Early or delayed sigmoid resection in complicated diverticular disease? A single-center experience

Abstract

Summary Background Diverticular disease appears to be one of the most common conditions in the Western world. The standard approach in treatment of diverticular disease is a laparoscopic resection, usually after an inflammation-free time of 4 to 6 weeks. The aim of this study was to evaluate the timing of operation. Materials and methods A total of 61 patients underwent left-sided colonic resection because of diverticular disease between January 2017 and February 2020. Because of complicated diverticulitis (CDD stage 2a or 2b) 37 patients were treated either early within 7 days after first symptoms (group A: n = 17) or delayed about 6 weeks after the first contact and conservative therapy (group B: n = 20). Results Overall mortality was 0%. The average operation time was shorter in the early elective group (group A: 140.4 min vs. group B: 151.2 min; p = 0.29). The hospital stay (group A: 9.9 days vs. group B: 16.9 days) and the postoperative stay (group A: 4.8 days vs. group B: 8.1 days) were significantly longer in group B (p = 0.01). We observed—although not reliable due to the low number of patients—more postoperative complications in the delayed group (group A: 5.9% vs. group B: 15.0%; p = 0.61). Conclusion The data in this study confirm the early operation as safe and efficient due to lower costs. We can recommend an early approach in selected cases with the first episode of a complicated diverticulitis.

The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

“…The initial database research with the previously defined keywords identified 2347 potentially relevant abstracts. Of these, 17 full-text articles were assessed for eligibility and finally, 11 studies (8 retrospective and 3 prospective non-randomized cohort studies) comparing the outcome of operative timing in sigmoid diverticular disease were included in the qualitative and quantitative data analysis [26][27][28][29][30][31][32][33][34][35][36]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the literature search is depicted in Fig.…”

“…Preoperative laboratory findings including inflammatory markers were available in only two studies [ 30 , 36 ]. With the exception of one study in which single-port sigmoidectomy was performed in 88–100% of cases [ 35 ], all remaining studies used the multi-port approach. The study characteristics as well as clinically relevant data are summarized in more detail in Tables 1 and 2 .…”

“…Operative Time The reported duration of the operative procedure was significantly shorter in DE sigmoidectomy in comparison to the EE resection in the 9 included studies [27,28,[30][31][32][33][34][35][36] with a total of 1481 patients (SMD 0.14, 95% CI 0.0020-0.2701, p = 0.0466) (Fig. 4a).…”

“…Over an enrollment period from 2003 to 2021, the 11 included studies from six different countries (USA, Egypt, Switzerland, Austria, and Germany) reported their outcomes of primary minimally invasive sigmoidectomy in the early elective and delayed elective setting. All studies excluded patients with free perforation and peritonitis or patients within septic conditions prior to surgery [26][27][28][29][30][31][32][33][34][35][36]. Other exclusion criteria were initial open surgical approach and previous abdominal surgery.…”

“…Conversion rate as the primary endpoint was reported for all 2096 patients in the 11 included studies without exception [26][27][28][29][30][31][32][33][34][35][36] (Fig. 3a).…”