Page 135 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Long-term follow-up after diverticulitis
Introduction
The role of intra-abdominal adhesions with regard to symptoms remains unclear [1-4]. As the diagnosis of infertility and ileus caused by adhesions is well established, especially pain and other chronic complaints can be related to adhesions less obviously. Diverticular disease is a common condition which has been a cause of increased hospital admission in recent years [5]. Although in 75% of the cases non-surgical management will be sufficient, in about one quarter surgery should be considered. Elective surgery can be performed in cases of recurrent disease, stenosis, fistula formation and the suggestion of malignancy, while acute operative management can be indicated due to local or generalized peritonitis (Hinchey III and IV) [6, 7]. Especially the latter might induce abdominal adhesion formation possibly resulting in small bowel obstruction, difficulties at reoperation and infertility [8, 9]. Abdominal adhesions are also considered to be associated with chronic abdominal pain, although this remains widely under debate [1, 3, 10]. Provided that adhesions can induce chronic abdominal pain, one might expect more complaints after operation for diverticulitis with generalized peritonitis.
Recently it was shown that severe recurrence after successful non- operative management of acute diverticulitis was low, and emergency 8 surgery was rare [7, 11]. However for those cases that operation is inevitable, the evidence is sparse concerning long-term effects. The
aim of this study was to compare the severity of abdominal complaints
following acute versus elective surgery for diverticular disease with a follow-up of 7.5 years.
Methods
This study is a retrospective analysis of all patients undergoing operation for diverticulitis from 2003 through 2010 in two academic hospitals (Erasmus Medical Center Rotterdam and Academic Medical Center Amsterdam) and two affiliated community hospitals (Flevohospital in Almere and Havenziekenhuis Rotterdam). Patients were identified using
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