Emergency surgical treatment in complicated diverticulitis: a systematic review

Abstract

The traditional treatment approach for complicated diverticulitis with purulent or fecal peritonitis is an open surgery procedure with resection of the perforated colon and colostomy (Hartmann`s surgery). Less invasive, laparoscopic surgery techniques have been established but the decision whether patients should undergo open or laparoscopic treatment remains challenging and has to take into account individual factors such as the surgeon's skillset and available resources. Selection of the adequate procedure is further hampered by heterogeneity of the literature. We conducted a systematic review following PRISMA guidelines of studies of efficacy on open and laparoscopic surgical approaches for complicated diverticulitis using databases SciELO, LILACS and MEDLINE. We included prospective controlled studies published from 2005 to 2015. Out of 896-screened articles, 6 articles met our criteria and were included in the systematic review. Included studies tended to support the laparoscopic treatment over conventional open surgery. In particular, two staged laparoscopic surgery with lavage and subsequent follow up surgery to remove the pathological tissue appears to be superior to open surgery in both short and long term outcomes