PDF(Pubmed)
Abstract：
BACKGROUND: Laparoscopic lavage (LPL) has been suggested for treatment of non-feculent perforated diverticulitis. In this observational study, the surgical treatment of diverticular disease in Sweden outside prospective trials was investigated.
METHODS: This population-based study used the National Patient Register to identify all patients in Sweden with emergency admissions for diverticular disease, as defined by ICD codes from July 2014 to December 2020. Demographics, surgical procedures and outcomes were assessed. In addition, register data since 1997 were retrieved to assess co-morbidities, previous abdominal surgeries, and previous admissions for diverticular disease.
RESULTS: Among 47 294 patients with emergency hospital admission, 2035 underwent LPL (427 patients) or sigmoid resection (SR, 1608 patients) for diverticular disease. The mean follow-up was 30.8 months. Patients selected for LPL were younger, healthier and with less previous abdominal surgery for diverticular disease than those in the SR group (P < 0.01). LPL was associated with shorter postoperative hospital stay (mean 9.4 versus 14.9 days, P < 0.001) and lower 30-day mortality (3.5% versus 8.7%, P < 0.001). Diverticular disease-associated subsequent surgery was more common in the SR group than the LPL group except during the first year (P < 0.001). LPL had a lower mortality rate during the study period (stratified HR 0.70, 95% c.i. 0.53-0.92, P = 0.023).
CONCLUSIONS: Laparoscopic lavage constitutes a safe alternative to sigmoid resection for selected patients judged clinically to require surgery.
Diverticulitis is inflammation in pouches of the large bowel. Rarely, diverticulitis can lead to a bowel perforation causing peritonitis. Traditionally, it was treated by resection of the inflamed bowel with a stoma. A milder treatment has been proposed in which the abdomen is rinsed with saline laparoscopically and drained (laparoscopic lavage). This study aimed to examine the outcomes of laparoscopic lavage in Sweden. Our findings support the use of this method in younger and healthier patients with a history of no or only minor previous abdominal surgery.
METHODS: This population-based study used the National Patient Register to identify all patients in Sweden with emergency admissions for diverticular disease, as defined by ICD codes from July 2014 to December 2020. Demographics, surgical procedures and outcomes were assessed. In addition, register data since 1997 were retrieved to assess co-morbidities, previous abdominal surgeries, and previous admissions for diverticular disease.
RESULTS: Among 47 294 patients with emergency hospital admission, 2035 underwent LPL (427 patients) or sigmoid resection (SR, 1608 patients) for diverticular disease. The mean follow-up was 30.8 months. Patients selected for LPL were younger, healthier and with less previous abdominal surgery for diverticular disease than those in the SR group (P < 0.01). LPL was associated with shorter postoperative hospital stay (mean 9.4 versus 14.9 days, P < 0.001) and lower 30-day mortality (3.5% versus 8.7%, P < 0.001). Diverticular disease-associated subsequent surgery was more common in the SR group than the LPL group except during the first year (P < 0.001). LPL had a lower mortality rate during the study period (stratified HR 0.70, 95% c.i. 0.53-0.92, P = 0.023).
CONCLUSIONS: Laparoscopic lavage constitutes a safe alternative to sigmoid resection for selected patients judged clinically to require surgery.
Diverticulitis is inflammation in pouches of the large bowel. Rarely, diverticulitis can lead to a bowel perforation causing peritonitis. Traditionally, it was treated by resection of the inflamed bowel with a stoma. A milder treatment has been proposed in which the abdomen is rinsed with saline laparoscopically and drained (laparoscopic lavage). This study aimed to examine the outcomes of laparoscopic lavage in Sweden. Our findings support the use of this method in younger and healthier patients with a history of no or only minor previous abdominal surgery.
摘要：
背景：腹腔镜灌洗（LPL）已被建议用于治疗非生殖道穿孔憩室炎。在这项观察性研究中,在前瞻性试验之外研究了瑞典憩室病的外科治疗.
方法：这项基于人群的研究使用国家患者登记册来确定瑞典所有因憩室疾病而紧急入院的患者，根据2014年7月至2020年12月的ICD代码定义。人口统计,评估手术程序和结果.此外,自1997年以来的登记数据被检索以评估合并症，以前的腹部手术，和以前因憩室疾病入院。
结果：在47294例急诊住院患者中，2035例接受LPL（427例）或乙状结肠切除术（SR，1608例）用于憩室疾病。平均随访30.8个月。选择LPL的患者更年轻，与SR组相比，健康且以前的憩室疾病腹部手术次数较少（P<0.01）。LPL与术后住院时间较短相关(平均9.4天对14.9天,P<0.001）和更低的30天死亡率（3.5%对8.7%，P<0.001)。除第一年外，SR组比LPL组更常见与关节病相关的后续手术(P<0.001)。在研究期间，LPL的死亡率较低（分层HR0.70，95％c.i.0.53-0.92，P=0.023）。
结论：腹腔镜灌洗是一种安全的替代乙状结肠切除术的选择，适用于临床判断需要手术的患者。
憩室炎是大肠小袋内的炎症。很少,憩室炎可导致肠穿孔，引起腹膜炎。传统上,它是通过切除发炎的肠和造口来治疗的。已经提出了更温和的治疗方法，其中用盐水腹腔镜冲洗腹部并引流（腹腔镜灌洗）。本研究旨在检查瑞典腹腔镜灌洗的结果。我们的发现支持在没有或仅有轻微腹部手术史的年轻和健康患者中使用这种方法。
方法：这项基于人群的研究使用国家患者登记册来确定瑞典所有因憩室疾病而紧急入院的患者，根据2014年7月至2020年12月的ICD代码定义。人口统计,评估手术程序和结果.此外,自1997年以来的登记数据被检索以评估合并症，以前的腹部手术，和以前因憩室疾病入院。
结果：在47294例急诊住院患者中，2035例接受LPL（427例）或乙状结肠切除术（SR，1608例）用于憩室疾病。平均随访30.8个月。选择LPL的患者更年轻，与SR组相比，健康且以前的憩室疾病腹部手术次数较少（P<0.01）。LPL与术后住院时间较短相关(平均9.4天对14.9天,P<0.001）和更低的30天死亡率（3.5%对8.7%，P<0.001)。除第一年外，SR组比LPL组更常见与关节病相关的后续手术(P<0.001)。在研究期间，LPL的死亡率较低（分层HR0.70，95％c.i.0.53-0.92，P=0.023）。
结论：腹腔镜灌洗是一种安全的替代乙状结肠切除术的选择，适用于临床判断需要手术的患者。
憩室炎是大肠小袋内的炎症。很少,憩室炎可导致肠穿孔，引起腹膜炎。传统上,它是通过切除发炎的肠和造口来治疗的。已经提出了更温和的治疗方法，其中用盐水腹腔镜冲洗腹部并引流（腹腔镜灌洗）。本研究旨在检查瑞典腹腔镜灌洗的结果。我们的发现支持在没有或仅有轻微腹部手术史的年轻和健康患者中使用这种方法。
