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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
56th Annual Meeting Abstracts


Functional Outcomes Following Surgery for Diverticulitis May be worse than Previously Appreciated
Melissa Levack, MD, Lieba Savitt, MD, David Berger, MD, Paul Shellito, MD, Richard Hodin, MD, David, Rattner, MD, Stanley Godlberg, MD, Liana Bordeianou, MD
Massachusetts General Hospital, Boston, MA

PURPOSE OF STUDY

Bowel function after surgery for diverticulitis has not been described previously in a systematic manner. We surveyed 379 patients who underwent laparoscopic or open sigmoid colectomy with restoration of intestinal continuity from July 2001 through February 2008, in order to document frequency, severity and predictors of suboptimal bowel function.

 

METHODS USED

Of 379 patients, 207 (54.6%) completed all or most of a 70-question survey, including the validated Fecal Incontinence Severity Index (FISI),  Fecal Incontinence Quality of Life Scale (FIQL) and Memorial Bowel Function Instrument (MBFI).  Responders and non-responders were compared (chi square, t-test), and were found to be similar, differing only in age and rates of splenic flexure takedown (table).  Responders who reported suboptimal bowel function (urgency of movements, fecal incontinence, incomplete emptying, need for dietary, medical or life-style adjustments to control symptoms) were then compared to those with good outcomes (Chi square, t-test).  Finally, a logistic regression model was used to determine predictors of poor function.

 

SUMMARY OF RESULTS

193 (94%) responders had ≤ 4 bowel movements/day. 144 (69.6%) had mostly solid bowel movements.  However, 51 (24.4%) reported moderate fecal incontinence (FISI≥ 24); 40 (19.1%) reported symptoms of fecal urgency (MBFI Urgency Subscale ≥ 4); 66 (31.8%) needed to modify diet to regulate their bowel function (MBFI Lifestyle Subscale ≥ 4); 41 (19.6%) reported incomplete emptying (MBFI Emptying Subscale ≥ 4)  and 37 (17.8%) reported a decreased quality of life (FIQL≤ 3).  On logistic regression, only female gender (OR=2.5, p= 0.008) was predictive of these indicators of suboptimal function.  Age, need for diversion, length of bowel removed, splenic flexure takedown and postoperative anastomotic leaks were not predictive.

 

CONCLUSIONS

This is the first study looking at the question of bowel function following surgery for diverticulitis.  Surprisingly, we found that one fifth of patients asked to fill out confidential questionnaires following surgery reported fecal urgency, fecal  incontinence, incomplete emptying or a combination of the above.  These results are worse than previously appreciated, especially in women. The rates of these disturbances are also higher than the rates reported in the general population.  Nevertheless, a prospective study will be needed to account for preoperative function and further delineate actual impact of surgery in these patients.

 

TABLES AND CHARTS

Table 1. Comparison of responders to non-responders

Variable

Responders

Non-responders

P Value

Age (years)

57.4

54.4

0.01*

Gender (% male)

51.5

48.6

0.41

Charlson Comorbidity Index

1.8

1.7

0.66

Emergent surgery for free air/perforation (%)

9.2

6.4

0.32

Elective surgery:

To prevent further attacks (%)

For complicated disease (%)

 

68.6

 

22.2

 

62.2

 

31.4

 

 

0.19

Preoperative intraabdominal abscess (%)

18.4

22.7

0.29

>2 attacks (%)

55

54

0.70

Temporary diversion (%)

10.2 

11.6

0.65

Splenic flexure takedown (%)

57.0

43.6

0.01*

Length of bowel removed (cm)

18.7

18.6

0.76

Anastomotic leak (%)

2.4

2.9

0.7

Postoperative sepsis (%)

1.4

1.2

0.8

Postoperative intraabdominal abscess (%)

5.3

5.2

0.97


 

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