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Elective surgery for persistent complaints, recurrences of diverticulitis improves QOL
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WASHINGTON — For patients who have ongoing complaints after an episode of diverticulitis or frequent recurrences, elective resection improved quality of life compared with conservative management, according to data from a late-breaker abstract presented at Digestive Disease Week.
“It was our aim to compare conservative and operative treatment for patients with recurrences and ongoing complains of diverticulitis,” Marguerite Stam, MD, from Meander Medical Center in the Netherlands, said in her presentation.
Stam and colleagues performed an intention-to-treat analysis in patients (DIRECT trial) included from June 2010 through April 2014 to evaluate subsequent quality of life at 6 months. One-hundred-and-nine patients (64.2% women)were included from 27 hospitals in the Netherlands who had ongoing abdominal complaints for 3 or more months or had three or more recurrent diverticulitis episodes within 2 years. Patients were randomly assigned to undergo laparoscopic elective resection (48.6%; mean age, 54.2 ± 10.9 years) or conservative treatment (51.3%; mean age, 56 ± 9.8 years).
Gastrointestinal Quality of Life Index scores were 114.4 ± 22.3 in the surgery group compared with 100.4 ± 22.7 in the conservative treatment group (P = .0001). Serious adverse events in patients who underwent elective resection included anastomotic leakage (13.2%), serious wound infections (4.2%) and wound dehiscence (2.1%). Serious adverse events in the conservative treatment group and were mostly related to unbearable complaints (21.4%) and recurrences (12.5%).
“In summary, we can say that elective resection is significantly better in terms of quality of life despite surgery related risks,” Stam said. “We can conclude that quality of life significantly improves after elective resection for patients suffering from recurrences and ongoing complaints of diverticulitis.” – by Adam Leitenberger
For more information:
Stam M, et al. Abstract 901c. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.
Disclosure: Stam did not provide relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.
Perspective
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John Vargo, MD, MPH
Stam and colleagues undertook a very difficult study where they looked at conservative therapy for recurrent diverticulitis vs. early operative intervention. I have to compliment the authors because this is a difficult group to study. Sometimes patients with recurrent disease may not want to be randomized to one arm or the other, but they carried on and what they were able to find was conservative management was associated with a significantly lower quality of life. I think this is very important.
When you have a patient who has had one or two bouts of diverticulitis, there is a very good chance that they are going to have another one. As a physician your patients ask you, “When will the storm cloud on the horizon go away?” This data will help us help our patients when we counsel them that surgical intervention can really change all that, not only alleviating symptoms but also augmenting quality of life.
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