ACTUAL CLINICAL APPROACH FOR COMPLICATED DIVERTICULAR DISEASE IN GENERAL SURGERY DEPARTMENT

Abstract

AIM. To revise clinical approaches for patients with complicated diverticular disease used in daily clinical practice in tertiary referral regional center and its compliance with Federal Guidelines. PATIENTS AND METHODS. Twenty-three patients with inflammatory complications of diverticular disease were treated in a General Surgery Department of Regional Hospital of Tumen City in 2015-2016. Preoperative ultrasound was performed for 19 (82.6%) patients, CT - only for 4 (17.4%), laparoscopy - for 13 (56.5%). Seven of them had uncomplicated acute diverticulitis and were treated conservatively. Sixteen (69.6°%) patients underwent Hartmann procedure. Five of them had phlegmonous diverticulitis, 10 - sealed perforation and only 1 - free perforation with fecal peritonitis. RESULTS. According to recent studies in diverticular disease, conservative approach had positive prognosis in 15 of 16 operated patients. All procedures included extended resections with an aim to remove not only inflamed segment of bowel but segments with multiple diverticula as well. Distal part of sigmoid colon was included in specimen in all cases. CONCLUSION. None of recommendations of Federal Guidelines was used in daily clinical practice for patients with diverticular disease and indications for surgery were unreasonably extended in majority of cases. A juridical status of Federal Clinical Recommendations should be increased.