Clinical and surgical approach in diverticulitis: indications, results and complications
Keywords:
Diverticulitis; Tratamiento médico; Cirugía; Laparoscopia; Complicaciones quirúrgicas., Diverticulitis; Medical treatment; Surgery; Laparoscopy; Surgical complications.Abstract
Introduction: diverticulitis is an inflammatory disease of the colon with increasing prevalence, whose clinical presentation ranges from uncomplicated forms manageable on an outpatient basis to severe cases requiring urgent surgery.
Objective: analyze the indications, outcomes, and complications of clinical and surgical management of diverticulitis, evaluating its impact on clinical evolution, based on scientific evidence from 2019–2024.
Methods: literature review was conducted following PRISMA methodology in PubMed, Scopus, SciELO, and Cochrane (2019–2024). MeSH terms: "diverticulitis" AND ("treatment" OR "surgery"). Of 312 records identified, 28 studies met inclusion criteria after systematic selection.
Results: utpatient clinical treatment showed effectiveness of 70–80 % in uncomplicated cases, with complications <5 %. Recent studies demonstrate the safety of management without antibiotics in selected patients. In complicated diverticulitis, the Hartmann procedure was performed in 65–70 % of cases with diffuse peritonitis (success 85–90 %, complications 18–22 %). Resection with primary anastomosis presented fewer complications (10–12 %) and better quality of life. Laparoscopy showed success rates of 90–95 % with morbidity <8 %.
Conclusions: he management of diverticulitis requires a personalized strategy. Current guidelines emphasize conservative treatment in uncomplicated cases, reserving surgery for complicated cases. The choice of surgical technique must balance efficacy, morbidity, and preservation of intestinal function.
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1. Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, et al. Colonic diverticular disease. Nat Rev Dis Primers[Internet]. 2020 [citado 04 abril 2025]; 6(1): 20. Disponible en: https://doi.org/10.1038/s41572-020-0153-5
2. Bharucha AE, Parthasarathy G, Ditah I, Fletcher JG, Ewelukwa O, Pendlimari R, et al. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol[Internet]. 2020 [citado 04 abril 2025];115(11):1812-9. Disponible en: https://doi.org/10.14309/ajg.0000000000000868
3. Daniels L, Budding AE, de Korte N, Eck A, Bogaards JA, Stockmann HB, et al. Fecal microbiome analysis as a diagnostic test for diverticulitis. Eur J Clin Microbiol Infect Dis[Internet]. 2020 [citado 04 abril 2025]; 39(3):557-65. Disponible en: https://doi.org/10.1007/s10096-019-03744-y
4. Maguire LH, Song M, Strate LE, Giovannucci EL, Chan AT. Association of geographic and seasonal variation with diverticulitis admissions. JAMA Surg[Internet]. 2020 [citado 04 abril 2025]; 155(7):596-605. Disponible en: https://doi.org/10.1001/jamasurg.2020.0529
5. Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg[Internet]. 2020 [citado 04 abril 2025];15(1):32. Disponible en: https://doi.org/10.1186/s13017-020-00313-4
6. Schultz JK, Yaqub S, Wallon C, Blecic L, Forsmo HM, Folkesson J, et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis[Internet]. 2020 [citado 04 abril 2025]; 22(Suppl 2): 5-28. Disponible en: https://doi.org/10.1111/codi.15140
7. Hall JF, Hardiman K, Snyder M, Orkin B, Steele S. American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum[Internet]. 2020 [citado 04 abril 2025]; 63(6):728-47. Disponible en: https://doi.org/10.1097/DCR.0000000000001679
8. Jaung R, Nisbet S, Gosselink MP, Keane C, Costello SP, Kumar S, et al. Antibiotics do not reduce length of hospital stay for uncomplicated diverticulitis in a pragmatic double-blind randomized trial. Clin Gastroenterol Hepatol[Internet]. 2021 [citado 04 abril 2025]; 19(3): 503-10.e1. Disponible en: https://doi.org/10.1016/j.cgh.2020.03.049
9. Daniels L, Unlu C, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg[Internet]. 2019 [citado 04 abril 2025]; 106(2): 95-9. Disponible en: https://doi.org/10.1002/bjs.11103
10. Cirocchi R, Nascimbeni R, Binda GA, Di Saverio S, Desiderio J, Coratti A, et al. Laparoscopic lavage versus resection in perforated diverticulitis with purulent peritonitis: a systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2019 [citado 04 abril 2025]; 98(9):e14710. Disponible en: https://doi.org/10.1097/MD.0000000000014710
11. Pereira N, Vega J, Readi A, Abedrapo M. Lavado peritoneal laparoscópico como tratamiento de diverticulitis aguda perforada. Rev Chil Cir[Internet]. 2020 [citado 04 abril 2025]; 72(2): 154-60. Disponible en: https://doi.org/10.35687/s2452-45492020002456
12. Regenbogen SE, Hardiman KM, Hendren S, Morris AM. Surgery for diverticulitis in the 21st century: a systematic review. JAMA Surg[Internet]. 2019 [citado 04 abril 2025]; 154(3): 243-51. Disponible en: https://doi.org/10.1001/jamasurg.2018.4557
13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ[Internet]. 2021 [citado 04 abril 2025]; 372: n71. Disponible en: https://doi.org/10.1136/bmj.n71
14. Vennix S, Morton DG, Hahnloser D, Lange JF, Bemelman WA. Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Colorectal Dis[Internet]. 2020 [citado 04 abril 2025]; 22(11): 1654-68. Disponible en: https://doi.org/10.1111/codi.15176
15. Forcén PJM, Carmona ZG, Sierra IB, Márquez MF, Redondo MG, Duarte ÁR. Tratamiento ambulatorio en la diverticulitis aguda no complicada. Cir Andal[Internet]. 2021 [citado 04 abril 2025];32(4):463-8. Disponible en: Revista Cirugía Andaluza | Asociación Andaluza de Cirujanos | ASAC
16. Isacson D, Thorisson A, Andreasson K, Nikberg M, Smedh K, Chabok A. Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study. Int J Colorectal Dis[Internet]. 2020 [citado 04 abril 2025]; 35(10):1923-7. Disponible en: https://doi.org/10.1007/s00384-020-03662-w
17. Palma ÁJM, Mainguyague MJI, Lorca JE, Schmied GIU. Terapéutica en diverticulitis aguda: una actualización de la evidencia disponible. ARS Med Rev Cienc Méd[Internet]. 2022 [citado 04 abril 2025]; 47(1): 35-41. Disponible en: https://doi.org/10.11565/arsmed.v47i1.1823
18. Bolkenstein HE, Consten ECJ, van der Palen J, van de Wall BJM, Broeders IAMJ, Draaisma WA. Long-term outcome of surgery versus conservative management for recurrent and ongoing left-sided diverticulitis. Ann Surg[Internet]. 2019 [citado 04 abril 2025]; 269(4): 612-20. Disponible en: https://doi.org/10.1097/SLA.0000000000003033
19. Ferrada P, Xenos E, Derhake W, Velamuri S. Emergency colon resection with primary anastomosis: a safe management strategy for complicated diverticulitis. J Trauma Acute Care Surg[Internet]. 2020 [citado 04 abril 2025]; 88(5): 660-5. Disponible en: https://doi.org/10.1097/TA.0000000000002617
20. Lambrichts DPV, Vennix S, Musters GD, Mulder IM, Swank HA, Hoofwijk AGM, et al. Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial. Lancet Gastroenterol Hepatol[Internet]. 2019 [citado 04 abril 2025]; 4(8): 599-610. Disponible en: https://doi.org/10.1016/S2468-1253(19)30174-8
21. Binda GA, Arezzo A, Serventi A, Bonelli L, Facchini M, Veronese E, et al. Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study). Br J Surg[Internet]. 2021 [citado 04 abril 2025]; 108(8): 894-902. Disponible en: https://doi.org/10.1093/bjs/znaa129
22. Schultz JK, Wallon C, Blecic L, Schultz M, Buchwald P, Folkesson J, et al. One-year results of the DILALA trial: laparoscopic lavage versus resection for acute perforated diverticulitis. World J Surg[Internet]. 2019 [citado 04 abril 2025]; 43(6): 1472-80. Disponible en: https://doi.org/10.1007/s00268-019-04924-5
23. McDermott FD, Collins D, Heeney A, Winter DC. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis. Br J Surg[Internet]. 2014 [citado 04 abril 2025]; 101(1): e90-9. Disponible en: https://doi.org/10.1002/bjs.9359
24. Strate LL, Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology[Internet]. 2019 [citado 04 abril 2025]; 156(5):1282-91.e1. Disponible en: https://doi.org/10.1053/j.gastro.2018.12.033
25. Mali JP, Mentula PJ, Leppäniemi AK, Sallinen VJ. Determinants of treatment and outcomes of diverticular abscesses. World J Emerg Surg[Internet]. 2020 [citado 04 abril 2025]; 15: 31. Disponible en: https://doi.org/10.1186/s13017-020-00310-7
26. Dichman MS, Grinspan LT, Cohen-Mekelburg S, Wallace J, Sanchez-Santos MT, Syngal S, et al. Antibiotic stewardship in patients with acute diverticulitis: a systematic review. Clin Gastroenterol Hepatol[Internet]. 2021 [citado 04 abril 2025]; 19(7): 1332-1340. e1. Disponible en: https://doi.org/10.1016/j.cgh.2020.08.062
27. Vergara-Fernandez O, Morales-Cruz M, Armillas-Canseco F, Pérez-Soto R, Arcia-Guerra E, Trejo-Ávila M. Procedimiento de Hartmann vs. anastomosis primaria para diverticulitis Hinchey III: estudio prospectivo de casos y controles. Rev Gastroenterol Méx[Internet]. 2022 [citado 04 abril 2025]; 87(4): 509-512. Disponible en: https://doi.org/10.1016/j.rgmx.2022.04.007
28. Angenete E, Thornell A, Burcharth J, Pommergaard HC, Skullman S, Bisgaard T, et al. Laparoscopic lavage is feasible and safe for the treatment of perforated diverticulitis with purulent peritonitis: the first results from the randomized controlled trial DILALA. Ann Surg[Internet]. 2016 [citado 04 abril 2025]; 263(1): 117-122. Disponible en: https://doi.org/10.1097/SLA.0000000000001061
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