Current management of diverticulitis.

Am Surg. 2008 Nov;74(11):1041-9

Authors: McCafferty MH, Roth L, Jorden J

Diverticulitis is classified as uncomplicated or complicated, i.e., associated with perforation, fistula, or obstruction. CT allows more reliable characterization of an acute attack of diverticulitis. Medical management is reserved for uncomplicated diverticulitis and the initial phase of treatment of diverticulitis associated with abscess formation. Percutaneous abscess drainage is a major advance, which permits one-stage resection in a majority of cases. Diverticulitis associated with free perforation can be selectively managed with resection and primary anastomosis, although a Hartmann resection is likely to be performed. A fistula associated with diverticulitis can usually be managed with a one-stage resection. Obstruction can be managed selectively with resection with on-table bowel preparation, primary anastomosis, and proximal diversion. Laparoscopic techniques permit successful performance of elective resections most of the time. Hand assistance is of particular value when the patient has dense fibrosis.

PMID: 19062658 [PubMed - indexed for MEDLINE]

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Shared by Robert Mahoney

Link: http://wustl.library.ingentaconnect.com/content/sesc/tas/2008/00000074/00000006/art00009?token=0057190cabec0550a6e58654624404442314735217a7867442e5e4e26634a492f253033297653868ab98ba9
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Can the MELD score predict perioperative morbidity for patients with liver cirrhosis undergoing laparoscopic cholecystectomy?

Am Surg. 2008 Feb;74(2):156-9

Authors: Bingener J, Cox D, Michalek J, Mejia A

The Model for End Stage Liver Disease (MELD) score is a mortality predictor in patients awaiting liver transplantation. We evaluated the MELD score's ability to predict morbidity for patients with cirrhosis undergoing laparoscopic cholecystectomy. From March 1991 to February 2004, data of all patients undergoing laparoscopic cholecystectomy were prospectively collected. Data of patients with liver cirrhosis were reviewed. The MELD and Child scores were correlated with outcome variables. Of 7859 patients undergoing laparoscopic cholecystectomy, 99 patients (1.3%) exhibited liver cirrhosis, 44 women and 55 men. The mean age was 55 years (range, 28 to 92 years). The mortality rate was 6.3 per cent, morbidity rate 18 per cent, and conversion rate 11 per cent. Laboratory values on 55 patients were available to calculate MELD scores. The mean MELD score was 11 (range, 6 to 23). There was no significant variation in MELD scores with gender (P = 0.61) or cirrhosis etiology, alcoholic and nonalcoholic (P = 0.52). MELD and Child's score correlated well (P < 0.001); however, the risk of complication was not related to the MELD (P = 0.94) or Child-Pugh-Turcotte score (P = 0.26). Morbidity for patients with liver cirrhosis undergoing laparoscopic cholecystectomy remains high. The MELD score is useful for transplant risk stratification for but requires further investigation regarding morbidity prediction for laparoscopic cholecystectomy.

PMID: 18306870 [PubMed - indexed for MEDLINE]

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