Massimo Sartelli1, Gian Andrea Binda2, Francesco Brandara3, Andrea Borasi4, Francesco Feroci5, Salvatore Vadalà6, Francesco M Labricciosa7, Arianna Birindelli8, Gianluigi Luridiana9, Federico Coccolini10, Salomone Di Saverio11, Fausto Catena12, Luca Ansaloni13, Fabio Cesare Campanile14, Ferdinando Agresta15, Diego Piazza16. 1. Department of Surgery, Macerata Hospital, Macerata, Italy. 2. Department of Surgery, Galliera Hospital, Genoa, Italy. 3. Department of General Surgery, ULSS 3, Bassano Del Grappa (VI), Italy. 4. Department of General Surgery, Humanitas Gradenigo, Turin, Italy. 5. Department of Surgery, Santo Stefano Hospital, Prato, Italy. 6. Department of Surgery, Cannizzaro Hospital, Catania, Italy. 7. Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, UNIVPM, Ancona, Italy. 8. Department of General Surgery, University of Bologna, Bologna, Italy. 9. Department of Surgery, Brotzu Hospital, Cagliari, Italy. 10. Department of Surgery, Rimini Hospital, Rimini, Italy. 11. General Surgery, Emergency and Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy. salo75@inwind.it. 12. Department of Emergency Surgery, Maggiore Hospital, Parma, Italy. 13. Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy. 14. Unit of General Surgery, AUSL VT, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy. 15. Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy. 16. Department of Surgery, Vittorio Emanuele Hospital, Catania, Italy.
Abstract
BACKGROUND: In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. METHODS: IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. RESULTS: Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. CONCLUSIONS: The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.
BACKGROUND: In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. METHODS: IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. RESULTS: Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. CONCLUSIONS: The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.
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