Page 143 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Long-term follow-up after diverticulitis
differences were seen for gender, operation technique, reoperation rate within 30 days or the presence of a (temporary) stoma. It is also possible that the impact of other abdominal operations during follow- up influenced our data. However, the number of operations did not significantly differ between the two groups suggesting that a potential effect of these operations was the same in both groups (Table 4)
Although the Hansen-Stock classification might have been more appropriate to apply, in the hospitals as involved in this study the Hinchey classification for severity of diverticulitis was used, as it is still generally applied in most studies [26-29]. Even more promising seems to be CT in combination with clinical parameters as recently was stated by Bolkenstein et al [26].
Despite the fact that this study did not find any differences between the
two groups concerning abdominal complaints, a significant number of
patients suffered from them. One can only hypothesize about the cause
of these complaints. In recent years an evident correlation between the development of IBS and one or more episodes of diverticulitis has been
shown, as well in conservatively as in operatively treated patients [30-
32]. The exact pathophysiological mechanism still remains unclear, but
one hypothesis includes a strong correlation between the inflammatory 8 reaction induced by diverticulitis and the development of IBS, analogous
to the postinflammatory (PI) model of PI–IBS [30, 33]. Since all patients in the present study were diagnosed with diverticular disease, the amount of patients possibly suffering from IBS should be randomly divided between the different groups and therefore not interfere with our results.
To the knowledge of the authors, the long-term effect on chronic abdominal complaints of acute versus elective surgery for diverticular disease has never been investigated. In recent years, it has become more and more evident that individual patient factors are of significant importance when deciding if colonic resection for diverticular disease should be performed or not. Different authors have shown that in carefully selected patients elective surgery improves quality of life
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