Elective sigmoid resection wards off recurrent diverticulitis, enhance quality of life
For patients with recurrent, complicated, or persistent painful diverticulitis, elective sigmoid resection appears to prevent recurrence as well as improve quality of life (QOL) within 2 years as compared with conservative treatment, according to the results of an open-label trial.
This study was conducted across five Finnish hospitals and included 90 patients, of whom 28 were men (mean age 54.11 years) and 62 were women (mean age 57.13 years). Of these, 85 were randomly assigned to undergo laparoscopic elective sigmoid resection (n=41) or conservative treatment (patient education and fibre supplementation; n=44).
The primary outcome was the difference in Gastrointestinal Quality of Life Index (GIQLI) score at randomization and 6 months after randomization. Prespecified secondary outcomes included GIQLI score, complications, and recurrences within 2 years. A total of 75 and 70 patients were available for QOL outcome assessment at 1 year and 2 years, respectively, and 79 and 78 for the recurrence outcome assessment at 1 year and 2 years, respectively. Eight patients (18 percent) in the conservative treatment group underwent sigmoid resection within 2 years.
The GIQLI score at 1 year was significantly higher in the surgery group than in the conservative treatment group, with a difference of 9.51 points (mean, 118.54 vs 109.03 points, 95 percent confidence interval [CI], 0.83–18.18; p=0.03). This difference disappeared at 2 years, with the mean GIQLI score being similar in the two treatment groups.
Within 2 years, recurrent diverticulitis occurred more frequently in the conservative treatment group than in the surgery group (61 percent vs 11 percent). However, slightly more patients in the latter had major postoperative complications (10 percent vs 5 percent).
In per-protocol analyses, the mean GIQLI score was significantly higher in the surgery group than in the conservative treatment group at 12 months (119.42 vs 108.15 points, 95 percent CI, 2.24–20.29; p=0.02) and at 24 months (117.24 vs 106.82 points, 95 percent CI, 1.52–19.33; p=0.02).