Abstract:
BACKGROUND:In Western countries, the incidence of acute diverticulitis (AD) is increasing. Patients with uncomplicated diverticulitis can undergo a standard antibiotic treatment in an outpatient setting. The aim of this systematic review was to assess the safety and efficacy of the management of acute diverticulitis in an outpatient setting. METHODS:A literature search was performed on PubMed, Scopus, Embase, Central and Web of Science up to September 2018. Studies including patients who had outpatient management of uncomplicated acute diverticulitis were considered. We manually checked the reference lists of all included studies to identify any additional studies. Primary outcome was the overall failure rates in the outpatient setting. The failure of outpatient setting was defined as any emergency hospital admission in patients who had outpatient treatment for AD in the previous 60 days. A subgroup analysis of failure was performed in patients with AD of the left colon, with or without comorbidities, with previous episodes of AD, in patients with diabetes, with different severity of AD (pericolic air and abdominal abscess), with or without antibiotic treatment, with ambulatory versus home care unit follow-up, with or without protocol and where outpatient management is a common practice. The secondary outcome was the rate of emergency surgical treatment or percutaneous drainage in patients who failed outpatient treatment. RESULTS:This systematic review included 21 studies including 1781 patients who had outpatient management of AD including 11 prospective, 9 retrospective and only 1 randomized trial. The meta-analysis showed that outpatient management is safe, and the overall failure rate in an outpatient setting was 4.3% (95% CI 2.6%-6.3%). Localization of diverticulitis is not a selection criterion for an outpatient strategy (p 0.512). The other subgroup analyses did not report any factors that influence the rate of failure: previous episodes of acute diverticulitis (p = 0.163), comorbidities (p = 0.187), pericolic air (p = 0.653), intra-abdominal abscess (p = 0.326), treatment according to a registered protocol (p = 0.078), type of follow-up (p = 0.700), type of antibiotic treatment (p = 0.647) or diabetes (p = 0.610). In patients who failed outpatient treatment, the majority had prolonged antibiotic therapy and only few had percutaneous drainage for an abscess (0.13%) or surgical intervention for perforation (0.06%). These results should be interpreted with some caution because of the low quality of available data. CONCLUSIONS:The outpatient management of AD can reduce the rate of emergency hospitalizations. This setting is already part of the common clinical practice of many emergency departments, in which a standardized protocol is followed. The data reported suggest that this management is safe if associated with an accurate selection of patients (40%); but no subgroup analysis demonstrated significant differences between groups (such as comorbidities, previous episode, diabetes). The main limitations of the findings of the present review concern their applicability in common clinical practice as it was impossible to identify strict criteria of failure.
journal_name
Tech Coloproctoljournal_title
Techniques in coloproctologyauthors
Cirocchi R,Randolph JJ,Binda GA,Gioia S,Henry BM,Tomaszewski KA,Allegritti M,Arezzo A,Marzaioli R,Ruscelli Pdoi
10.1007/s10151-018-1919-6subject
Has Abstractpub_date
2019-02-01 00:00:00pages
87-100issue
2eissn
1123-6337issn
1128-045Xpii
10.1007/s10151-018-1919-6journal_volume
23pub_type
杂志文章,meta分析abstract::Hepatic resection for colorectal liver metastases remains the only therapeutic option that improves long-term survival and offers potential cure. By conventional resectability criteria, only a limited number of patients with metastatic disease can be subjected to surgical intervention. In the past decade, better under...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-011-0750-0
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Accurate delineation of anal fistula anatomy in recurrent cases will assist in surgical fistula eradication whilst preserving continence. Recently, transperineal ultrasonography (TPUS) has been used in perirectal inflammation where there may be advantage over endoanal ultrasonography (EAUS) in complex fistul...
journal_title:Techniques in coloproctology
pub_type: 临床试验,杂志文章
doi:10.1007/s10151-006-0296-8
更新日期:2006-12-01 00:00:00
abstract::We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations. An emergency laparotomy was performed with debridment, urethral rec...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-011-0680-x
更新日期:2011-12-01 00:00:00
abstract::After pelvic pouch surgery (restorative proctocolectomy), periodic or continuous diarrhea is common. Distressing diarrhea may be triggered by pouchitis, cuffitis or an anastomotic stricture. Medical therapy with loperamide or diphenoxylate is often unsatisfactory even after the correction of the underlying problem. Se...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-006-0306-x
更新日期:2006-12-01 00:00:00
abstract::Anal fistula repair still remains challenging. Up to 30% of fistulas persist after surgery despite many improvements in surgical skills and technique. One major reason for surgical failure is a persistent fistula track or remnants of the fistula epithelium which could not be removed during surgery. To overcome this pr...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-011-0726-0
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Obese patients have higher complication rates after pelvic surgery. Laparoscopic rectal surgery may not be possible in the obese individual due to mesorectal, total pelvic and general visceral fat volumes. Very low energy diets reduce visceral fat but the changes within the pelvis and mesorectum are unknown....
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-019-02074-y
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Diverticulitis is a common indication for surgical emergency room admission, often leading to abdominal computed tomography (CT) scanning for both diagnosis and staging. C-reactive protein (CRP) has been identified as a useful biomarker of inflammation. Aspirin and corticosteroids are known to down-regulate ...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-013-1044-5
更新日期:2014-02-01 00:00:00
abstract::Obstructed defecation is one subtype of constipation, and may be due to functional or mechanical causes. Here, we report an unusual cause, never described before, of obstructed defecation due to a large uterine myoma that reverted to normal bowel habits after surgery. The importance of an accurate evaluation of the ca...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-009-0510-6
更新日期:2009-09-01 00:00:00
abstract::We present a new video-assisted minimally invasive technique for the treatment of pilonidal disease (E.P.Si.T: endoscopic pilonidal sinus treatment). Between March and November 2012, we operated on 11 patients suffering from pilonidal disease. Surgery is performed under local or spinal anesthesia using the Meinero fis...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-013-1016-9
更新日期:2014-04-01 00:00:00
abstract::We describe obliteration of the rectal lumen during stapled haemorrhoidopexy in a patient with marked mucosal prolapse. The complication was recognised immediately and continuity was restored by performing a limited Delorme's procedure. The possible cause of this complication is explored and serves as a reminder that ...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-007-0382-6
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Various sequelae which might lead to reintervention have been described after stapled rectal mucosectomy for hemorrhoids. One potential treatment modality for persistent complaints after stapled hemorrhoidopexy (SHP) or stapling for rectocele is the so-called agraffectomy (removal of the retained staples). T...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,评审
doi:10.1007/s10151-011-0704-6
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Large bowel obstruction is occasionally the mode of presentation of advanced colorectal or pelvic malignancies, and a prognostic of poor survival. The choices of treatment range from palliative tube decompression to curative or palliative surgery. METHODS:Twelve out of 500 women with various malignancies an...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-004-0127-8
更新日期:2004-11-01 00:00:00
abstract::Colorectal cancer remains a leading cause of cancer death in the UK. With the advent of screening programmes and developing techniques designed to treat and stage colorectal neoplasia, there is increasing pressure on the colonoscopist to keep up to date with the latest practices in this area. This review looks at the ...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,评审
doi:10.1007/s10151-007-0319-0
更新日期:2007-03-01 00:00:00
abstract::The purpose of this study was to assess outcome measures and cost-effectiveness of robotic colorectal resections in adult patients with inflammatory bowel disease. The Cochrane Library, PubMed/Medline and Embase databases were reviewed, using the text "robotic(s)" AND ("inflammatory bowel disease" OR "Crohn's" OR "Ulc...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,评审
doi:10.1007/s10151-018-1766-5
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Fibre is often recommended as the first-choice treatment but its effects can be uneven. The aim of the study was to compare the clinical efficacy and tolerability of fibre versus lactulose in outpatients with chronic constipation. METHODS:In a prospective randomized crossover trial, patients were randomized...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10151-006-0262-5
更新日期:2006-07-01 00:00:00
abstract::The aim of this prospective study was to assess the effectiveness in healing anal fissure (AF) of lacidipine, a calcium channel blocker with a better tolerability in comparison to other calcium antagonists. Twenty-one consecutive patients (16 women, 76.2%) with AF (16 chronic, situated posteriorly in 17 patients (81.0...
journal_title:Techniques in coloproctology
pub_type: 临床试验,杂志文章
doi:10.1007/s101510200017
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Ligation of the intersphincteric tract (LIFT), a novel sphincter-saving technique, has been recently described with promising results. Literature data are still scant. In this prospective observational study, we present our experience with this technique. METHODS:Between October 2010 and April 2011, 18 pati...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-011-0779-0
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Representatives from the Italian centers experienced in sacral neuromodulation (SNM) for the treatment of bowel dysfunction met in order to define the current clinical practice in Italy and to produce a consensus statement regarding indications for this therapy and patient management. METHODS:Fifty Italian ...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-013-1002-2
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-014-1232-y
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:The aim of this study was to systematically analyse the clinical trials on the effectiveness of transanal haemorrhoidal de-arterialisation (THD) and stapled haemorrhoidopexy (SH) in the management of haemorrhoidal disease (HD). METHODS:Clinical trials on the effectiveness of THD and SH in the management of ...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s10151-011-0796-z
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:The quantitative immunochemical faecal occult blood test (qFOBT) has been shown to be an accurate method of identifying significant colorectal neoplasia including cancer and advanced adenomas. This study reports the results of a Singapore population-based colorectal cancer screening event using the qFOBT. M...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-009-0515-1
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:The introduction of transanal minimally invasive surgery (TAMIS) in 2009 allowed colorectal surgeons to approach transanal access with a different perspective. This has lead to the development of TAMIS for total mesorectal excision (TME). We have previously described robotic transanal TME and here report our...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-014-1181-5
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The aim of this study was to report the outcomes of sacral neuromodulation (SNM) in chronic pelvic pain (CPP) patients in the Finnish national cohort. METHODS:This was a register-based retrospective study, involving all the centers that provide SNM treatment in Finland. The data of all patients treated with...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-020-02148-2
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Liver metastases from colorectal cancer are treatable and potentially curable when hepatic resection is applied. This paper is to illustrate surgical treatment of metastatic colorectal cancer in China. PATIENTS AND METHODS:Between January 1993 and December 2002, 485 patients with colorectal liver metastases...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,多中心研究
doi:10.1007/s10151-004-0109-x
更新日期:2004-11-01 00:00:00
abstract::The Malone appendicostomy is a novel option for surgical management of faecal incontinence and chronic constipation, by permitting the administration of antegrade colonic enemas for colonic evacuation. We report the case of a 54-year-old female who had undergone abdomino perineal resection for low rectal cancer follow...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-010-0672-2
更新日期:2011-03-01 00:00:00
abstract::The aim of this study was to evaluate the role of ayurvedic setons in the treatment of low fistula-in-ano. One hundred and eight patients were randomised into either conventional fistulotomy (F) or ayurvedic cutting seton insertion (C). Endpoints investigated included time to wound healing and complications of surgery...
journal_title:Techniques in coloproctology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s101510100015
更新日期:2001-12-01 00:00:00
abstract::Prompt and appropriate referrals to colorectal surgeons result in better clinical and more cost-effective outcome: the question that then arises is how patients with large bowel diseases get in contact with the specialist. The aim of the present research was to investigate the sources of clinical referrals of 1000 pat...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s101510170001
更新日期:2001-08-01 00:00:00
abstract::Rectovaginal fistula are a relatively rare kind of anorectal fistulas. Spontaneous healing is rare and the rectal advancement flap repair is the most popular procedure with success rates ranging between 60% and 80%. We present a new technique for repairing damage in the rectovaginal septum that consists of placing a f...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-004-0088-y
更新日期:2004-11-01 00:00:00
abstract::Transanal endoscopic microsurgery (TEM) was introduced in 1983 as a minimally invasive technique allowing the resection of adenomas and early rectal carcinomas unsuitable for local or colonoscopic excision which would otherwise require major surgery. After 25 years, there is still much debate about the procedure. This...
journal_title:Techniques in coloproctology
pub_type: 杂志文章,评审
doi:10.1007/s10151-009-0466-6
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:This study was designed to assess defecatory function in patients who underwent laparoscopic ventral rectopexy (LVR) for external rectal prolapse (ERP). METHODS:Thirty-one patients who underwent evacuation proctography 6 months postoperatively were assessed. Preoperative proctography had been performed in 2...
journal_title:Techniques in coloproctology
pub_type: 杂志文章
doi:10.1007/s10151-015-1395-1
更新日期:2016-02-01 00:00:00