New insights in the management of (uncomplicated) diverticulitis: towards more cost-effective diverticulitis care

A surgeon sees on average 1-2 diverticulitis patients per week in the emergency department. Despite this high incidence, there are still many mysteries regarding this disease that remain unsolved. In order to improve the quality, as well as the cost-effectiveness of diverticulitis care, this thesis tried to solve some of these mysteries. The paradigm of diverticulitis treatment is shifting towards a more conservative approach where uncomplicated diverticulitis patients are treated at home without antibiotics. In this thesis we take it even a step further by stating that patients with isolated pericolic air can be considered as uncomplicated diverticulitis and treated as such. Moreover, patients with small abscesses can (<3cm) be treated without percutaneous drainage or surgical intervention and there are indications that percutaneous abscess drainage is also not always mandatory in large abscesses (≥3cm). To safely implement a conservative outpatient treatment strategy without antibiotics, we need be able to select those patients who are at higher risk of complications and therefore not suitable for such a treatment strategy. In this thesis we developed tools which clinical physicians can use to help them in the decision whether or not to refer and/or admit a diverticulitis patient and whether or not to start antibiotic treatment. Furthermore we analyzed the optimal treatment strategy in patients with recurrent diverticulitis and/or ongoing complaints. Based on our studies we advise to offer surgery more frequently to patients presenting with recurrent diverticulitis and/or ongoing complaints as surgical intervention improves quality of life and is also proven to be cost-effective.