Recurrent left-sided diverticulitis after surgery: A systematic review and single arm meta-analysis

Recurrent diverticulitis after resection remains a key concern despite advances in minimally invasive surgery. These recurrences may result from incomplete resection of the diseased segment, unrecognized synchronous diverticulosis or ongoing alterations in colonic motility and microbiome composition. This systematic review and single-arm meta-analysis aimed to estimate long-term recurrence and stoma rates following elective surgery for left-sided diverticulitis.

Following PRISMA guidelines and PROSPERO registration, PubMed, Cochrane and Scopus databases were searched (2000-2025) for studies reporting recurrence after elective resection. Single-arm meta-analysis of proportions was performed using random-effects models. Quality was assessed using the JBI Checklist, while subgroup and sensitivity analyses explored heterogeneity. A comparative meta-analysis with medical treatment was not performed due to selection bias, crossover and lack of standardized non-operative protocols.

Twenty-four studies (7,525 patients; mean follow-up 53 months) were included. Pooled recurrence rate was 6.2% (95% CI: 4.8-8.0%; I² = 80.6%), with no difference between RCTs (6.3%) and observational studies (6.1%) or complicated vs. uncomplicated disease. Stoma rate (16 studies, 6,400 patients) was 17.1% (95% CI: 8.4-31.9%; I² = 99.3%), significantly higher in complicated (31.0%) than uncomplicated (5.5%) cases (p = 0.009) and significantly lower post-2020 (8.0% vs. 31.2%; p = 0.003). Quality was high in 92% of studies, while sensitivity analyses confirmed robustness.

Surgical resection achieves durable control with low recurrence and stoma rates. Research priorities include standardized definitions of recurrence, assessing long-term QOL and exploring microbiome influences to refine patient selection and minimize residual risk.