Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study

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发表日期：

2024年11月7日

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E. Karam,
C. Sabbagh,
L. Beyer-Bergeot,
P. Zerbib,
V. Bridoux,
G. Manceau,
Y. Panis,
E. Buscail,
A. Venara,
I. Khaoudy,
M. Gaillard,
M. Viennet,
A. Thobie,
B. Menahem,
C. Eveno,
C. Bonnel,
J.-Y. Mabrut,
B. Badic,
C. Godet,
Y. Eid,
E. Duchalais,
Z. Lakkis,
E. Cotte,
A. Laforest,
V. Desfourneaux,
L. Maggiori,
L. Rebibo,
N. Christou,
A. Talal,
M. Aubert,
C. Bonnamy,
A. Germain,
F. Mauvais,
C. Tresallet,
J. Roudie,
A. Laurent,
B. Trilling,
M. Bertrand,
D. Massalou,
B. Romain,
H. Tranchart,
U. Giger-Pabst,
A. Alves,
M. Ouaissi,
Alexandra Pellegrin,
Jean Marc Regimbeau,
Julien Gillet,
Antoine Hamy,
Amine Lahmidi,
Mohamed Sebbagh,
Antoine Bres,
Nicolas Girard,
Aurélie Desjouis,
Nadjib Ainseba,
Julien Epailly,
Fabienne Huysman,
Maud Dezeustre,
Alexandre Doussot,
Célia Turco,
Diane Bourrhis,
Camille Godet,
Morgane Finocchi,
Yoan Marion,
Gil Lebreton,
Flavie Benard,
Elodie Pineau,
Véronique Bouvier,
Olivier Dejardin,
Manon Viennet,
Nathan Moreno-Lopez,
Patrick Rat,
Bassem Makar,
Paola Fara,
Marc Pompilio,
Hugo Hertault,
Corentin Guezennec,
Habchi Saida,
Alexandre Brinza,
Laurent Plard,
Antoine Ailhaud,
Léa Gutierrez,
Vincent Venchiarutti,
Jean-Luc Faucheron,
Bertrand Morin,
Bertrand Pech de la clause,
Eglantine Voitellier,
Guillaume Gagnat,
Barbara Noiret,
Constance Laroye,
Guillaume Piessen,
Katia Lécolle,
Jean Robert,
Nzamushelepanmabla,
Perrine Engel,
Muriel Mathonnet,
Cyprien Rodriguez,
Ammar Makki,
Anne-Cécile Couchard,
François Duramé,
Cécile Marceau,
Jean-Christophe Paquet,
Vahan Kepenekian,
Guillaume Passot,
Olivier Glehen,
Ninon Wallach,
Kayvan Mohkam,
Marie-Caroline Blanc,
Stéphane Berdah,
Diane Mege,
Ahmet Ayav,
Hervé Chanty,
Alexandre Didier,
Estelle Vigneron,
Noémie Périard,
Marie Thaumoux,
Océane Grenouilloux,
Seila Fall,
Sophoclis Thomareis,
Chloé Marsollier,
Michel Prud’homme,
Christos Antonopulos,
Simon Msika,
Marie Monsinjon,
Massimo Giacca,
Antoine Cazelles,
Mehdi Karoui,
Valentina Malerba,
Ibrahim Dagher,
Nicola de Angelis,
Francesco Brunetti,
Omar Ahmed,
Jean-Marc Ferraz,
Yassir Ramjaun,
Christine Denet,
Basile Fuchs,
Daniel Pietrasz,
Pénélope Raimbert,
Juliette Benedetti,
Chloé Coton,
Hélène Corte,
Aude Medrignac,
Daphné Chavrier,
Robin Girard,
Julia Berthelot,
Matthieu Monge,
Eloïse Papet,
Jean Pinson,
Elise Dolbeau,
Jean-Jacques Tuech,
Julien Chautard,
Mathilde Boullier,
François Goujard,
Laurent Perrot,
Ludovic Loge,
Jean-Michel Petiot,
Simone Mandefredelli,
Diane Charleux-Muller,
Guillaume Sauvinet,
Jean-Baptiste Bertin,
Louis Vincent,
Blandine Simeu,
Jean-Baptiste Delhorme,
Cécile Brigand,
Serge Rohr,
Manon Bouchet,
Jean-Pierre Duffas,
Laurent Ghouti,
Antoine Philis,
Guillaume Portier,
Nicolas Michot,
Alice Artus,
Emilien Mauny,
Pierre-olivier Jouppe,
Céline Bourbao-Tournois,
Hugo Barbin,
Julien Thiery

摘要

Background

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.

Methods

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.

Results

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).

Conclusion

Operated on in emergency, ARDs have more resection anastomosis, with a similar rate of complications, less mortality, and more recurrence of diverticulitis than ASD.