The role of surgery in the treatment of diverticulitis

The article was written by Doctor Mai Vien Phuong - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

Diverticulitis of the colon is not a rare disease in Vietnam today and its frequency is increasing. The characteristics of colonic diverticulum in our country are similar to other Asian countries with the right diverticulum predominating.

Most of the current recommendations and treatment regimens focus only on solving left-sided diverticulitis according to Western experience. Consensus on the treatment of diverticulitis in Asia has not yet been reached. Most studies suggest that the medical treatment of patients with right colonic diverticulitis simply as recommended in the left colon is still appropriate.
However, in cases where surgery is indicated or when right colonic diverticulitis is detected intraoperatively (with a misdiagnosed appendicitis (VRT), the choice of the appropriate surgical method is still controversial. The right colon is too large, if only appendectomy and/or drainage and medical treatment are performed, the patient still has to undergo an operation without resolving the lesion, the possibility of recurrence is 4.3% with the rate of complicated diverticulitis of the 2nd time is 60%.
Author Fang believes that dialysis should be a reasonable treatment because according to his study, patients only had diverticulectomy. However, according to today's trend, surgeons are turning to less invasive and safe surgical methods
Many authors suggest to consider diverticulectomy only as a treatment method. The right value for e-mail, agreeing with the above view, is authored by Le Huy Luu in the country, by Lee, Ngoi, and Tan in Asia and by Hildebrand and Lane in Europe. The above author's limitation is that it is only performed in uncomplicated cases of UTI.

However, because right colonic diverticulum is present in young adults, the long survival time increases the likelihood of future recurrence. Especially in patients with multiple diverticula, lesions persist after surgery.
Therefore, authors Lane, Lee and Tan suggested that diverticulectomy and accompanying appendectomy should only be performed in patients with isolated diverticulum. Author Lee through the studies also concluded that this is an appropriate surgery in emergency or in case of misdiagnosis as VRT because it is a fairly simple surgery, less complications and complications, high rate of diverticulitis. Recurrence of the colon was also not higher than that of right colectomy.
The author recommends not to apply this surgical method in cases of suspected malignancy, UC with severe complications and multiple inflammatory diverticula at the same time. The cases of multiple diverticulitis were all surgically resection of the colon (DT).

The second surgical method applied to the right colon is ileocecal resection or right colectomy. Colectomy in cases of ruptured rectal prolapse and in cases of multiple diverticulitis is considered an appropriate surgery. The recommendations also suggest that the tip should be anastomosed if the peritoneal cavity is not too dirty. Although it is not technically difficult to evaluate, the complication rate in the postoperative period is high, about 44%. Patients with right dialysis also have other discomforts such as prolonged use of analgesics, long recovery time for bowel motility, prolonged hospital stay, and disturbances in walking.
The studies in Asian countries have shown good results and all suggest that surgery to remove the dialysis should be a safe surgery with few complications. The method is applicable to patients with multiple diverticulitis, UTI with severe complications or in cases where malignancy cannot be excluded. Surgical time, hospital stay and recurrence rate were not different when comparing open surgery and laparoscopic surgery (laparotomy) to remove right colon in colorectal cancer. However, the benefits of performing laparoscopic surgery are less pain for the patient and a reduced risk of wound infection.

Sigmoidectomy is considered the best treatment for patients with CRC at this location. Hartmann surgery was once considered the gold standard in treatment but is now less popular because in addition to the high mortality and complications, the patient also had to undergo 2 surgeries, the second surgery was difficult. and the connection failure rate is up to 30%.
The current trend of treatment is to attempt an anastomosis if the assessment of the intra-abdominal infection is not serious and the patient's condition allows. Even, many studies have performed ileostomy in surgery, abdominal lavage, 2 layer anastomosis, ileostomy to the skin to protect the anastomosis in specific selected cases to increase the possibility of anastomosis.
The trend of the world today is laparoscopic. The undisputed advantages of laparoscopic surgery compared to open surgery are less pain, less wound infection, and faster recovery time. Rates of recurrence, complications, and mortality were the same or lower. Laparoscopic resection of emergency radiographs in UC in accordance with Hinchey grades I and II.
Conclusion Due to similar symptoms, VTE must be easily misdiagnosed with acute VRT.
Ultrasonography has low sensitivity while CT has high sensitivity in diagnosing CRC. The accuracy of CT is also higher than that of ultrasound in the evaluation of CRC. Surgical treatment of colorectal cancer is very diverse depending on the location of the diverticulum and the extent of the injury. The laparoscopic approach to diverticulectomy with appendix in isolated UC is a safe, adequate and can be successfully performed in the majority of cases through laparoscopic approach.

References:
Le Huy Luu, Nguyen Van Hai (2010), "Results of right colonic diverticulum surgery by laparoscopic surgery", Medicine of Ho Chi Minh City, volume 14 (additional to no. 4), p.12-15. Ly Minh Tung, Nguyen Van Hai (2011), Clinical features, images, and surgical results for diverticulitis. Aldoori W.H., Giovannucci E.L., Rockett H.R., et al. (1998), "A prospective study of dietary fiber types and symptomatic diverticular disease in men", J Nutr, Vol.128 (4), p.714-719. Ambrosetti P., Robert J.H., Witzig J.A., et al. (1994), "Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases", Surgery, Vol.115 (5), p.546-550.