Surgical resection does not avoid the risk of diverticulitis recurrence—a systematic review of risk factors

Abstract

Purpose Fifteen percent of patients undergoing elective sigmoidectomy will present a diverticulitis recurrence, which is associated with significant costs and morbidity. We aimed to systematically review the risk factors associated with recurrence after elective sigmoidectomy. Methods PubMed/MEDLINE, Embase, Cochrane, and Web of Science were searched for studies published until May 1, 2020. Original studies were included if (i) they included patients undergoing sigmoidectomy for diverticular disease, (ii) they reported postoperative recurrent diverticulitis, and (iii) they analyzed ≥ 1 variable associated with recurrence. The primary outcome was the risk factors for recurrence of diverticulitis after sigmoidectomy. Results From the 1463 studies initially screened, six studies were included. From the 1062 patients included, 62 patients recurred (5.8%), and six variables were associated with recurrence. Two were preoperative: age (HR = 0.96, p = 0.02) and irritable bowel syndrome (33.3% with recurrence versus 12.1% without recurrence, p = 0.02). Two were operative factors: uncomplicated recurrent diverticulitis as indication for surgery (73.3% with recurrence versus 49.9% without recurrence, p = 0.049) and anastomotic level (colorectal: HR = 11.4, p = 0.02, or colosigmoid: OR = 4, p = 0.033). Two were postoperative variables: the absence of active diverticulitis on pathology (39.6% with recurrence versus 26.6% without recurrence) and persistence of postoperative pain (HR = 4.8, p < 0.01). Conclusion Identification of preoperative variables that predict the occurrence of diverticulitis recurrence should help surgical decision-making for elective sigmoidectomy, while peri- and postoperative factors should be taken into account for optimal patient follow-up.

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“…Six factors related to recurrence after bowel resection with diverticulitis were identified: younger age and irritable bowel syndrome (preoperative); anastomotic level and uncomplicated recurrent diverticulitis (operative); absence of active diverticulitis on pathology and persistence of postoperative pain (postoperative). According to the results of this study, elective surgery prevents diverticulitis recurrence or colostomy risk 78 …”

“…According to the results of this study, elective surgery prevents diverticulitis recurrence or colostomy risk. 78 …”

Novel patch biomaterial treatment for colon diverticulosis in swine model

“…Except for colectomy to remove diseased colon permanently, current leading managements for diverticular disease including medication and endoscopic/laparoscopic surgery cannot prevent the occurrence/recurrence of diverticulitis, bleeding and/or other complications ( Cirocchi et al, 2015 ; Yamada et al, 2015 ; Kaushik et al, 2016 ; Longchamp et al, 2021 ). Developing more effective minimally invasive approaches leading to less complications and lower diverticulosis recurrence are urgently needed both for patients and the healthcare system.…”

Recurrence of diverticulitis after prophylactic sigmoidectomy: an underestimated problem?

“…In a recent review of six studies including 1062 patients operated on for diverticulitis, the rate of PRD was 5.8%. The authors identified six perioperative variables associated with recurrence: younger age [hazard ratio (HR) = 0.96, 95% CI = 0.93–0.99, p = 0.02], preoperative irritable bowel syndrome (33% vs. 12%, p = 0.02), uncomplicated recurrent diverticulitis as the indication for surgery (73% vs. 50%, p = 0.049), colosigmoid anastomosis (OR = 4, 95% IC = 1.1–15, p = 0.033), absence of active diverticulitis on pathology (40% vs. 27%, p = 0.01) and persistence of postoperative pain (HR = 4.8, 95% CI = 1.8–12.5, p < 0.01) [22]. However, this review presented some bias: it included a heterogeneous group of patients with inclusion of both elective and emergent indications, open and laparoscopic approaches and an absence of multivariate analysis.…”

“…p < 0.05 was considered as significant (in bold). Risk of recurrence according to the presence of independent predictive factors (more than two episodes of diverticulitis before surgery and age < 50 years) = 4, 95% IC = 1.1-15, p = 0.033), absence of active diverticulitis on pathology (40% vs. 27%, p = 0.01) and persistence of postoperative pain (HR = 4.8, 95% CI = 1.8-12.5, p < 0.01)[22].However, this review presented some bias: it included a heterogeneous group of patients with inclusion of both elective and emergent indications, open and laparoscopic approaches and an absence of multivariate analysis. In another study including 361 patients undergoing laparoscopic PS, PRD was observed in 4.2%.A preoperative diagnosis of irritable bowel syndrome [n = 5/15 (33.3%) with recurrence versus n = 42/344 (12.1%) without recurrence, p = 0.02] and uncomplicated recurrent episodes of diverticulitis before surgery [n = 11/15 (73%) versus n = 171/346 (49%), p = 0.049] were significantly associated with PRD in univariate analysis but not after multivariate analysis[13].Young age as a risk factor for recurrence of diverticulitis after conservative medical treatment has been debated for a long time among surgeons.…”