43 - Freie Mitteilung
16. Mai 2019, 08:30 - 10:00, Szenario 1, 5. OG
Long-term quality of life is similar in operated and conservatively managed patients with diverticular disease
D. W. Stimpfle, E. Gerns, U. Zingg, Presenter: D. W. Stimpfle (Schlieren)
There is substantial debate whether elective surgery in diverticular disease is indicated at any point. Sceptics argue, among other things, that morbidity is high and quality of life is impaired after surgery. The aim of this study was to analyse the long-term quality of life of operated patients with comparison to a conservatively managed cohort.
All patients treated for diverticular disease with elective surgery or conservatively with antibiotics from 2008-2015 were assessed. Patients were contacted by phone and invited for a clinical assessment. Patients` characteristics, long-term complications and Gastrointestinal Quality of Life (GIQLI) score were collected. Surgery was indicated if two or more acute attacks occurred, patients suffered from abscess or stenosis, were young or immunocompromised, according to the 2000/2006 ASCRS Guidelines.
In total 150 patients agreed to participate. 119 patients were operated (114 laparoscopically, 5 open) and 31 treated conservatively. Age, gender, Charlson comorbidity index, medication use and mobility were comparable. In the operated group the number of attacks (p=0.002) and the Hinchey score (p=0.005) were significantly higher. Median of GIQLI Score was 123 in non-operative patients and 119 in operative patients, respectively (p=0.308). Number of attacks, Hinchey score, and severity of diverticular disease in colonoscopy had no significant influence on the GIQLI score. Overall short-term surgical morbidity in the surgery group was 22.7%, with an anastomotic leak rate of 3.4%. Overall long term complications were significantly higher in the operated group [45 (37.8%) vs. 5 (16.1%), p=0.023]. 11 patients (9.2%) in the operated group and 4 (12.9%) in the non-operated group had anamnestically recurrent attacks (p=0.514). Impaired urinary and sexual function, respectively, occurred in 7 (5.9%) and 11 (9.2%) patients in the surgery group, none in the conservative group. 9 operated patients (7.6%) developed incisional hernia, 5 (4.2%) anastomotic stricture and 1 (0.8%) a small bowel obstruction.
Despite relevant short and long term morbidity, patients undergoing resection for diverticular disease reach similar GIQLI quality of life scores compared to conservatively treated patients. However, the surgery must be indicated with care and awareness of a substantial morbidity in the long term.