Surgical management of complicated diverticulitis: systematic review and individual patient data network meta-analysis : An EAES/ESCP collaborative project. in Surgical endoscopy / Surg Endosc. 2025 Feb;39(2):699-715. doi: 10.1007/s00464-024-11457-8. Epub 2024 Dec 28.
2025
ASL Alessandria
Tipo pubblicazione
Systematic Review
Autori/Collaboratori (27)Vedi tutti...
Huo B
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada. brighthuo@dal.ca.
Ortenzi M
Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
Anteby R
Department of Surgery B, Sheba Medical Center, Tel Hashomer, Israel.

et alii...
Abstract
BACKGROUND: We performed a systematic review and network meta-analysis (NMA) of individualized patient data (IPD) to inform the development of evidence-informed clinical practice recommendations. METHODS: We searched MEDLINE, Embase, and Cochrane Central in October 2023 to identify RCTs comparing Hartmann's resection (HR), primary resection and anastomosis (PRA), or laparoscopic peritoneal lavage (LPL) among patients with class Ib-IV Hinchey diverticulitis. Outcomes of interest were prioritized by an international, multidisciplinary panel including two patient partners. Article screening, data extraction for IPD, and risk of bias appraisal were performed by two reviewers. We used a random-effects NMA to synthesize direct and indirect evidence. Heterogeneity was evaluated using the I(2) statistic. The panel appraised the certainty of the evidence using GRADE and CINeMA. RESULTS: Fourteen reports of seven RCTs were derived from 4,659 articles. IPD data were available for 595/678 patients (88.8%) across trials. Patients had a mean age?±?SD of 64.61?±?13.64 years and a mean BMI?±?SD of 26.12?±?5.20 kg/m(2), representing Hinchey classes I (1.2%), II (1.0%) III (76.3%), and IV (12.1%), respectively. Using minimal important difference thresholds, in-hospital/30-day mortality was higher among patients receiving LPL versus HR [42 more per 1000, 95% CI (41 fewer to 331 more), moderate effect; low certainty] as well as PRA [45 more per 1000 patients, 95% CI (33 fewer to 340 more) moderate effect; low certainty] without heterogeneity (I(2)?=?0%). Among 417 patients from four trials, there was a lower stoma rate among patients receiving PRA versus LPL [539 fewer per 1000, 95% CI (647 fewer to 306 fewer), large effect; low certainty]. CONCLUSION: PRA likely confers a lower stoma rate at 1 year compared to HR, while there may be no difference in 30-day/in-hospital mortality. LPL likely confers a higher in-hospital/30-day mortality rate compared to HR and PRA.
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PMID : 39733170
DOI : 10.1007/s00464-024-11457-8
Keywords
Humans; Network Meta-Analysis as Topic; Diverticulitis, Colonic/surgery/complications; Laparoscopy/methods; Peritoneal Lavage/methods; Anastomosis, Surgical/methods; Colectomy/methods; Colorectal surgery; Diverticulitis; Guidelines; Laparoscopic surgery; Minimally invasive surgery;