Abstract
PurposeThe German Classification of Diverticular Disease was introduced a few years ago. The aim of this study was to determine whether Classification of Diverticular Disease enables an exact stratification of different types of diverticular disease in terms of course and treatment.MethodsThis was a prospective, bicentric observational trial. Patients aged ≥ 18 years with diverticular disease were prospectively included. The primary endpoint was the rate of recurrence within 2 year follow-up. Secondary outcome measures were Gastrointestinal Quality of Life Index, Quality of life measured by SF-36, frequency of gastrointestinal complaints, and postoperative complications.ResultsA total of 172 patients were included. After conservative management, 40% of patients required surgery for recurrence in type 1b vs. 80% in type 2a/b (p = 0.04). Sixty percent of patients with type 2a (micro-abscess) were in need of surgery for recurrence vs. 100% of patients with type 2b (macro-abscess) (p = 0.11). Patients with type 2a reached 123 ± 15 points in the Gastrointestinal Quality of Life Index compared with 111 ± 14 in type 2b (p = 0.05) and higher scores in the “Mental Component Summary” scale of SF-36 (52 ± 10 vs. 43 ± 13; p = 0.04). Patients with recurrent diverticulitis without complications (type 3b) had less often painful constipation (30% vs. 73%; p = 0.006) when they were operated compared with conservative treatment.ConclusionDifferentiation into type 2a and 2b based on abscess size seems reasonable as patients with type 2b required surgery while patients with type 2a may be treated conservatively. Sigmoid colectomy in patients with type 3b seems to have gastrointestinal complaints during long-term follow-up.Trial registrationhttps://www.drks.de ID: DRKS00005576
Highlights
MethodThe prevalence of diverticulosis and diverticular disease (DD) is rising in the western population
It is associated with increasing age—approximately 5% of the population under the age of 40 suffer from diverticulosis or DD and up to 65% of people aged 65 or more [1]
The internationally used modified Hinchey classification provides a detailed analysis of perforated diverticulitis irrespective of the abscess size and does not include uncomplicated and chronic recurrent types of diverticular disease [4]
Summary
The prevalence of diverticulosis and diverticular disease (DD) is rising in the western population It is associated with increasing age—approximately 5% of the population under the age of 40 suffer from diverticulosis or DD and up to 65% of people aged 65 or more [1]. Patients with diverticulosis suffer from acute diverticulitis in 10–25% in the course of their lifetime. Another 15–20% with acute diverticulitis develop complications such as perforation, abscess, fistula, or stenosis [2]. The internationally used modified Hinchey classification provides a detailed analysis of perforated diverticulitis irrespective of the abscess size and does not include uncomplicated and chronic recurrent types of diverticular disease [4]
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