Elective Colectomy Versus Observation Following Initial Nonoperative Success in Hinchey Ib/II Diverticulitis: A Systematic Review and Meta-Analysis

Abstract

Introduction/Purpose

Diverticulitis with abscess (Hinchey Ib or II) is often initially managed nonoperatively with antibiotics and/or percutaneous drainage (PCD). For patients who respond successfully to this approach, it remains controversial whether an elective colectomy (EC) should routinely follow. This systematic review and meta-analysis evaluate and compare the outcomes of two strategies in this population: EC vs continued observation after successful nonoperative management.

Methods

We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library through August 15, 2024, for studies comparing EC to continued observation in patients with Hinchey Ib/II diverticulitis who achieved initial successful nonoperative management. Outcomes assessed included recurrence of diverticulitis. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model.

Results

We included four studies comprising 7236 patients. Among these, 1719 patients (24%) underwent EC following initial successful nonoperative treatment, while 5517 (76%) did not undergo elective surgery. The average patient age was 58.5 years, with a mean follow-up of 3.22 years. The mean time to EC ranged from 2 to 6 months. Elective colectomy was associated with a significantly lower recurrence rate (OR 0.14; 95% CI 0.11-0.17; P < .001; I² = 0%) but a higher frequency of stoma formation (OR 1.83; 95% CI 1.51-2.23; P < .001; I² = 0%).

Conclusions

In patients with Hinchey Ib or II diverticulitis who initially underwent successful nonoperative management, subsequent EC was associated with lower odds of recurrence but higher odds of stoma formation.

Registration

PROSPERO CRD42024582759.

Keywords

antibiotics nonoperative management diverticulitis elective colectomy percutaneous drainage

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