[Indications for surgical treatment of diverticular disease].
Indikationsstellung zur chirurgischen Therapie der Divertikelkrankheit.
Diverticulitis
Perforation
Prophylaxis
Quality of life
Sigmoid colon resection
Journal
Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen
ISSN: 1433-0385
Titre abrégé: Chirurg
Pays: Germany
ID NLM: 16140410R
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
accepted:
27
04
2021
pubmed:
9
6
2021
medline:
4
8
2021
entrez:
8
6
2021
Statut:
ppublish
Résumé
The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality. Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence. The narrative review is based on current national and international guidelines and a selective literature search. There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1-3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment. The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks. HINTERGRUND: Die korrekte medizinische Indikationsstellung ist der grundlegende Entscheidungsprozess für die chirurgische Behandlung und deren Qualität. Darstellung der Indikationsstellung zur chirurgischen Therapie bei den unterschiedlichen Typen der Divertikelkrankheit nach aktuellem Evidenzniveau. Das narrative Review basiert auf aktuellen nationalen und internationalen Leitlinien und einer selektiven Literaturrecherche. Es bestehen grundlegend drei Indikationen zur Sigmaresektion: 1) prophylaktisch zur Vermeidung von Komplikationen nach erfolgreicher konservativer Therapie einer akuten komplizierten Divertikulitis mit Makroabszess mit hohem Rezidivrisiko („classification of diverticular disease“ [CDD] Typ 2b). 2) Bei Patienten mit anhaltender Symptomatik und eingeschränkter Lebensqualität kann die Sigmaresektion bei unterschiedlichen Typen (CDD-Typ 1–3) effektiv eine signifikante Verbesserung der Lebensqualität ermöglichen und ist daher bei individuell vertretbaren perioperativen Risiken zu empfehlen. 3) Indikation zur umgehenden Sigmaresektion besteht bei der freien Perforation oder beim Versagen der konservativen Therapie. Die Indikationsstellung sollte den Typ der Divertikelkrankheit, die Festlegung des Behandlungsziels, die Bewertung der Effektivität der chirurgischen Therapie im Vergleich zur konservativen Therapie und eine individuelle Bewertung von Risiken beinhalten.
Sections du résumé
BACKGROUND
BACKGROUND
The correct medical indications are the fundamental decision process for the surgical treatment and ensuring the quality.
OBJECTIVE
OBJECTIVE
Description of the indications for surgical treatment of the various types of diverticular disease according to the current level of evidence.
MATERIAL AND METHODS
METHODS
The narrative review is based on current national and international guidelines and a selective literature search.
RESULTS
RESULTS
There are basically three main indications for resection of the sigmoid colon. 1) Prophylactic for avoidance of complications after successful conservative treatment of acute complicated diverticulitis with macroabscess formation and high risk of recurrence (classification of diverticular disease, CDD, type 2b). 2) In patients with persistent symptoms and impaired quality of life resection of the sigmoid colon of various types (CDD types 1-3) can effectively enable a significant improvement in the quality of life and is therefore to be recommended in cases of individually acceptable perioperative risks. 3) Indications for urgent resection of the sigmoid colon are present for free perforation or failure of conservative treatment.
CONCLUSION
CONCLUSIONS
The indications for surgery should be defined by the type of diverticular disease, the aim of surgical treatment, the evaluation of the efficacy of surgical treatment in comparison to conservative treatment and an individual appraisal of the risks.
ZUSAMMENFASSUNG
UNASSIGNED
HINTERGRUND: Die korrekte medizinische Indikationsstellung ist der grundlegende Entscheidungsprozess für die chirurgische Behandlung und deren Qualität.
ZIEL DER ARBEIT
UNASSIGNED
Darstellung der Indikationsstellung zur chirurgischen Therapie bei den unterschiedlichen Typen der Divertikelkrankheit nach aktuellem Evidenzniveau.
MATERIAL UND METHODEN
METHODS
Das narrative Review basiert auf aktuellen nationalen und internationalen Leitlinien und einer selektiven Literaturrecherche.
ERGEBNISSE
UNASSIGNED
Es bestehen grundlegend drei Indikationen zur Sigmaresektion: 1) prophylaktisch zur Vermeidung von Komplikationen nach erfolgreicher konservativer Therapie einer akuten komplizierten Divertikulitis mit Makroabszess mit hohem Rezidivrisiko („classification of diverticular disease“ [CDD] Typ 2b). 2) Bei Patienten mit anhaltender Symptomatik und eingeschränkter Lebensqualität kann die Sigmaresektion bei unterschiedlichen Typen (CDD-Typ 1–3) effektiv eine signifikante Verbesserung der Lebensqualität ermöglichen und ist daher bei individuell vertretbaren perioperativen Risiken zu empfehlen. 3) Indikation zur umgehenden Sigmaresektion besteht bei der freien Perforation oder beim Versagen der konservativen Therapie.
DISKUSSION
CONCLUSIONS
Die Indikationsstellung sollte den Typ der Divertikelkrankheit, die Festlegung des Behandlungsziels, die Bewertung der Effektivität der chirurgischen Therapie im Vergleich zur konservativen Therapie und eine individuelle Bewertung von Risiken beinhalten.
Autres résumés
Type: Publisher
(ger)
HINTERGRUND: Die korrekte medizinische Indikationsstellung ist der grundlegende Entscheidungsprozess für die chirurgische Behandlung und deren Qualität.
Identifiants
pubmed: 34100113
doi: 10.1007/s00104-021-01432-7
pii: 10.1007/s00104-021-01432-7
doi:
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
694-701Informations de copyright
© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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