• J-P Ritz, J Gröne, S Engelmann, K S Lehmann, H J Buhr, and C Holmer.
• Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, Chirurgische Klinik I, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
• Chirurg. 2013 Aug 1; 84 (8): 673-80.

IntroductionThe correct therapeutic management of acute sigmoid diverticulitis (SD) is still controversially discussed. Essential to the success of therapy is primarily the long-term resolution of Patient symptoms after surgical or conservative therapy. The aim of this study was to compare the long-term outcome after conservative and surgical treatment of Patients with acute SD.Patients And MethodsConsecutive admissions of all Patients with acute SD were prospectively recruited from January 2005 to June 2008 with the exception of a free perforation. The following data were recorded: age, sex, first or recurrent episode of SD, computed tomography (CT) stage, white blood cell count, C-reactive protein, persistent symptoms and recurrence after conservative and surgical therapy. Furthermore, information on the rates of postoperative sexual and bladder dysfunction was collected. The long-term outcome was evaluated by a standardized questionnaire. In June 2008 all Patients were contacted using a standardized questionnaire.ResultsA total of 153 Patients were included in the study of whom 70 (45.8  %) presented with the first episode, 83 (54.2  %) had a prior history of SD and 40 Patients were treated conservatively whereas 113 Patients were surgically treated by sigmoid resection. Uncomplicated SD was seen in 16 Patients (conservative 4, surgical 12, p = 0.961), phlegmonous SD was seen in 88 cases (conservative 29, surgical 59, p = 0.026) and covered perforated SD in 49 cases (conservative 7, surgical 42, p = 0.022). The median follow-up was 32 months (range 12-52 months). At follow-up 25  % of conservative and 8.8  % of Patients treated surgically complained about persistent symptoms (p = 0.009). The following symptoms occurred (conservative vs. surgery): painful defecation (22.5  % versus 8.8  %, p = 0.024.), constipation (25  % versus 8.8  %, p = 0.009), abdominal cramp (22.5 % versus 4.4  %, p = 0.001) and painful flatulence (25  % versus 8.8  %, p = 0.009). Sexual or bladder dysfunction occurred postoperatively in 7  % and 9  %, respectively. Of the conservatively treated Patients 32.5  % had a recurrence of SD during follow-up compared to 3.5 % of surgically treated Patients (p < 0.001).ConclusionsSurgical treatment of acute SD is more effective than conservative therapy for the prophylaxis of recurrent SD and avoidance of persistent symptoms.

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