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Multicentre study of non-surgical management of diverticulitis with abscess formation.

ABSTRACT: This multicentre retrospective cohort study included 447 patients with Hinchey Ib and II diverticular abscesses, who were treated with antibiotics, with or without percutaneous drainage. Abscesses of 3 and 5?cm in size were at higher risk of short-term treatment failure and emergency surgery respectively. Initial non-surgical treatment of Hinchey Ib and II diverticular abscesses was comparable between patients treated with antibiotics only and those who underwent percutaneous drainage in combination with antibiotics, with regard to short- and long-term outcomes. Most do not need drainage.

SUBMITTER: Lambrichts DPV

PROVIDER: S-EPMC6593757 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Multicentre study of non-surgical management of diverticulitis with abscess formation.

Lambrichts D P V DPV Bolkenstein H E HE van der Does D C H E DCHE Dieleman D D Crolla R M P H RMPH Dekker J W T JWT van Duijvendijk P P Gerhards M F MF Nienhuijs S W SW Menon A G AG de Graaf E J R EJR Consten E C J ECJ Draaisma W A WA Broeders I A M J IAMJ Bemelman W A WA Lange J F JF

The British journal of surgery 20190301 4

This multicentre retrospective cohort study included 447 patients with Hinchey Ib and II diverticular abscesses, who were treated with antibiotics, with or without percutaneous drainage. Abscesses of 3 and 5 cm in size were at higher risk of short-term treatment failure and emergency surgery respectively. Initial non-surgical treatment of Hinchey Ib and II diverticular abscesses was comparable between patients treated with antibiotics only and those who underwent percutaneous drainage in combina ...[more]

PMID: 30811050

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Project description:IntroductionPerianal fistula is a burdening disease with an annual incidence of 6-12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal abscess. Despite adequate drainage, up to 83% recur or result in an anal fistula, the majority developing within 12 months. There is some evidence that gut-derived bacteria play a role in the development of perianal fistula. Up till now, it is not common practice to routinely administer prophylactic antibiotics to prevent anal fistula development. There is a need for a study to establish whether adding antibiotic treatment to surgical drainage of perianal abscess results in a reduction in perianal fistulas.Methods and analysisThis multicentre, double-blind, randomised, placebo-controlled trial investigates whether addition of antibiotics (ciprofloxacin and metronidazole) to surgical drainage of a perianal abscess is beneficial compared with surgical drainage alone. The primary outcome is the development of a perianal fistula within 1 year. Secondary outcomes include quality of life, treatment costs, need for repeated drainage, patient-reported outcomes and other clinical outcomes. Participants are recruited in one academic and seven peripheral Dutch clinics. To demonstrate a reduction of perianal fistula from 30% to 15% when treated with adjuvant antibiotics with a two-sided alpha of 0.05, a power of 80% and taking a 10% loss to follow-up percentage into account, the total sample size will be 298 participants. Data will be analysed according to the intention-to-treat principle.Ethics and disseminationThe study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers (nr. 2021_010). Written consent is obtained from each participant prior to randomisation into the study. The results of this trial will be submitted for publication in international peer-reviewed journals, presented at conferences and spread to coloproctological associations.Trial registration numbers2020-004449-35; NCT05385887.

Dataset Information

Multicentre study of non-surgical management of diverticulitis with abscess formation.

Publications

Multicentre study of non-surgical management of diverticulitis with abscess formation.

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