Surgical treatment of diverticulitis and its complications: A systematic review and meta- analysis of randomized control trials (original) (raw)

Purpose: The surgical interventions of diverticulitis vary according to its grade and severity. There is a controversy about the best of these different surgical procedures. We aimed to systematically review and meta-analyze randomized controlled trials (RCTs) comparing outcomes and complications between different surgical approaches for acute diverticulitis and its complications. Methods: Nine electronic databases including PubMed, Scopus, and Web of Science were searched for RCTs comparing different surgical procedures for different grades of diver-ticulitis. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered in PROSPERO (CRD42015032290). Results: Outcome data were analyzed from five RCTs comparing laparoscopic sigmoid resection (LSR) (n ¼ 247) versus open sigmoid resection (OSR) (n ¼ 237) for treatment of acute complicated diverticulitis with minimal heterogeneity. There was no significant difference in short-term postoperative overall morbidity (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61e1.31; P ¼ 0.56) and long-term postoperative major morbidity (RR 0.78, 95% CI 0.46e1.31, P ¼ 0.34). In other six RCTs compared laparoscopic lavage with resection for treatment of perforated diverticulitis with peritonitis, the postoperative mortality rate was non-significant in both short-term (RR 1.55, 95% CI 0.79e3.04; P ¼ 0.21) and long-term (RR 0.67, 95% CI 0.29e1.58; P ¼ 0.36) follow up.

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