Elective Surgery for Diverticulitis Benefits Patient Quality of Life

Elective sigmoid resection was a superior alternative to conservative treatment in reducing recurrence of diverticulitis and boosting the patient’s overall quality of life, a 2-year analysis of the randomized LASER trial found.

“The risk of further episodes of diverticulitis can be predicted and is largely based on the number of earlier episodes of diverticulitis,” the researchers said. “While patients with first-time uncomplicated diverticulitis have only a 30% risk of recurrence within 5 years, patients who have had 3 or more earlier cases of diverticulitis have about an 80% chance of another recurrence.”

For the multicenter, parallel, open-label randomized clinical trial, the team recruited patients from 5 hospitals in Finland from September 2014 to October 2018. Of the 85 patients randomized, 75 and 70 were available for quality-of-life outcomes at 1 year and 2 years, respectively, and 79 and 78 were available for the recurrence outcome at 1 year and 2 years.

Conservative treatment included patient education and fiber supplementation.

The surgery group consisted of 41 individuals and the conservative group had 44. From the conservative group, 8 patients (18%) underwent sigmoid resection within 2 years and 61% of patients had recurrent diverticulitis. In the surgery group, 11% of patients experienced a recurrence of diverticulitis. Four of the 41 patients in the surgery group (10%) reported postoperative complications within 2 years compared to 2 of 44 in the conservative group (5%).

The mean Gastrointestinal Quality of Life Index (GIQLI) score was 9.51 points higher in the surgery group versus the conservative group at 1 year (mean 118.54 vs 109.03; P=0.03), though this score was similar at 2 years, the results revealed.

While conservative treatment was safe, surgery could be effective in preventing recurrences of diverticulitis, the researchers observed.

Reference:
Santos A, Mentula P, Pinta T et al. Quality-of-life and recurrence outcomes following laparoscopic elective sigmoid resection vs conservative treatment following diverticulitis: Prespecified 2-year analysis of the LASER randomized clinical trial. JAMA Surg. 2023;158(6):593–601. DOI:10.1001/jamasurg.2023.0466