Patient-reported Outcomes After Conservative or Surgical Management of Recurrent and Chronic Complaints of Diverticulitis: Systematic Review and Meta-analysis

Abstract

On the basis of a systematic review and meta-analysis, patients have better QOL and fewer symptoms after laparoscopic surgery vs conservative treatment. However, studies of PROs for treatment of diverticulitis were of low quality.

Severity of Diverticulitis Does Not Influence Abdominal Complaints during Long-Term Follow-Up

“…In recent years, it has become increasingly evident that individual patient factors are of significant importance when deciding whether colonic resection for diverticular disease should be performed or not. Different authors have shown that in carefully selected patients, elective surgery improves the quality of life compared to conservative therapy, although obviously the risk of complications should always be considered [34-36]. Recent results of the direct-direct trial confirm this, showing that elective sigmoidectomy, despite its inherent risk of complications, results in better quality of life than conservative management in patients with recurrent and persisting abdominal complaints after an episode of diverticulitis [28].…”

Recurrent Acute Diverticulitis: When to Operate?

“…Readmission rate for recurrent diverticulitis ranges from 9 to 25% [6, 8, 11-13] (Table 2). After a follow-up of 4 years, El Sayed et al [6], in an English study of over 65,000 patients managed nonoperatively for their first episode of diverticulitis, found the recurrence rate to be around 11.2%.…”

“…There is no high-level evidence to support either conservative management or surgical treatment for recurrent diverticulitis. Some studies have shown a lower incidence of persisting symptoms after elective resection compared to conservative management (95 vs. 36%, respectively) [13]. A meta-analysis by Andeweg et al [13] in 2016 showed that patients who underwent resection had a better mean SF-36 score (73.4 vs. 58.2) and a lower occurrence of chronic abdominal pain (11 vs. 38%) compared to those who were managed conservatively.…”

“…This occurs despite complete remission and is a major economic burden amongst diseases of the gut. Additionally, 36% of people have ongoing abdominal symptoms after the first episode of diverticulitis [11-13]. As the incidence of diverticulitis increases, one would infer that recurrent attacks would begin to increase in frequency.…”

Enfermedad diverticular: mitos y realidades

“…Estudios han demostrado que la calidad de vida después de una cirugía electiva no difiere al compararla con el grupo tratado con cirugía de urgencia o terapia farmacológica 72 . Sin embargo, un metaanálisis señala que la calidad de vida en pacientes con diverticulitis no complicada es mejor post-cirugía laparoscópica versus tratamiento conservador 73 . Pese a esta controversia, es importante considerar que 22% de los pacientes puede persistir con síntomas digestivos post-cirugía, < 5% de las recurrencias serán complicadas después de un episodio de DA no complicada y, finalmente, el número de episodios de recurrencia no tiene relación con el riesgo de complicaciones 74 .…”