Long-term outcome after conservative and surgical treatment of acute sigmoid diverticulitis.

ABSTRACT

PURPOSE: This study was designed to compare the long-term outcome of patients treated with conservative versus surgical treatment for acute sigmoid diverticulitis (SD). PATIENTS AND METHODS: Consecutive admissions of all patients with acute SD were prospectively recruited from January 2004 to June 2007. In June 2008, all patients were contacted using a standardized questionnaire. Outcomes were compared based on initial therapy (conservative vs. surgical). Furthermore, multiple logistic regression was used to identify risk factors for recurrence of SD. RESULTS: A total of 210 patients were included in the study. One hundred fifty-three patients were reached for follow-up 70 (45.8%) presented with their first episode, and 83 (54.2%) had a prior history of SD. The median follow-up was 32 months (range 12-52). Thirteen (32.5%) of 40 conservatively treated patients and four (3.5%) of 113 surgically treated patients had a recurrence of SD (p < 0.001) during follow-up. One patient (2.5%) required emergency surgery after conservative treatment due to free perforation (p = 0.567). Treatment groups did not differ in age, gender, and inflammatory parameters, but conservatively treated patients had a significantly higher comorbidity (>2 disorders; p = 0.038) and less frequently a severe SD (p = 0.022) at the index admission. Recurrent episode of SD, covered perforated SD, and conservative treatment were identified as risk factors for recurrence of SD on multiple logistic regression. CONCLUSIONS: Surgical treatment of acute SD is more effective in preventing an eventual relapse of SD than conservative treatment, particularly in patients with recurrent and severe diverticulitis. The necessity for an emergency operation during follow-up is low and did not differ between the two treatment groups. The initial clinical presentation of SD is not a strong predictor of recurrence.