Reassessment of primary resection of the perforated segment for severe colonic diverticulitis

Article Abstract:

Diverticulosis is characterized by pouch-like herniations (diverticula) through the muscle layer of the colon. When diverticula become inflamed diverticulitis develops and fecal matter penetrating through the thin wall of the diverticula can cause abscess formation and perforation of the colon. The surgical treatment for complications of diverticulosis is primary colon resection which involves removing the affected segment of colon, and then re-establishing bowel continuity by connecting (anastomosing) the two ends of the colon. This one-stage procedure is indicated if the patient is a good medical risk and can be properly prepared for surgery. Patients who did not meet this criteria previously had a three-stage procedure performed; colostomy (connecting a segment of the colon through a hole to the outside of the abdominal wall) and closing or draining the perforation in the colon. However, in the past ten years, these poor-risk patients were treated with a two-stage procedure; primary resection with temporary colostomy. Initial reports indicated that the mortality rate was lower among patients who were treated by the two-stage approach. Then records of all patients who had surgery for colon diverticular disease at one hospital during two periods were reviewed. From 1974 to 1978 when the three-stage approach was most prevalent 196 patients were treated; from 1982 to 1986 when the two-stage procedure was used 230 patients had their first operation for nonbleeding colonic diverticular disease. In the first period colostomy and drainage alone were used to treat 72 percent of the patients; in the later period 75 percent were treated with primary resection and colostomy. The mortality rate increased from 14 percent in the earlier period to 19 percent in the later. There was no difference in mortality for patients who developed peritonitis (inflammation of the lining of the abdomen). The mortality for patients who had abscesses increased from 8 percent in the earlier period to 15 percent in the later one. In the treatment of severe complications of diverticulitis, primary resection of the colon has not changed mortality of patients with peritonitis, but it may have increased mortality of patients who develop abscesses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Patient outcomes, Mortality, Colon (Anatomy), Diverticulitis, Diverticular disease, Colostomy, Colectomy, Colon surgery

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Proper timing of surgery for gallstone pancreatitis

Article Abstract:

Gallstone pancreatitis is an inflammation of the pancreas caused by the migration of a gallstone and subsequent obstruction of the ampulla of Vater, the point at which the ducts from the gallbladder and liver enter into the small intestine. It is agreed that surgery for gallstone pancreatitis should be performed at the time of initial hospital admission. There is disagreement, however, as to whether surgery should be performed early in the hospital stay or should be postponed until after the acute phase of pancreatic inflammation has subsided. Prospective randomized studies of patients having surgery for gallstone pancreatitis have shown a lower morbidity and mortality when the surgery was delayed until the pancreatitis subsided. Current evidence suggests that the severity of gallstone pancreatitis is determined by the amount of tissue destroyed initially. Surgery would be most beneficial in the presence of severe pancreatitis, however when there is severe pancreatitis, the benefits of removing all the stones from the ducts does not appear to outweigh the hazards of early surgery. There is no evidence to indicate that progression of the pancreatitis is affected by the presence of a stone, once the pancreatitis has occurred, and it is also known that the severity of the attack is determined early in the illness by the amount of tissue destroyed. It is concluded that early stone removal does not influence the progression of pancreatitis, and therefore surgery should be performed during the initial hospitalization but after pancreatitis has subsided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Gallstones, Pancreatitis, editorial

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Combined use of topical and systemic antibiotics

Article Abstract:

The incidence of wound infection following surgery has been reduced with the use of prophylactic (preventive) antibiotics in the period before, during and after the operation. Those studies that established the effectiveness of antibiotic prophylaxis usually used antibiotics given systemically (intended to treat the whole body, by oral or intravenous administration). There is little information on the use of topical antibiotics to prevent wound infection, although may surgeons actually use a combination of both systemic and topical antibiotic prophylaxis. Antibiotics can be given topically in powder form directly to the wound, or more commonly are placed in solutions used to irrigate the operative area. A study was undertaken with mice to compare the effectiveness of systemic and topical antibiotics in the prevention of infection. Gross infection rates and bacterial concentrations at the wound site were evaluated. It was found that when there was moderate wound infection, either topical or systemic antibiotics alone were equally effective in preventing infection. When there was a high level of wound infection, the combination of topical and systemic antibiotics was more effective than either single method of administration. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Antibiotics, Prevention, Surgical wound infections, Dosage and administration, Drug therapy, Combination, Combination drug therapy

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