Do We Need to Operate on Patients After Successful Percutaneous Drainage of a Diverticular Abscess?


P (patients)

I (intervention)

C (comparator)

O (outcomes)

Patients status post percutaneous drainage of diverticular abscess

Colectomy

Expectant management

Recurrent diverticulitis





Results


The initial literature search retrieved 362 studies. After applying the exclusion criteria, 21 studies were included in the final review. There are no randomized clinical trials comparing outcomes of different management strategies for diverticular abscess. The majority of studies are retrospective series from single institutions reporting on different treatment strategies for diverticular abscess with short follow-up intervals (Table 26.2). The outcomes from these studies are heavily influenced by institutional policy and surgeon preference, and biased towards performing colectomy even after successful PD. Furthermore, patients who did not undergo colectomy after PD commonly followed a non-operative pathway because they were unfit for surgery, refused colectomy or lost to follow-up.


Table 26.2
Descriptive data of the analyzed studies




























































































































































































Author (year)
Study type
Level of evidence
Patients managed with percutaneous drainage (%)
Average size of drained abscess (cm)
Immunosuppressed patients managed with percutaneous drainage alone (%)
Average follow-up (m)

Saini et al. (1986) [8]
PSI
4
8 (73)
NS
NS
NS

Mueller et al. (1987) [9]
PSI
4
21 (100)
NS
NS
10

Neff et al. (1987) [10]
PSI
4
16 (100)
NS
NS
12–29

Stabile et al. (1990) [11]
PNR
4
19 (100)
8.7
NS
17.4

Hachigian et al. (1992) [12]
PSI
4
4 (31)
NS
NS
NS

Ambrosetti et al. (1992) [13]
PSI
3b
1 (4.5)
NS
NS
24

Bahadursingh et al. (2003) [14]
R
4
6 (24)
NS
NS
NS

Macias et al. (2004) [15]
R
4
10 (36)
5.8
NS
NS

Ambrosetti et al. (2005) [16]
PSI
3b
19 (26)
6.7
NS
43a

Kaiser et al. (2005) [17]
R
4
16 (16)
7.1
NS
46.5

Siewert et al. (2006) [18]
R
4
4 (13)
5.9
NS
13.1a

Durmishi et al. (2006) [19]
R
4
34 (100)
6.0
NS
NS

Brandt et al. (2006) [5]
CC
3b
34 (52)
6.0
NS
NS

Singh et al. (2008) [20]
R
4
16 (100)
8.5
3 (19)
34.8

Dharmarajan (2011) [21]
R
4
38 (39)
>4.0
NS
19.7

Van de Wall (2013) [22]
R
4
54 (8.1)
>5.0
NS
27.5a

Gaertner et al. (2013) [23]
R
4
191 (100)
4.7
7 (21.8)
88.8

Felder et al. (2013) [24]
R
4
40 (100)
5.6 ± 2.0
5 (13)
46.8a

Subhas et al. (2014) [25]
R
4
42 (35.8)
6.3
NS
NS

Elagili et al. (2015) [26]
R
4
133 (100)
5.0
1/18 (5.5)
90a

Knapp et al. (2015)b [27]
R
4
29 (100)
NS
NS
NS


R retrospective series, CC case control study, PSI prospective single institution series, PNR prospective nonrandomized series, NA not applicable, NS not specified

aMedian

bMeeting abstract

Failure of PD requiring urgent fecal diversion with or without colectomy was reported in 20 studies and was required in 9.4 (0–33) percent of cases with various definitions of failure (Table 26.3). Operative indications for failed PD largely depended on clinical parameters of infection and peritonitis, as well as surgeon preference. Elective colectomy after successful PD was performed in 64.3 (33–100) percent of cases with no clear operative criteria. Gaertner et al [23] reported the largest experience with interval colectomy (137 of 191 patients [72 %]) after successful PD but did not specify operative indications or the morbidity of interval colectomy after successful PD. The overall postoperative morbidity rate of elective colectomy after successful PD was 7 (0–28.6) percent in 7 of 21 studies. Severity of postoperative morbidity after interval colectomy and its association with operative approach (laparoscopic vs. open) was not described in detail in the reviewed studies.


Table 26.3
Outcomes after percutaneous drainage of diverticular abscess
























Author (year)
Colectomy or fecal diversion for failed percutaneous drainage (%)
Elective colectomy after successful percutaneous drainage (%)
Postoperative morbidity for elective colectomy after successful percutaneous drainage (%)
Overall symptomatic recurrence after percutaneous drainage alone (%)

Saini et al. (1986) [8]
0 (0)
7 (87.5)
0 (0)
NA

Mueller et al. (1987) [9]

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Aug 23, 2017 | Posted by in ABDOMINAL MEDICINE | Comments Off on Do We Need to Operate on Patients After Successful Percutaneous Drainage of a Diverticular Abscess?

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