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

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 recurrenceversus12.1% without recurrence,p= 0.02). Two were operative factors: uncomplicated recurrent diverticulitis as indication for surgery (73.3% with recurrenceversus49.9% 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 recurrenceversus26.6% 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.

Automated summary

This study reviewed the risk factors associated with diverticulitis recurrence after elective sigmoidectomy. Factors such as age, irritable bowel syndrome, surgical indication, anastomotic level, absence of active diverticulitis on pathology, and persistence of postoperative pain were found to be associated with recurrence. Preoperative variables can help predict the risk of recurrence, while peri- and postoperative factors are important for optimal patient follow-up.