Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients

Abstract

Abstract Purpose Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication. Methods All patients who underwent elective surgery for diverticulitis between 2011 and 2020 were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed. Results Criteria for RSI were fulfilled in 585npatients and for ASI in 318. After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p<0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI (p<0.001). Major morbidity (Clavien/Dindo ≥IIIb) occurred less frequently in RSI (3.77% vs. 10%, p=0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p<0.001). Conclusion The lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM. Knowledge of stage-specific perioperative risk is important in determining indications and counseling patients.