The majority were ASA 1 or 2 (n = 41/27.9% and n = 82/55.8%). The most common surgical indication was uncomplicated diverticulitis (n = 77, 52.4%) followed by perforation (n = 26/17.7%). The majority (n = 108/73.5%) of cases were elective. Seventy-nine (57.3%) of all cases were performed laparoscopically. Primary anastomosis without diversion was the most common surgical outcome (n = 108/73.5%). Median length of stay was 5 (4, 7) days. There was no mortality. There were three (2.0%) intraoperative and 38 (25.9%) postoperative complications. The most common complication was anastomotic leak (n = 6/4.1%). The majority (n = 5) of leaks occurred after elective surgery. Two neoplastic lesions (1.3% of cohort) were found (1 adenoma with low-grade dysplasia/1 polyp cancer). Over a mean follow-up of 96 (74, 123) months, only 2 (1.3%) patients experienced a surgical or radiological recurrence.
Both neoplasia and recurrence after resection for diverticular disease in young onset patients are rare. Leaks after primary anastomosis even in the elective setting warrant careful consideration of a defunctioning ileostomy.
憩室疾病曾被认为是老年病，但现在在年轻人群中越来越普遍。关于手术切除的指南已经从建议所有年轻发病患者切除转变为个体化治疗。因此，我们旨在确定在接受憩室疾病切除术的<40 岁患者中，人口统计学和结果（包括放射学和手术复发率）。
进行了一项回顾性单中心研究。纳入 2010 年 1 月至 2017 年 7 月期间因左侧憩室疾病接受手术干预的所有≤39 岁患者。通过对影像学和手术报告的单独回顾来确定复发情况。
总体而言，共有 147 例患者（107/72.8%男性，平均年龄 34.93±4.12 岁）被纳入研究。大多数患者为 ASA 1 或 2 级（n=41/27.9%和 n=82/55.8%）。最常见的手术指征是单纯性憩室炎（n=77，52.4%），其次是穿孔（n=26/17.7%）。大多数（n=108/73.5%）病例为择期手术。79 例（57.3%）全部为腹腔镜手术。最常见的手术结果是无转流的一期吻合（n=108/73.5%）。中位住院时间为 5（4，7）天。无死亡病例。有 3 例（2.0%）术中并发症和 38 例（25.9%）术后并发症。最常见的并发症是吻合口漏（n=6/4.1%）。大多数（n=5）漏发生在择期手术后。发现 2 例肿瘤病变（队列的 1.3%）（1 例低级别异型增生腺瘤/1 例息肉癌）。在平均 96（74，123）个月的随访中，只有 2 例（1.3%）患者经历了手术或放射学复发。
年轻发病患者的憩室疾病切除术后的肿瘤和复发都很少见。即使在择期手术中，一期吻合后的吻合口漏也需要仔细考虑行预防性回肠造口术。
