EAES rapid guideline: surgical management of complicated diverticulitis - with ESCP participation

Stavros A Antoniou; Bright Huo; Monica Ortenzi; Roi Anteby; Yegor Tryliskyy; Francesco Maria Carrano; Georgios Seitidis; Dimitris Mavridis; Vincent T Hoek; Alberto Serventi; Willem A Bemelman; Gian Andrea Binda; Rafael Duran; Triantafyllos Doulias; Nauzer Forbes; Nader K Francis; Fabian Grass; Jesper Jensen; Marianne Krogsgaard; Lisa H Massey; Luca Morelli; Christian E Oberkofler; Dorin E Popa; Johannes Kurt Schultz; Shahnaz Sultan; Jean-Jacques Tuech; Hendrik Jaap Bonjer

doi:10.1007/s00464-024-11445-y

EAES rapid guideline: surgical management of complicated diverticulitis - with ESCP participation

Surg Endosc. 2024 Dec 28. doi: 10.1007/s00464-024-11445-y. Online ahead of print.

Authors

Stavros A Antoniou^{1

2}, Bright Huo³, Monica Ortenzi⁴, Roi Anteby^{5

6}, Yegor Tryliskyy⁷, Francesco Maria Carrano⁸, Georgios Seitidis⁹, Dimitris Mavridis⁹, Vincent T Hoek¹⁰, Alberto Serventi¹¹, Willem A Bemelman¹², Gian Andrea Binda¹³, Rafael Duran¹⁴, Triantafyllos Doulias^{15

16

17}, Nauzer Forbes^{18

19}, Nader K Francis²⁰, Fabian Grass²¹, Jesper Jensen²², Marianne Krogsgaard²³, Lisa H Massey²⁴, Luca Morelli²⁵, Christian E Oberkofler^{26

27}, Dorin E Popa²⁸, Johannes Kurt Schultz^{29

30

31}, Shahnaz Sultan³², Jean-Jacques Tuech³³, Hendrik Jaap Bonjer^{34

35}

Affiliations

¹ Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece. [email protected].
² Guidelines Committee, European Association for Endoscopic Surgery, Eindhoven, Netherlands. [email protected].
³ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁴ Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
⁵ Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel.
⁶ Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
⁷ Great Western Hospitals, NHS, Swindon, UK.
⁸ Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
⁹ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
¹⁰ Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
¹¹ Department of Surgery, Ospedale Mons Galliano, Acqui Terme (AL), Italy.
¹² Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹³ General Surgery, Biomedical Institute, 16152, Genoa, Italy.
¹⁴ Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁵ Department of Colorectal Surgery, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK.
¹⁶ Colorectal Surgery Department, Kettering Hospital, University Hospitals of Northamptonshire, Kettering, Northamptonshire, UK.
¹⁷ Department of Genetics and Genome Biology, Honorary Lecturer in the Leicester Cancer Research Centre, Leicester, UK.
¹⁸ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
¹⁹ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
²⁰ Northwick Park and St Mark's Hospital, The Griffin Institute, London, UK.
²¹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
²² Patient Partner, Roskilde, Denmark.
²³ Department of Surgery, Zealand University Hospital, Koege, Denmark.
²⁴ Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
²⁵ Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy.
²⁶ Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
²⁷ Vivévis - Clinic Hirslanden Zurich, Zurich, Switzerland.
²⁸ Department of Surgery, Linköping University Hospital, Linköping, Sweden.
²⁹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³⁰ Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, 0424, Oslo, Norway.
³¹ Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway.
³² Department of Medicine, Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA.
³³ Department of Digestive Surgery, Rouen University Hospital, 1 Rue de Germont, 76000, Rouen, France.
³⁴ Cancer Center Amsterdam, Amsterdam, Netherlands.
³⁵ Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, Netherlands.

PMID: 39733172
DOI: 10.1007/s00464-024-11445-y

Abstract

Background: The surgical management of complicated diverticulitis varies across Europe. EAES members prioritized this topic to be addressed by a clinical practice guideline through an online questionnaire.

Objective: To develop evidence-informed clinical practice recommendations for key stakeholders involved in the treatment of complicated diverticulitis; to improve operative and perioperative outcomes, patient experience and quality of life through a systematic evidence-to-decision approach by a diverse, multidisciplinary panel.

Methods: Informed by a linked individual participant data network meta-analysis of resection and primary anastomosis (PRA) versus Hartmann's resection (HR) versus laparoscopic lavage (LPL), a panel of general and colorectal surgeons, patient partners, trialists, and fellows appraised the certainty of the evidence using GRADE and CINeMA. The panel discussed the evidence using the evidence-to-decision framework during a synchronous consensus meeting. An asynchronous modified Delphi survey was used to establish consensus.

Results: The panel suggests that patients with complicated diverticulitis without sepsis receive PRA over HR or LPL when there is availability of a surgeon with skills and experience in colorectal surgery. HR is suggested over PRA or LPL in the subgroups of septic, frail, as well as immunocompromised patients. These recommendations apply to patients with an indication for surgery. Surgeons and patients should first consider conditionally recommended interventions, then conditionally recommended against. Based on the evidence, the key benefit of PRA was a higher likelihood of not having a stoma at 1 year, with similar risks across comparisons. Conditional recommendations call for shared decision-making when considering management options. The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/7490 .

Conclusion: This clinical practice guideline provides evidence-informed recommendations on the management of patients with complicated diverticulitis in accordance with the highest methodological standards through a structured framework informed by an international, multidisciplinary panel of stakeholders.

Keywords: Colorectal surgery; Diverticulitis; Guidelines; Laparoscopic surgery; Minimally invasive surgery.