الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Diverticular disease of the colon covers a wide clinical spectrum: from an incidental finding to complicated diverticulitis. A quarter of patients with diverticulitis develop potentially life-threatening complications including perforation, fistulae, stricture, obstruction and abscess formation. The optimal treatment for complicated diverticulitis is a matter of debate and has undergone significant changes with the evolution of surgical techniques and supportive medical care. Over the past several years, research, considering management of complicated diverticulitis, has been incorporated into the management recommendations and guidelines for this challenging disease. However, these guidelines are inclusive, and not prescriptive.
The aim of this study was to analyze the impact of applying practice guidelines on the short-term outcome of management of complicated diverticular disease of the colon.
Methods: 60 patients were included who presented with complicated diverticulitis. Patient demographics, disease manifestation, management, and outcomes were collected. Patients were divided according to the assessment of application of practice guidelines on their management into two groups (group A) managed according to guidelines by colorectal surgeons and (group B) managed by none colorectal surgeons and not necessary according to guidelines. The primary outcome was in-hospital mortality and secondary outcomes were surgical and systemic medical complications. The primary and secondary outcomes between patient’s groups were compared.
Results: There were no significant differences between both groups regarding number of patients (30 in each group), sex (63.3% in group Avs. 66.7% in group B male), mean age (59.83 years in group Avs. 57.70 years in group B), disease presentation, comorbidities, previous abdominal surgery, hypoalbuminemia, BMI, ASA grade and affected site of the colon. Patients in group B had a significantly higher overall morbidity, surgical and medical complications as incidence of postoperative complications as wound complications, intra-abdominal sepsis, intestinal obstruction, septicemia, chest infection and the need for re-intervention and postoperative diversion. Mortality rate in group Awas 3.3% compared with 6.7% in group B; however, this did not reach statistical significance (p = 0.353). The mean Hospital stay in group A(5.0 ± 0.53 days) was significantly shorter than in group B (8.17 ± 4.41 days) (p= 0.001).
Conclusions: Complicated diverticular disease of the colon imposes a serious risk for patient’s life and challenge to surgeons. Applying the ASCRS practice guidelines on the management of complicated diverticular disease showed significantly better outcome when compared to situations where the surgeons are reluctant to commit to these guidelines.
Improved surgical results with decreased morbidity, recurrence of the disease as well as mortality in our series confirmed the necessity to commit to evidence–based practice. Colorectal surgeons are found to be more committing to practice guidelines in management of complicated diverticular disease than non specialized surgeons in terms of patient evaluation, investigation, decision making and executing proper surgical steps. Eventually they are expected to enjoy better results for their patients. Practice guidelines for management of complicated diverticular disease should be respected. Moreover, they should be dynamically and continuously monitored and revisited to cope with updates in diagnostic and therapeutic modalities as well as our national parameters, peculiarities of the disease and health care system.