Santos reports receiving grants from the Finnish Medical Foundation during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.
- Mean quality of life score was nearly 10 points higher in surgery vs. conservative group at 1 year.
- Within 2 years, 61% of the conservative group had recurrent diverticulitis compared with 11% in surgery group.
Elective sigmoid resection reduced recurrence and improved quality of life in patients with recurrent, complicated or persistent painful diverticulitis within 2 years compared with conservative treatment, according to data in JAMA Surgery.
“Elective sigmoid resection has been used as a treatment method for recurring uncomplicated or persistent painful diverticulitis or as a preventive measure for recurrence after complicated diverticulitis has been treated conservatively,” Alexandre Santos, MD, gastroenterological surgeon at the University of Helsinki and Helsinki University Hospital, and colleagues wrote. “To our knowledge, only one randomized clinical trial comparing elective sigmoid resection to conservative treatment has reported long-term outcomes.”
Santos and colleagues conducted the Laparoscopic Elective Sigmoid Resection vs. Conservative Treatment Following Diverticulitis randomized clinical trial at multiple university and community hospitals in Finland and enrolled 90 patients: 69% women (mean age, 57.13 years) and 31% men (mean age, 54.11 years). Eligible participants underwent surgery (n = 41) or conservative treatment (n = 44) for recurrent, complicated or persistent painful diverticulitis.
Assessed outcomes included difference in Gastrointestinal Quality of Life Index (GIQLI) and Short-Form Health Survey 36 (SF-36) scores, complications and recurrence 1 and 2 years after intervention.
Researchers noted 18% of patients in the conservative treatment group underwent elective sigmoid resection within 2 years.
According to intention-to-treat analyses, higher mean GIQLI scores were reported in the surgery group compared with the conservative group at 1 year (118.54 vs. 109.03; 95% CI, 0.83-18.18), with similar mean QIQLI scores at 2 years. The surgery group also had a higher mean mental component score of SF-36 at 1 year (55.89 vs. 54.05) but not at 2 years, with no difference in physical component scores between groups at either timepoint.
Within 2 years, 11% of the surgery group experienced recurrent diverticulitis compared with 61% of the conservative group, with major postoperative complications occurring in 10% and 5%, respectively.
Results from per-protocol analyses confirmed higher mean GIQLI scores among patients in the surgery group at 12 months (119.42 vs. 108.15; 95% CI, 2.24-20.29) and 24 months (117.24 vs. 106.82; 95% CI, 1.52-19.33).
“Elective sigmoid resection increased [quality of life] and reduced future recurrences of diverticulitis of patients with either recurrent or persistent painful diverticulitis in both randomized clinical trials on the topic,” Santos and colleagues concluded. “Decisions to proceed to elective sigmoid resection for recurrent or painful diverticulitis need to be made together with the patient using shared decision-making and considering the benefits and harms of both surgery and conservative treatment.
“Three or more episodes of diverticulitis seemed to serve as an appropriate threshold for offering surgical options in this study.”