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Diverticulitis

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Hartmann's Procedure or Primary Anastomosis for Generalized Peritonitis due to Perforated Diverticulitis: A Prospective Multicenter Randomized Trial (DIVERTI).
Bridoux V, Regimbeau JM, Ouaissi M, Mathonnet M, Mauvais F, Houivet E, Schwarz L, Mege D, Sielezneff I, Sabbagh C, Tuech JJ.
J Am Coll Surg. 2017 Dec;225(6):798-805.

Rationale for inclusion: a well-designed prospective, multicenter, randomized controlled study comparing mortality between patients with diverticular peritonitis (Hinchey stage III and IV) who had a primary anastomosis with a protective diverting stoma versus patients who had a Hartmann’s procedure. No significant difference found in mortality, but primary anastomosis patients were > 30% more likely to have stoma reversal by 18 months. 

Citations - 0 (as of January 2018)

Multicenter validation of American Association for the Surgery of Trauma grading system for acute colonic diverticulitis and its use for emergency general surgery quality improvement program.
Shafi S, Priest EL, Crandall ML, Klekar CS, Nazim A, Aboutanos M, Agarwal S, Bhattacharya B, Byrge N, Dhillon TS, Eboli DJ, Fielder D, Guillamondegui O, Gunter O, Inaba K, Mowery NT, Nirula R, Ross SE, Savage SA, Schuster KM, Schmoker RK, Siboni S, Siparsky N, Trust MD, Utter GH, Whelan J, Feliciano DV, Rozycki G; American Association for the Surgery of Trauma Patient Assessment Committee.
J Trauma Acute Care Surg. 2016 Mar;80(3):405-10; discussion 410-1.

Rationale for inclusion: This retrospective study found that the newly developed AAST grades for acute colonic diverticulitis were independently associated with clinical outcomes and resource use. This has important implications for EGS quality improvement program methodology. 

Citations - 5 (as of July 2017)

The impact of elective colon resection on rates of emergency surgery for diverticulitis.
Simianu VV, Strate LL, Billingham RP, Fichera A, Steele SR, Thirlby RC, Flum DR.
Ann Surg. 2016 Jan;263(1):123-9.

Rationale for inclusion: This retrospective cohort study found that although the rate of elective colectomy for diverticulitis has more than doubled since 1987, the rate of emergent surgical intervention has not declined. Perhaps this reinforces the notion that elective colectomy does not help reduce the need for emergency surgery and should not be done routinely.

Citations - 11 (as of July 2017)

Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: The SCANDIV Randomized Clinical Trial.
Schultz JK, Yaqub S, Wallon C, Blecic L, Forsmo HM, Folkesson J, Buchwald P, Korner H, Dahl FA, Oresland T; SCANDIV Study Group.
JAMA. 2015 Oct 6;314(13):1364-75.

Rationale for inclusion: This multi-center, randomized clinical superiority trial found that the use of laparoscopic lavage did not reduce postoperative complications. There was no difference in mortality, postoperative length of stay or quality of life. 

Citations - 70 (as of July 2017)

Surgery for diverticulitis in the 21st century: a systematic review.
Regenbogen SE, Hardiman KM, Hendren S, Morris AM.
JAMA Surg. 2014 Mar;149(3):292-303.

Rationale for inclusion: This comprehensive systematic review presents the more recent data since 2000 guiding decision making, technical consideration, and surgical outcomes of sigmoid diverticulitis.

Citations - 67 (as of July 2017)

Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy.
Shahedi K, Fuller G, Bolus R, Cohen E, Vu M, Shah R, Agarwal N, Kaneshiro M, Atia M, Sheen V, Kurzbard N, van Oijen MG, Yen L, Hodgkins P, Erder MH, Spiegel B.
Clin Gastroenterol Hepatol. 2013 Dec;11(12):1609-13.

Rationale for inclusion: This Veterans Affairs (VA) study demonstrated that a very low percentage (4%) of patients with incidentally diagnosed diverticulosis will go on to develop acute diverticulitis.

Citations - 112 (as of July 2017)

Trends in diverticulitis management in the United States from 2002 to 2007.
Masoomi H, Buchberg BS, Magno C, Mills SD, Stamos MJ.
Arch Surg. 2011 Apr;146(4):400-6.

Rationale for inclusion: Using the NIS database, this study demonstrates an increased use of laparoscopy as well as decreased use of colostomy for urgent open operations.

Citations - 90 (as of July 2017)

Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial.
Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA.
Ann Surg. 2009 Jan;249(1):39-44.

Rationale for inclusion: This is a multi-center double-blind randomized controlled trial comparing laparoscopic versus open sigmoid resection for symptomatic diverticulitis. The study found that the laparoscopic approach was associated with longer operative times but lower complication rates, less pain and shorter hospital length of stay.

Citations - 250 (as of July 2017)

Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?
Chapman JR, Dozois EJ, Wolff BG, Gullerud RE, Larson DR.
Ann Surg. 2006 Jun;243(6):876-830; discussion 880-3.

Rationale for inclusion: Retrospective study that found that patients with multiple (>2) episodes of diverticulitis are not at increased risk for poor outcomes compared to those with fewer attacks. Therefore elective resection may not be warranted in these patients. 

Citations - 222 (as of July 2017)

Elective surgery after acute diverticulitis.
Janes S, Meagher A, Frizelle FA.
Br J Surg. 2005 Feb;92(2):133-42.

Rationale for inclusion: This review of the literature on the role of elective resection after recurrent diverticulitis found no evidence to support the role of elective surgery after two attacks of diverticulitis. 

Citations - 303 (as of July 2017)

Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis? A systematic review.
Salem L, Flum DR.
Dis Colon Rectum. 2004 Nov;47(11):1953-64.

Rationale for inclusion: One of the most well cited systematic reviews of the literature on primary anastomosis versus Hartmann's procedure for perforated diverticulitis found that primary anastomosis is a safe option without increased morbidity or mortality.

Citations - 342 (as of July 2017)

Treatment of perforated diverticular disease of the colon.
Hinchey EJ, Schaal PG, Richards GK.
Adv Surg. 1978;12:85-109.

Rationale for inclusion: Although several modifications and new grading systems have been proposed that provide a more contemporary overview of the disease, this discusses Hinchey's traditional classification for perforated diverticulitis.

Citations - 881 (as of July 2017)

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