Divergent viewpoints focusing on the management of diverticulitis will be the subject of two debates in today’s session, “The Great Diverticulitis Debates: Conservative Treatment vs. Resection; Primary Anastomosis vs. Stoma,” at 4:15 pm in Room W-375b.
Diverticulitis affects a significant portion of the population with rates ranging from 5% for those under 40, to 50% for individuals older than 60 years of age. While perforation is much less common, it is a more serious complication with a six-fold greater risk of first-year mortality.
“Diverticulitis is a common disease that many surgeons face,” said comoderator Virginia L. Shaffer, MD, FACS. “Notably, treatment for diverticulitis has changed so much since the time of Ernst Graser, William J. Mayo, MD, and John Lockhart-Mummery, MD, each of whom were instrumental in shaping our understanding and treatment of diverticulitis starting in the late 1800s—and that knowledge is continuing to evolve, with some topics experiencing a full-circle moment.”
The first debate will address whether perforation necessitates resection or whether conservative nonoperative management is appropriate after resolution of the acute event. In addition, panelists will delve into the role of laparoscopic lavage for these patients.
The use of primary anastomosis as the optimal surgical option for patients with perforated diverticulitis will be the subject of the second debate. The speakers will review the role of the Hartmann’s procedure as well as primary anastomosis with and without diversion.
Topics were selected by moderators from current literature and “word on the street conversations via hospital hallways or operating room lounges,” according to Dr. Shaffer, and have been known to spark vigorous debate among clinicians for a variety of reasons.
“The topics are polarizing because there are some data to support each of the approaches,” explained Dr. Shaffer. “It shows that the field of surgery is evolving and not dogmatic. The differing viewpoints also have to do with training and comfort level with each technique. The experts will bring a diverse training background, as well a diverse patient practice to both debates.”
In this 90-minute session, each side is allotted 10-12 minutes to present their case, which is followed by a debate among panelists and, ideally, attendees.
“It can be challenging to listen intently to an hour-long presentation, but the hope is that the change in speakers and topics will continue to engage and awaken curiosity on the part of the audience,” said Dr. Shaffer.
No matter what side of a debate attendees gravitate toward, each presentation is structured to help clinicians demystify complex medical information for patients regarding the management of perforated diverticulitis.
“I hope the information presented in this session will help contribute to the best possible individualized shared decision-making with patients,” Dr. Shaffer said.
