BACKGROUND: Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice. AIM: To assess outcomes of out-patient management of acute UD. METHODS: A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings. RESULTS: The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria. CONCLUSION: Ambulatory management of acute UD is reasonable in selected patients.
BACKGROUND: Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice. AIM: To assess outcomes of out-patient management of acute UD. METHODS: A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings. RESULTS: The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria. CONCLUSION: Ambulatory management of acute UD is reasonable in selected patients.
Authors: R Cirocchi; J J Randolph; G A Binda; S Gioia; B M Henry; K A Tomaszewski; M Allegritti; A Arezzo; R Marzaioli; P Ruscelli Journal: Tech Coloproctol Date: 2019-01-25 Impact factor: 3.781
Authors: S T van Dijk; K Bos; M G J de Boer; W A Draaisma; W A van Enst; R J F Felt; B R Klarenbeek; J A Otte; J B C M Puylaert; A A W van Geloven; M A Boermeester Journal: Int J Colorectal Dis Date: 2018-03-12 Impact factor: 2.571
Authors: Massimo Sartelli; Dieter G Weber; Yoram Kluger; Luca Ansaloni; Federico Coccolini; Fikri Abu-Zidan; Goran Augustin; Offir Ben-Ishay; Walter L Biffl; Konstantinos Bouliaris; Rodolfo Catena; Marco Ceresoli; Osvaldo Chiara; Massimo Chiarugi; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Gian Luigi De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Francesco Di Marzo; Salomone Di Saverio; Therese M Duane; Mario Paulo Faro; Gustavo P Fraga; George Gkiokas; Carlos Augusto Gomes; Timothy C Hardcastle; Andreas Hecker; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Kenneth Y Y Kok; Kenji Inaba; Arda Isik; Francesco M Labricciosa; Rifat Latifi; Ari Leppäniemi; Andrey Litvin; John E Mazuski; Ronald V Maier; Sanjay Marwah; Michael McFarlane; Ernest E Moore; Frederick A Moore; Ionut Negoi; Leonardo Pagani; Kemal Rasa; Ines Rubio-Perez; Boris Sakakushev; Norio Sato; Gabriele Sganga; Walter Siquini; Antonio Tarasconi; Matti Tolonen; Jan Ulrych; Sannop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2020-05-07 Impact factor: 5.469