Retrospective Study
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World J Gastroenterol. Aug 7, 2014; 20(29): 10115-10120
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10115
Surgical management of colonic diverticular disease: Discrepancy between right- and left-sided diseases
Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park
Heung-Kwon Oh, Eon Chul Han, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea
Author contributions: Oh HK and Park KJ conceived and designed the study; Oh HK, Ha HK, Choe EK, Moon SH, Ryoo SB and Park KJ conducted the research; Oh HK, Han EC and Ha HK collected and analyzed the data; Oh HK, Jeong SY and Park KJ drafted the manuscript; Oh HK, Han EC, Choe EK, Moon SH, Ryoo SB and Park KJ reviewed and modified the manuscript.
Correspondence to: Kyu Joo Park, MD, PhD, Professor, Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea. kjparkmd@plaza.snu.ac.kr
Telephone: +82-2-20722901 Fax: +82-2-7663975
Received: March 23, 2014
Revised: May 4, 2014
Accepted: June 21, 2014
Published online: August 7, 2014
Abstract

AIM: To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.

METHODS: The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients.

RESULTS: The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P < 0.05). Moreover, no differences in gender, body mass index, multiplicity of the diverticula, fever, or leukocytosis were noted between patients with right-sided and left-sided disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P < 0.01). Furthermore, left-sided disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P < 0.01), combined resection due to extensive inflammation (21.6% vs 5.0%, P < 0.05), operative complications (51.4% vs 27.5%, P < 0.05), and in-hospital mortality (10.8% vs 0%, P < 0.05), along with longer post-operative hospitalization duration (21.3 ± 10.2 d vs 10.6 ± 8.1 d, P < 0.05).

CONCLUSION: Compared with right-sided diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.

Keywords: Colonic diverticulosis, Diverticular bleeding, Diverticulitis, Poor surgical outcome, Left-sided diverticulitis

Core tip: In Asian countries, including South Korea, diverticulosis is relatively rare and usually detected on the right side of the colon. In the present study, the outcome of the surgical management of left-sided and right-sided diverticular disease was assessed. The results demonstrate that the incidence of left-sided diverticular disease in South Korea is increasing. Furthermore, left-sided disease is generally more severe than right-sided disease and associated with worse surgical outcomes.