Acute Left-Side Colonic Diverticulitis: A Historical Cohort Study on the Optimization of Non-Operative Management...

Background: The guidelines proposed by the World Society for Emergency Surgery (WSES) in 2020 for the management of Acute Diverticulitis (AD) emphasize the safety of non-operative management (NOM) in selected patients and recommend sigmoid resection (SR) with primary anastomosis (PA) as the surgical technique of choice. Aim: To analyze the clinical outcomes following the implementation of an evidence-based clinical pathway developed by an Acute Care Surgery Unit (ACSu) at a reference center. Methods: For analysis, patients were divided into two groups: pre-guidelines (2018-2019) and post-guidelines (2020-2023), following the May 2020 WSES publication. Patients were classified according to the WSES classification. Results: NOM failure and PA after SR rates by groups were as follows (NOM failure not applicable to III-IV): 0-IA, 2.7% and 94.7%; IB-IIA, 16% and 85.2%; IIB, 7.1% and 50%; III-IV, 75.6%. The global stoma-free rate was 78.8%, with a 15.7% anastomotic leak rate and 14.2% significant morbidity, with an increased rate of anastomosis in unstable patients thanks to Damage Control Surgery (DCS). A logistic regression model was performed to identify factors associated with postoperative morbidity. Patients who underwent primary anastomosis had a lower risk of postoperative morbidity compared to those treated with Hartmann's procedure (OR = 0.22 (0.04-1.25), p = 0.088). Conclusions: Excellent outcomes in AD healthcare may be achieved if evidence-based recommendations are followed. The ACSu plays a key role in designing and promoting these protocols.