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  • Azhar, NajiaLund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,Surgery,Lund University Research Groups,Department of Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden,Skane Univ Hosp, Dept Surg, Jan Waldenstromsgata 11, S-21428 Malmö, Sweden.;Lund Univ, Dept Clin Sci Malmö, Lund, Sweden. (författare)

Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: Long-term Outcomes From the Scandinavian Diverticulitis (SCANDIV) Randomized Clinical Trial

  • Artikel/kapitelEngelska2021

Förlag, utgivningsår, omfång ...

  • Chicago, IL, United States :American Medical Association,2021
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:liu-184024
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-184024URI
  • https://doi.org/10.1001/jamasurg.2020.5618DOI
  • https://lup.lub.lu.se/record/a659060e-2a41-4bdd-a62d-97bb04c65fd0URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-479405URI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Funding agencies: Department of Surgery of Skåne University Hospital were used to complete the manuscript. A fellowship was awarded to Johannes Kurt Schultz by the Southeastern Norway Regional Health Authority (grant PNR 2719011). Additional research funding from Akershus University Hospital covered running expenses (grants PNR 2619041, 2629038, and 2649054).
  • IMPORTANCE Perforated colonic diverticulitis usually requires surgical resection, with significant morbidity. Short-term results from randomized clinical trials have indicated that laparoscopic lavage is a feasible alternative to resection. However, it appears that no long-term results are available.OBJECTIVE To compare long-term (5-year) outcomes of laparoscopic peritoneal lavage and primary resection as treatments of perforated purulent diverticulitis.DESIGN, SETTING, AND PARTICIPANTS This international multicenter randomized clinical trial was conducted in 21 hospitals in Sweden and Norway, which enrolled patients between February 2010 and June 2014. Long-term follow-upwas conducted between March 2018 and November 2019. Patients with symptoms of left-sided acute perforated diverticulitis, indicating urgent surgical need and computed tomography-verified free air, were eligible. Those available for trial intervention (Hinchey stagesINTERVENTIONS Patients were assigned to undergo laparoscopic peritoneal lavage or colon resection based on computer-generated, center-stratified block randomization.MAIN OUTCOMES AND MEASURES The primary outcome was severe complications within 5 years. Secondary outcomes included mortality, secondary operations, recurrences, stomas, functional outcomes, and quality of life.RESULTS Of 199 randomized patients, 101were assigned to undergo laparoscopic peritoneal lavage and 98were assigned to colon resection. At the time of surgery, perforated purulent diverticulitiswas confirmed in 145 patients randomized to lavage (n = 74) and resection (n = 71). The median follow-upwas 59 (interquartile range, 51-78; full range, 0-110) months, and 3 patientswere lost to follow-up, leaving a final analysis of 73 patients who had had laparoscopic lavage (mean [SD] age, 66.4 [13] years; 39 men [53%]) and 69 who had received a resection (mean [SD] age, 63.5 [14] years; 36 men [52%]). Severe complications occurred in 36%(n = 26) in the laparoscopic lavage group and 35%(n = 24) in the resection group (P = .92). Overall mortalitywas 32%(n = 23) in the laparoscopic lavage group and 25%(n = 17) in the resection group (P = .36). The stoma prevalencewas 8%(n = 4) in the laparoscopic lavage group vs 33% (n = 17; P =.002) in the resection group among patients who remained alive, and secondary operations, including stoma reversal, were performed in 36%(n = 26) vs 35%(n = 24; P = .92), respectively. Recurrence of diverticulitiswas higher following laparoscopic lavage (21% [n = 15] vs 4%[n = 3]; P = .004). In the laparoscopic lavage group, 30%(n = 21) underwent a sigmoid resection. Therewere no significant differences in the EuroQoL-5Dquestionnaire or Cleveland Global Quality of Life scores between the groups.CONCLUSIONS AND RELEVANCE Long-term follow-up showed no differences in severe complications. Recurrence of diverticulitis after laparoscopic lavage was more common, often leading to sigmoid resection. This must be weighed against the lower stoma prevalence in this group. Shared decision-making considering both short-term and long-term consequences is encouraged.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Johanssen, AnetteDepartment of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway,Akershus Univ Hosp, Dept Digest Surg, Lorenskog, Norway. (författare)
  • Sundström, ToveDepartment of Clinical Sciences Malmö, Lund University, Lund, Sweden,Lund Univ, Dept Clin Sci Malmö, Lund, Sweden. (författare)
  • Folkesson, JoakimUppsala universitet,Uppsala University,Gastrointestinalkirurgi,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden(Swepub:uu)jofol839 (författare)
  • Wallon, Conny,1966-Linköping University,Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US,Linköping Univ, Dept Surg, Linköping, Sweden.;Linköping Univ, Dept Clin & Expt Med, Linköping, Sweden.(Swepub:liu)conwa24 (författare)
  • Kørner, HartvigDepartment of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway,Stavanger Univ Hosp, Dept Gastrointestinal Surg, Stavanger, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway. (författare)
  • Blecic, LjiljanaDepartment of Gastrointestinal Surgery, Østfold Hospital, Fredrikstad, Norway,Ostfold Hosp, Dept Gastrointestinal Surg, Fredrikstad, Norway. (författare)
  • Forsmo, Håvard MjørudDepartment of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway,Haukeland Hosp, Dept Gastrointestinal & Emergency Surg, Bergen, Norway. (författare)
  • Øresland, TomFaculty of Medicine, University of Oslo, Oslo, Norway,Univ Oslo, Fac Med, Oslo, Norway. (författare)
  • Yaqub, SherazDepartment of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Dept Gastrointestinal Surg, Oslo, Norway. (författare)
  • Buchwald, PamelaLund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,Surgery,Lund University Research Groups,Department of Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden,Skane Univ Hosp, Dept Surg, Jan Waldenstromsgata 11, S-21428 Malmö, Sweden.;Lund Univ, Dept Clin Sci Malmö, Lund, Sweden.(Swepub:lu)med-pbc (författare)
  • Schultz, Johannes KurtDepartment of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway,Akershus Univ Hosp, Dept Digest Surg, Lorenskog, Norway.(Swepub:lu)jo5150sc (författare)
  • KirurgiForskargrupper vid Lunds universitet (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:JAMA SurgeryChicago, IL, United States : American Medical Association156:2, s. 121-1272168-62542168-6262

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