Surgery or 'Watch and Wait' for Patients With Diverticulitis?

Albert B. Lowenfels, MD


May 17, 2019

Is surgery a better strategy than conservative management for patients with complicated diverticulitis? In a recent issue of Annals of Surgery, Bolkenstein and colleagues[1] present the results of a 5-year follow-up of 109 patients previously randomly assigned to either conservative management (n = 56) or operative intervention (n = 53). These patients were originally selected because they had two or more attacks of diverticulitis within a 2-year period or because they had persistent abdominal complaints.

The main outcome measure was the Gastrointestinal Quality of Life Index (GIQLI). At 5 years, the GIQLI score was significantly better in the operative group than in the nonoperative group (P = .01). During those 5 years, 26 (46%) of the patients in the original nonoperative group underwent surgery because of severe symptoms.

Patients Who Had Surgery Reported Better Quality of Life

Selecting the appropriate treatment for patients diagnosed with diverticulitis is always challenging. In this randomized trial, patients with troublesome diverticulitis (frequent attacks, persistent pain) had a better quality of life after surgery than after conservative ("watch and wait") management. The results closely match the initial trial results reported after 6 months.[2] At the end of 5 years, almost half the patients originally in the conservative group required surgery—a high failure rate. However, surgery leads to its own set of complications; 10 of the original patients in the operative group required another operation, often because of an anastomotic leak.

The results of this report will help surgeons advise patients with complicated diverticulitis about the benefits and the potential drawbacks of excisional surgery. Because the 6-month results closely match the 5-year results, if the original decision for a patient with complicated diverticulitis was "let's see what happens," then a period of 6 additional months of observation should be sufficient to decide whether to suggest surgery.

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