Actualización de las lineas terapeuticas de la diverticulitis , diverticulosis y otros aspectos de la enfermedad diverticular.Mas información en http://www.dr-francisco-alba-mesa.es/

1. Hospital San Juan de Dios del Aljarafe Francisco Alba Mesa Abril 2011 Actualización en Enfermedad Diverticular del Colon

2. CRITERIOS CLASICOS PARA CIRUGIA ELECTIVA: 1) ¿Dos episodios de diverticulitis no complicada?, pero: -Solo el 1,5 % de estos pacientes presentarian un perforacion secundaria a diverticulitis. -La mayoria de los pacientes que debutan con una diverticulitis complicada no han presentado episodios de diverticulitis no complicada previa. -Tras el primer ataque el tratamiento debe ser conservador, la cirugía electiva se considera después de un segundo ataque, pero en pacientes inmunocomprometidos* * DIVERTICULITIS TRATAMIENTO QUIRURGICO ELECTIVO

3. Practice Parameters for Diverticulitis from the American Society of Colon and Rectal Surgery states that “the number of attacks of uncomplicated diverticulitis is not necessarily an overriding factor in defining the appropriateness of surgery”. Dos episodios de diverticulitis no complicada no es una indicación para cirugía electiva* Chapman J, Davies M, Wolff B, Dozois E, Tessier D, Harr- ington J, Larson D. Complicated diverticulitis: is it time to rethink the rules? Ann Surg 2005; 242: 576-581; discussion 581-583 Salem TA, Molloy RG, O'Dwyer PJ. Prospective study on the management of patients with complicated diverticular disease. Colorectal Dis 2006; 8: 173-176 * DIVERTICULITIS TRATAMIENTO QUIRURGICO ELECTIVO

5. “ Based on the available contemporary data there does not seem to be sufficient justification to recommend elective surgery after one attack of sigmoid diverticulitis in younger patients and rather the disease should be treated similarly in both younger and older patients depending on its severity and inclination to recurrence.” ¿Pacientes menores de 50 años con un solo episodio de diverticulitis no complicada? Current indications and role of surgery in the managementof sigmoid diverticulitis.Luca Stocchi. DCR. Febrero 2010 “ Los pacientes jóvenes con diverticulitis, debe estar sujetos a los mismos criterios utilizados para pacientes de edad avanzada”. DIVERTICULITIS TRATAMIENTO QUIRURGICO ELECTIVO

7. Thus suggested by some authors resection after two or three episodes of uncomplicated diverticulitis therefore needs to be reconsidered and should be limited to patients at risk with co-morbity like diabetes, collagenous disease and the immune compromised patient. Review article: management of diverticulitisM. M. SZOJDA, M. A. CUESTA, C. M. MULDER & R. J. F. FELT-BERSMA. 2007 Cirugía electiva ¿ a quién?

15. BIBLIOGRAFIA : Stocchi, Luca. " Current indications and role of surgery in the management of sigmoid diverticulitis ." World Journal of Gastroenterology 16.7 (2010):804. Mueller, M.H.a; Glatzle, J.b; Kasparek, M.S.b; Becker, H.D.b; Jehle, E.C.b; Zittel, T.T.b; Kreis, Martin E. “ Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon ”. European Journal of Gastroenterology & Hepatology: June 2005 - Volume 17 - Issue 6 - pp 649-654 Farthmann E.H.;Ruckauer K.D.;Haring R.U . “Evidence-based surgery: diverticulitis – a surgical disease? ”.Langenbeck´s archives of Surgery.Volume 385, Number 2, 143-151 Janes S. ; Meagher A. ; Frizelle F. A. “Elective surgery after acute diverticulitis” .British Journal of Surgery, Volume 92-Issue 2, pages 133–142, February 2005 R. Scott Nelson, Alfonso Velasco and Bickol N. Mukesh “ Management of Diverticulitis in Younger Patients ”.Diseases of The Colon & Rectum, Volume 49, Number 9, 1341-1345