Elective surgical versus conservative management of complicated diverticulitis: A systematic review and meta‐analysis

Yeow, Marcus; Syn, Nicholas; Chong, Choon Seng

doi:10.1111/1751-2980.13076

Cited by 2 publications

(4 citation statements)

References 23 publications

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“…Particularly, there has been increasing interest in the role of biological markers as non-invasive and reliable tools, able to support physicians in diagnosis, assessment of activity, monitoring the potential development of complications, and predicting recurrence in AD, as already reported widely for inflammatory bowel disease (IBD), and grounded on recent data suggesting continuous chronic inflammation in patients after an episode of AD [7,52,[59][60][61][62]. LCT count was not found to be sensitive nor specific for the diagnosis of AD and its severity, while CRP has been demonstrated to be the best laboratory marker for diagnosis and prognosis [46]. In fact, countless studies indicated that CRP levels correlate with the disease's severity and recurrence rates [52,59,[63][64][65][66][67].…”

Section: Assessment Of Predictive Factors For Severity and Recurrencementioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

“…Regarding the approach, laparoscopy is safe in the setting of elective surgery for diverticular disease and is associated with reduced rates of morbidity and length of stay compared to open surgery [46]. So, laparoscopic colectomy is recommended when feasible and when there is expertise available [18,46]. The timing is still unclear, and limited evidence suggests no difference in morbidity or mortality when comparing early (< 6 weeks) versus late (> 6 weeks) elective resection for diverticular disease, although with a trend to a higher rate of conversion in early surgery.…”

Section: Introductionmentioning

confidence: 99%

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The role of elective surgery: Which patients should be selected?

Sampaio,

D. Santos

2023

Diverticular Bowel Disease - Diagnosis and Treatment

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Although the incidence of acute diverticulitis (AD) has risen over the past few decades, particularly in younger patients, the rate of emergency surgery has been dropping due to a major paradigm shift toward more conservative management approaches. The long-term management strategy after successful nonoperative treatment of AD remains unclear, and indications for elective resection are a matter of ongoing debate. Most modern professional guidelines advise considering elective surgery in an individualized approach, particularly after recovery of acute complicated diverticulitis (ACD) with abscess and in patients with recurrence, persisting symptoms, and complications such as abscess, fistula, and stenosis, focusing on the patient’s quality of life, where recurrence, severity, and symptoms are major determinants. However, guidelines are still not clearly standardized for appropriate decision-making, with patients being managed very differently from institution to institution, and surgeon to surgeon, mainly due to a lack of risk stratification for recurrence and severity that have been the scope of numerous studies but still need to be clarified. In this chapter, we explore the current surgical indications for AD, considering this disease’s ongoing prognostic factors, for proper decision-making.

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Section: Assessment Of Predictive Factors For Severity and Recurrencementioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The role of elective surgery: Which patients should be selected?

Sampaio,

D. Santos

2023

Diverticular Bowel Disease - Diagnosis and Treatment

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“…There is a lifetime risk from 10 to 25% of developing diverticulitis in those diagnosed with diverticulosis, and it is associated with substantial healthcare burden and morbidity [ 5 ]. About 12% of diverticulitis cases are complex, involving abscess, fistula, stricture, or perforation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Do Colonic Mucosal Tumor Necrosis Factor Alpha Levels Play a Role in Diverticular Disease? A Systematic Review and Meta-Analysis

Sabo

Ismaiel

et al. 2023

IJMS

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Diverticular disease (DD) is the most frequent condition in the Western world that affects the colon. Although chronic mild inflammatory processes have recently been proposed as a central factor in DD, limited information is currently available regarding the role of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Therefore, we conducted a systematic review and meta-analysis aiming to assess the mucosal TNF-α levels in DD. We conducted a systematic literature search using PubMed, Embase, and Scopus to identify observational studies assessing the TNF-α levels in DD. Full-text articles that satisfied our inclusion and exclusion criteria were included, and a quality assessment was performed using the Newcastle–Ottawa Scale (NOS). The principal summary outcome was the mean difference (MD). The results were reported as MD (95% confidence interval (CI)). A total of 12 articles involving 883 subjects were included in the qualitative synthesis, out of which 6 studies were included in our quantitative synthesis. We did not observe statistical significance related to the mucosal TNF-α levels in symptomatic uncomplicated diverticular disease (SUDD) vs. the controls (0.517 (95% CI −1.148–2.182)), and symptomatic vs. asymptomatic DD patients (0.657 (95% CI −0.883–2.196)). However, the TNF-α levels were found to be significantly increased in DD compared to irritable bowel disease (IBS) patients (27.368 (95% CI 23.744–30.992)), and segmental colitis associated with diverticulosis (SCAD) vs. IBS patients (25.303 (95% CI 19.823–30.784)). Between SUDD and the controls, as well as symptomatic and asymptomatic DD, there were no significant differences in the mucosal TNF-α levels. However, the TNF-α levels were considerably higher in DD and SCAD patients than IBS patients. Our findings suggest that TNF-α may play a key role in the pathogenesis of DD in specific subgroups and could potentially be a target for future therapies.

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Elective surgical versus conservative management of complicated diverticulitis: A systematic review and meta‐analysis

Cited by 2 publications

References 23 publications

The role of elective surgery: Which patients should be selected?

The role of elective surgery: Which patients should be selected?

Do Colonic Mucosal Tumor Necrosis Factor Alpha Levels Play a Role in Diverticular Disease? A Systematic Review and Meta-Analysis

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