Emergency Surgery in Acute Diverticulitis: A Systematic Review.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Epidemiology

Background:

• Acute diverticulitis is a prevalent condition with significant public health implications.
• Recent high-quality evidence has emerged regarding surgical management strategies for acute diverticulitis.

Purpose of the Study:

• To systematically review and define optimal surgical management for acute diverticulitis.
• To synthesize current evidence on various surgical interventions for acute diverticulitis.

Main Methods:

• Systematic review of Medline, Embase, and Cochrane Library databases.
• Inclusion of guidelines, meta-analyses, systematic reviews, and randomized controlled trials.
• Assessment of laparoscopic peritoneal lavage, primary resection with anastomosis, and Hartmann procedure.

Main Results:

• Laparoscopic peritoneal lavage was associated with increased morbidity, deep abscesses, and reoperations.
• Hartmann procedure showed a shorter hospital stay but poorer long-term quality of life and higher stoma rates compared to primary resection.
• No high-quality data supported a laparoscopic approach; studies on Hinchey III/IV diverticulitis showed similar outcomes.

Conclusions:

• Laparoscopic peritoneal lavage is linked to increased morbidity in acute diverticulitis management.
• Hartmann procedure offers short-term benefits but inferior long-term outcomes compared to primary resection with anastomosis.
• Hartmann procedure remains a viable option for high-risk patients despite long-term considerations.