Recurrence of Acute Right Colon Diverticulitis Following Nonoperative Management: A Systematic Review and Meta-analysis.
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
entrez:
24
9
2020
pubmed:
25
9
2020
medline:
12
1
2021
Statut:
ppublish
Résumé
There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis. The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management. PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019. Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available. Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered. The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model. There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%-15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%-15%)) or heterogeneity. Funnel plot assessment revealed no publication bias. There were no randomized controlled trials available. The statistical heterogeneity was moderate (I = 46%). Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon. CRD42019131673.
Sections du résumé
BACKGROUND
There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis.
OBJECTIVE
The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management.
DATA SOURCES
PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019.
STUDY SELECTION
Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available.
INTERVENTIONS
Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered.
MAIN OUTCOME MEASURES
The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model.
RESULTS
There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%-15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%-15%)) or heterogeneity. Funnel plot assessment revealed no publication bias.
LIMITATIONS
There were no randomized controlled trials available. The statistical heterogeneity was moderate (I = 46%).
CONCLUSIONS
Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon.
PROSPERO
CRD42019131673.
Identifiants
pubmed: 32969890
doi: 10.1097/DCR.0000000000001787
pii: 00003453-202010000-00018
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1466-1473Références
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