Page 144 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 8
compared to conservative therapy, although obviously the risk of complications should always be considered [34-36]. Recent results of the Direct-direct trial confirm this, showing that elective sigmoidectomy, despite its inherent risk of complications, results in better quality of life than conservative management in patients with recurrent and persisting abdominal complaints after an episode of diverticulitis [28].
If elective surgery is indicated, guidelines agree that laparoscopic surgery is preferred in experienced hands because of lower morbidity and faster recovery [37, 38]. In those cases where acute surgery is inevitable, evidence for a safe laparoscopic approach is weak and similar to our study, an open approach is most commonly undertaken [37]. In the last decade laparoscopic peritoneal lavage has been investigated as an alternative to sigmoidectomy in patients with purulent peritonitis owing to perforated diverticulitis. However, recent randomised trials demonstrated that peritoneal lavage is not superior to sigmoidectomy [27, 29]. As our study period ended in 2010, just before increasing popularity of laparoscopic lavage in the Netherlands, no lavage was performed in our study. However, forthcoming data of two more trials on perforated diverticulitis might eventually change the way perforated diverticulitis will be treated [39-41]. It should be interesting to see what the effect will be on chronic abdominal complaints after long-term follow-up of laparoscopic lavage.
In the present study, 109 (52%) questionnaires were suitable for complete analysis. This is equivalent to other retrospective quality of life studies reporting follow-up percentages between 37-52% after 2.5 to 7 years of follow-up [2, 42-44]. Baseline characteristics did not significantly differ between responders and non-responders suggesting that the responder group reflects the whole study population. However, comparable to all retrospective studies, our data should be interpreted carefully because of selection bias. Additionally, the limited power of 28 responders in the acute group should be taken in account. As mentioned above 83% (39 out of 47) of the deceased patients were operated in the acute setting, relatively reducing the availability of patients for follow- up in this group. We can only speculate for the reason for the difference
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