Standardizing Elective Surgery in Diverticular Disease

AIM: Diverticular disease (DD) is one of the most common benign gastrointestinal conditions in the Western world, with a range of clinical manifestations from uncomplicated symptoms to acute complications requiring surgery. Elective sigmoidectomy is indicated in cases of Complicated Diverticular Disease (CDD) after recovery, Symptomatic Uncomplicated Diverticular Disease (SUDD), and Recurrent Diverticulitis (RD). This study aims to assess the short- and long-term outcomes of a standardized surgical approach for DD. METHODS: A retrospective analysis was conducted on 442 patients who underwent elective sigmoidectomy or left hemicolectomy for DD disease between January 2012 and March 2020. Different DD scenarios were included: 128 patients with SUDD (29%), 170 with RD (38.5%), 144 with CDD (34.0%). All patients had nearly 5 years of follow-up. Preoperative evaluations included computed tomography (CT) scans and colonoscopy. Surgical procedures followed a standardized protocol, including medial to lateral approach, inferior mesenteric artery preservation, distal resection at the level of the upper rectum with a 60 mm blue Endo Gia cartridge, an end-to-end Knight-Griffen anastomosis with a 29 mm circular stapler and Indocyanine Green (ICG) testing. Demographic data, type of DD, surgical technique, and postoperative outcomes were recorded. The primary outcome measures included intraoperative details, complication rates, recurrence rates, and quality of life (GastroIntestinal Quality of Life Index [GIQLI] scores) at 1 and 5 years post-surgery. RESULTS: The cohort included 240 males and 202 females with a median age of 50 years. The surgical procedure was standardized across all patients. The mean operative time was 121 ± 28 minutes, with a conversion rate of 5.2% and an overall complication rate of 16.1%. Major complications, including anastomotic leaks, were observed in 4.9% of patients. The mean hospital stay was 4 days. Diverticulitis recurrence occurred in 5.2% of patients, more frequently in those with a disease duration of more than 5 years (p = 0.028). Cox regression analysis revealed that the duration of DD greater than 5 years was the only significant risk factor for diverticulitis recurrence (Hazard Ratio [HR] 2.42, 95% CI 1.12 to 4.62, p = 0.028). GIQLI scores significantly improved 1 year after surgery (92.7 ± 9.5 vs 97.8 ± 8.5, p < 0.001) and continued to improve at 5 years (92.7 ± 9.5 vs 118.1 ± 10.6, p < 0.001). CONCLUSIONS: Elective sigmoidectomy for DD, using a standardized laparoscopic technique, is safe and effective, with low complication rates and significant long-term improvement in quality of life. The recurrence rate of diverticulitis is low, and surgery provides lasting relief, especially for patients with recurrent or complicated forms of the disease. Standardization appears essential to optimize safety and efficacy in DD management.