There is still controversy regarding the appropriate management of diverticulitis of the colon in cases when both surgical and conservative treatment may be an option.
Professor Matthew Falagas and colleagues from the USA performed a systematic review.
The research team evaluated the available evidence regarding the outcomes after medical and surgical treatment of diverticulitis.
The researchers assessed studies published after 1980, and indexed in the PubMed database.
|19% receiving medical treatment were readmitted|
|Journal of Gastroenterology and Hepatology|
The team included original studies that reported comparative data for at least 1 outcome in medically- and surgically-treated patients with transverse or left colon diverticulitis.
The main outcomes of interest were mortality, morbidity, and recurrence of diverticulitis after medical or surgical treatment.
The researchers found 21 studies fulfilling the inclusion criteria out of 1360 initially identified as possibly relevant.
More patients were treated conservatively in the included studies (24,862 patients) compared to emergency surgery (6504 patients).
Emergency surgery was the main option for patients with severe complications of diverticular disease, including peritonitis.
The team found in most studies, that in-hospital mortality for patients treated surgically was generally higher than that of patients treated medically.
However, the researchers report that there were insufficient comparative data regarding mortality during follow up.
Readmission to the hospital due to diverticular disease during follow up was more common in the group of patients treated conservatively, occurring in 19%.
The research team observed that 6% of those treated surgically were readmitted to the hospital due to biventricular disease during follow up.
Conservatively-treated patients, with a first or second episode of diverticulitis, required surgery for recurrent disease during follow up in a maximum of 45% of cases.
The research team noted that larger studies reported percentages lower than 11%.
Professor Falagas' team concluded, "It should be emphasized that medical and surgical treatments have not ever been compared in a randomized controlled trial in patients with diverticulitis, without generalized peritonitis that is a surgical emergency."
"Although medical treatment results in more readmissions due to recurrence, it may be reasonable to avoid surgical therapy in the vast majority of patients with acute diverticulitis."
"It is unclear what the best treatment option is for younger patients, namely whether elective surgery should be considered with the first episode of diverticulitis."