162 Conservative Management of Hinchey Ib and II Diverticulitis Versus Elective Colectomy: A Systematic Review and Meta-Analysis Free

Diverticulitis with abscess can be treated conservatively with antibiotics and/or percutaneous drainage (PCD). However, the necessity of a subsequent elective colectomy is controversial. This systematic review and meta-analysis assesses the outcomes of patients with Hinchey Ib or II diverticulitis after successful conservative management who underwent an elective colectomy versus those who did not.

This review was registered with PROSPERO (CRD42024582759) and followed PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Cochrane until August 15, 2024, for studies evaluating patients with diverticulitis who underwent initial successful conservative treatment. We pooled odds ratios (OR) with 95% confidence intervals (CI) using a random-effects model in R [4.4.0]. Outcomes of interest were diverticulitis recurrence and the need for a stoma.

Four studies, including one randomized controlled trial, involving 7,236 patients, were included. Of these, 1,719 (24%) underwent elective colectomy after initial successful conservative treatment, and 5,517 (76%) did not undergo elective surgery. The average patient age was 58.5 years, with a mean follow-up of 3.22 years. The average time to elective colectomy was 2-6 months for the whole cohort. Elective colectomy significantly reduced recurrence (OR 0.140; 95% CI 0.110–0.170; p < 0.001; I² = 0%). However, stoma was more frequent in the colectomy group (OR 1.83; 95% CI 1.51–2.23; p < 0.001).

In patients with Hinchey Ib or II diverticulitis who underwent initial successful conservative management, subsequent elective colectomy reduces recurrence.