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Invited Critique |

Clarity, Confusion, or Conundrum:  Comment on “Trends in Diverticulitis Management in the United States From 2002 to 2007”

David A. Rothenberger, MD
Arch Surg. 2011;146(4):406. doi:10.1001/archsurg.2011.58.
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It is not a surprise that Masoomi and colleagues documented that patients hospitalized for diverticulitis between 2002 and 2007 continue to experience significant morbidity. What may be surprising to many is that their analysis of more than a million patients in the NIS database revealed an unexplained dramatic increase of 38% in elective colectomy and a 4.3% increase in urgent colectomy. This occurred despite a growing consensus that indication(s) for surgery should be more restricted than in the past. Additionally, it is surprising that they could only discern “a trend toward increased use of laparoscopic techniques for elective operations and primary anastomosis for urgent operations.” This conclusion flies in the face of anecdotes that “nearly everyone” is successfully using laparoscopic resection and primary anastomosis for diverticulitis. The facts, as reported in this retrospective trends analysis, are that laparoscopic colectomy increased to only 13.5% for elective cases and a mere 3.9% for urgent surgery by 2007. Primary anastomosis with or without diversion increased from 38.8% in 2002 to 46% in 2007 following urgent surgery. Etzioni et al,1 in a similar study of trends from 1998 to 2005, reported “little change over time in the likelihood of a primary anastomosis” after resection for diverticulitis.

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