Recurrence of Acute Right Colon Diverticulitis Following Nonoperative Management: A Systematic Review and Meta-analysis

Abstract

BACKGROUND: There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis. OBJECTIVE: The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management. DATA SOURCES: PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019. STUDY SELECTION: Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available. INTERVENTIONS: Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered. MAIN OUTCOME MEASURES: The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model. RESULTS: There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%–15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%–15%)) or heterogeneity. Funnel plot assessment revealed no publication bias. LIMITATIONS: There were no randomized controlled trials available. The statistical heterogeneity was moderate (I 2 = 46%). CONCLUSIONS: Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon. PROSPERO: CRD42019131673

Colonic diverticulitis location is a risk factor for recurrence: a multicenter, retrospective cohort study in Asian patients

“…Stratified by the location, the cumulative recurrent rates in right-sided diverticulitis was 8%, 46% in the descending colon, and 68% in the sigmoid colon (Tale 2). As compared with the meta-analysis conducted by Lee et al, the recurrence rate of right-sided diverticulitis was relatively lower (12% in the meta-analysis) 17 . One of the possible reasons is ethnicity.…”

Right sided diverticulitis in western countries: A review

“…The first study[ 60 ] focused on the fact that only 4.4% of recurrences were complicated and there was only a 1.7% of re-recurrence rate. While the second[ 61 ] showed that only a small percentage of patients underwent surgery after recurrence (9.9% as urgent cases, 5.4% as elective cases). Both authors conclude that NOM is safe and feasible for Hinchey 1b-2 stages, similarly to the management of uncomplicated left-sided diverticulitis, while surgery should only be performed in selected cases.…”

Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery

“…[1][2][3][4] Similar to the more common sigmoid diverticulitis, nonoperative treatment methods are preferred for the vast majority of patients presenting with uncomplicated disease. [2][3][4] Albeit acute RCD tends to present a lower rate of complicated disease than left-sided diverticulitis, surgical resection is generally used in the treatment of complicated cases owing to a high recurrence rate ( > 60%) and a significant risk of developing local complications such as fistula, chronic abscess, and stenosis. 4,5 Though surgery for acute RCD is currently safer than in the past, the right-sided disease is still associated with significantly higher mortality among patients undergoing colectomy for acute diverticulitis.…”