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. 2021 Feb;36(2):227-237.
doi: 10.1007/s00384-020-03762-0. Epub 2020 Sep 28.

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

Gregoire Longchamp  1 , Ziad Abbassi  1 , Jeremy Meyer  1 , Christian Toso  1 , Nicolas C Buchs  1 , Frederic Ris  2
Affiliations

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

Gregoire Longchamp et al. Int J Colorectal Dis. 2021 Feb.

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.

Keywords: Diverticulitis; Postoperative recurrence; Risk factors; Sigmoidectomy.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) flowchart showing selection of publications for review
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