Department of Digestive, Oncological, Endocrine, Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Colorectal Surgery Unit, Trousseau Hospital, University Hospital of Tours, Avenue de la République, 37044, Tours, France.
Department of Surgery Department, Amiens University Hospital, Amiens, France.
Tech Coloproctol. 2024 Nov 7;28(1):149. doi: 10.1007/s10151-024-03024-z.
Acute right colic diverticulitis (ARD) is less frequent in Western countries than acute sigmoid diverticulitis (ASD). We aimed to compare the management of ARD and ASD operated on in emergency.
All consecutive patients who had emergency surgery for ASD and ARD (2010-2021) were included in a retrospective, multicenter, cohort study. Patients were identified from databases in French centers that were members of the French Surgical Association. Emergency surgery was performed during the same hospitalization for peritonitis or after failure of conservative treatment. Early and late postoperative outcomes were studied.
A total of 2297 patients were included with 2256 (98.2%) ASD and 41 (1.8%) ARD patients. Baseline characteristics were similar. Overall, patients were rated Hinchey 3-4 (63.9%, n = 1468, p = 0.287). ARD was more often treated with resection and anastomosis, protected or not (53.7%, n = 22), whereas ASD was mainly treated with resection and terminal ostomy (62.5% (n = 1409), p < 0.001). Median operative time was shorter for ARD (120 vs 146 min, p = 0.04). The group of ARD patients showed a higher prevalence of Clavien III/IV complications compared to the group of ASD patients, although no statistically significant difference was observed (41.5%, n = 17 vs. 27.6%, n = 620, p = 0.054). However 90-day mortality only happened in ASD patients (9.8%, n = 223 vs 0, p = 0.03). ARD patients had more diverticulitis recurrence (46.3%, n = 19 vs 13.4%, n = 303, p < 0.001). Multivariate analysis identified female sex as a protective factor for recurrence [odds ratio (OR) 0.55, p < 0.001] and ARD as a risk factor (OR 8.85, p < 0.001).
Operated on in emergency, ARDs have more resection anastomosis, with a similar rate of complications, less mortality, and more recurrence of diverticulitis than ASD.
急性右结肠憩室炎（ARD）在西方国家比急性乙状结肠憩室炎（ASD）少见。我们旨在比较急诊手术治疗 ARD 和 ASD 的效果。
所有因 ASD 和 ARD 接受急诊手术的连续患者（2010-2021 年）均纳入一项回顾性、多中心队列研究。患者从法国外科协会成员的法国中心数据库中确定。急诊手术是在腹膜炎或保守治疗失败时进行的。研究了早期和晚期术后结果。
共纳入 2297 例患者，其中 2256 例（98.2%）为 ASD 患者，41 例（1.8%）为 ARD 患者。基线特征相似。总体而言，患者的 Hinchey 分级为 3-4 级（63.9%，n=1468，p=0.287）。ARD 更常采用保护或不保护的切除吻合术（53.7%，n=22）治疗，而 ASD 主要采用切除和末端造口术（62.5%（n=1409），p<0.001）治疗。ARD 的手术时间中位数较短（120 分钟与 146 分钟，p=0.04）。与 ASD 患者相比，ARD 患者的 Clavien III/IV 并发症发生率更高，但差异无统计学意义（41.5%，n=17 与 27.6%，n=620，p=0.054）。然而，只有 ASD 患者在 90 天内死亡（9.8%，n=223 与 0，p=0.03）。ARD 患者的憩室炎复发率更高（46.3%，n=19 与 13.4%，n=303，p<0.001）。多变量分析确定女性为复发的保护因素[比值比（OR）0.55，p<0.001]，ARD 为危险因素（OR 8.85，p<0.001）。
在急诊手术中，ARD 行更多的切除吻合术，并发症发生率相似，死亡率较低，憩室炎复发率高于 ASD。
