Background
There are few reports of clinical outcomes or the natural history of definitive diverticular hemorrhage (DDH).
Aims
To describe 1-year clinical outcomes of patients with documented DDH ...treated with colonoscopic hemostasis, angioembolization, surgery, or medical treatment.
Methods
DDH was diagnosed when active bleeding or other stigmata of hemorrhage were found in a colonic diverticulum during urgent colonoscopy or extravasation on angiography or red blood cell (RBC) scanning. This was a retrospective analysis of prospectively collected data of DDH patients from two referral centers between 1993 and 2022. Outcomes were compared for the four treatment groups. The Kaplan–Meier analysis was for time-to-first diverticular rebleed.
Results
162 patients with DDH were stratified based on their final treatment before discharge—104 colonoscopic hemostasis, 24 medical treatment alone, 19 colon surgery, and 15 angioembolization. There were no differences in baseline characteristics, except for a higher Glasgow–Blatchford score in the angioembolization group vs. the colonoscopic group. Post-treatment, the colonoscopic hemostasis group had the lowest rate of RBC transfusions and fewer hospital and ICU days compared to surgical and embolization groups. The medical group had significantly higher rates of rebleeding and reintervention. The surgical group had the highest postoperative complications.
Conclusions
Medically treated DDH patients had significantly higher 1-year rebleed and reintervention rates than the three other treatments. Those with colonoscopic hemostasis had significantly better clinical outcomes during the index hospitalization. Surgery and embolization are recommended as salvage therapies in case of failure of colonoscopic and medical treatments.
Graphical Abstract
Colonoscopic hemostasis is recommended in patients with definitive diverticular hemorrhage for better clinical outcomes. Surgery and embolization are recommended as salvage therapies in case of failure of colonoscopic and medical treatments.
ASSESSING THE SIMILARITIES OF 3D SIMULATION MODEL OUTCOMES
The international archives of the photogrammetry, remote sensing and spatial information sciences/International archives of the photogrammetry, remote sensing and spatial information sciences,
06/2021
Conference Proceeding
The use of Robotic Surgery as a purported adjunct and aid to Minimal Access Surgery (MAS) is growing in several areas. The acknowledged advantages as also the obvious and hidden disadvantages of ...Robotic Surgery are highlighted. Survey of literature shows that while Robotic Surgery is "feasible" and the results are "comparable" there is no convincing evidence that it is any better than MAS or even open surgery in most areas. To move "Robotic Surgery is ready for prime time in India" with no less than two dozen robots, many sub-optimally utilized for a population of 1.2 billion seems untenable.
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