Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Ali Yasen Mohamedahmed; Shafquat Zaman; Niloy Das; Georgios Kakaniaris; Stelios Vakis; James Eccersley; Pradeep Thomas; Najam Husain

doi:10.1007/s00384-024-04618-7

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Int J Colorectal Dis. 2024 Apr 5;39(1):47. doi: 10.1007/s00384-024-04618-7.

Authors

Ali Yasen Mohamedahmed^#¹, Shafquat Zaman^#^{2

3}, Niloy Das¹, Georgios Kakaniaris¹, Stelios Vakis¹, James Eccersley¹, Pradeep Thomas¹, Najam Husain¹

Affiliations

¹ Department of General and Colorectal Surgery, Queen's Hospital Burton, University Hospital of Derby and Burton NHS Trust, Derby, UK.
² Department of General Surgery, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK. s.zaman@bham.ac.uk.
³ Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK. s.zaman@bham.ac.uk.

^# Contributed equally.

Abstract

Background: To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis.

Methods: A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters.

Results: The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61).

Conclusion: Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

Keywords: Acute diverticulitis; Hinchey 1a; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Acute Disease
Diverticulitis* / surgery
Diverticulitis, Colonic* / therapy
Humans
Neoplasm Recurrence, Local
Outcome Assessment, Health Care
Patient Readmission
Treatment Failure
Treatment Outcome