Does surgery improve quality of life in patients with ongoing- or recurrent diverticulitis; a systematic review and meta-analysis

Abstract

Background

Recurrences or persistent symptoms after an initial episode of diverticulitis are common, yet surgical treatment is rarely performed. Current guidelines lack clear recommendations on whether or not to operate, even though recent studies suggest an improved quality of life following surgery. The aim of this study is therefore to compare quality of life in patients with recurrent or ongoing diverticulitis treated conservatively versus surgically, giving a more definitive answer to the question of whether or not to operate on these patients.

Methods

A systematic literature search was conducted in EMBASE, MEDLINE and Cochrane. Only comparative studies reporting on quality of life were included. Statistical analysis included calculation of weighted mean differences and pooled odds ratios.

Results

Five studies were included; two RCT’s and three retrospective observational studies. Compared to conservative treatment, the SF-36 scores were higher in the surgically treated group at each follow-up moment but only the difference in SF-36 physical scores at six months follow-up was statistically significant (MD 6.02, 95%CI 2.62–9.42). GIQLI scores were also higher in the surgical group with a MD of 14.01 (95%CI 8.15-19.87) at six months follow-up and 7.42 (95%CI 1.23–12.85) at last available follow-up. Also, at last available follow-up, significantly fewer recurrences occurred in the surgery group (OR 0.10, 95%CI 0.05–0.23, p < 0.001).

Conclusion

Although surgery for recurrent diverticulitis is not without risk, it might improve long-term quality of life in patients suffering from recurrent- or ongoing diverticulitis when compared to conservative treatment. Therefore, it should be considered in this patient group.

Keywords:

• Diverticulitis
• elective surgery
• conservative treatment
• health questionnaire
• quality of life
• recurrences

Author contributions

Conceptualization: W. A Draaisma, H. E. Bolkenstein

Methodology: B. A. J. Kertzman, F. J Amelung, H.E. Bolkenstein

Validation: F. J. Amelung, H. E. Bolkenstein

Formal analysis: B. A. J. Kertzman, F. J. Amelung

Investigation: B. A. J. Kertzman, F. J. Amelung

Data curation: B. A. J. Kertzman, F. J. Amelung

Writing - initial draft: B. A. J. Kertzman, F. J. Amelung

Writing - review & editing: F. J. Amelung, H. E. Bolkenstein, E. C. J. Consten, W. A. Draaisma

Supervision: F. J. Amelung, W. A. Draaisma E. C. J. Consten

Disclosure statement

Three of the authors of this article (Bolkenstein, Consten, Draaisma) were also (co)authors of one of the included studies (Direct-trial).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.