Surgery might be best for some with diverticulitis

Last Updated: 2016-11-01

By David Douglas

NEW YORK (Reuters Health) - Patients with recurrent and ongoing left-sided diverticulitis may have better quality of life after surgery than with conservative management, according to Dutch researchers.

In a paper online October 19 in The Lancet Gastroenterology & Hepatology, Dr. Esther C. J. Consten of Meander Medical Centre in Amersfoort and colleagues note that, "Use of elective sigmoidectomy to treat diverticulitis is controversial and there is no data from randomized trials."

The team enrolled 109 patients into an open-label trial. All had recurrent or persistent abdominal complaints after an episode of left-sided diverticulitis, confirmed by CT, ultrasound, or endoscopy.

They were randomly assigned to receive conservative management or elective sigmoidectomy (98% of surgeries were laparoscopic); 47 patients had surgery and 43 had conservative management.

The researchers had intended to study more patients but the trial was terminated early because of difficulties in recruitment. A main obstacle was personal preference for one of the treatment strategies among potential participants and physicians.

At six months, mean health-related quality of life (QoL) score measured by the 144-point Gastrointestinal Quality of Life Index was 114.4 in the surgical group, significantly higher than the 100.4 seen in the conservative management group.

Perioperative complications included anastomotic leakage in seven patients and intra-abdominal abscess in two.

In all, 34% of patients in the surgery group and 40% of those in the conservative-treatment group had a severe adverse event in the six months after surgery. As a result, 13 (23%) patients who were initially managed conservatively ultimately required sigmoidectomy.

Given these findings, the researchers conclude, "elective sigmoidectomy, despite the inherent risk of complications, leads to improved quality of life compared with conservative management."

However, Dr. Johannes Kurt Schultz, author of an accompanying editorial, told Reuters Health by email that "the most important finding of this trial is that the observed improvement in QoL in the surgical group was relatively small and might well be a placebo effect."

"This combined with the risk of severe complications after surgery makes conservative treatment still the first choice, whereas surgery should be restricted to very selected patients," concluded Dr. Schultz of the University of Oslo, Norway.

Dr. Consten did not respond to requests for comments.

SOURCE: http://bit.ly/2fqnGPf and http://bit.ly/2fAerew

Lancet Gastro Hep 2016.