Clinical Trials Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2017; 9(11): 224-232
Published online Nov 27, 2017. doi: 10.4240/wjgs.v9.i11.224
Colorectal surgeon consensus with diverticulitis clinical practice guidelines
Javariah Siddiqui, Assad Zahid, Jonathan Hong, Christopher John Young
Javariah Siddiqui, Assad Zahid, Jonathan Hong, Christopher John Young, Discipline of Surgery, University of Sydney, Sydney, NSW 2050, Australia
Assad Zahid, Jonathan Hong, Christopher John Young, Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
Author contributions: All authors contributed to the conception, design, analysis and interpretation of data, as well as drafting and critically revising the manuscript; Siddiqui J was additionally responsible for the acquisition of data.
Institutional review board statement: The study was reviewed and approved by the Human and Research Ethics Committee, The University of Sydney and the Colorectal Surgical Society of Australia and New-Zealand for distribution to members.
Informed consent statement: Submission of the completed survey was an indication of the surgeon’s consent to participate in the study. This was mentioned in the participant information sheet (attached) to all members of the Colorectal Surgical Society of Australia and New Zealand.
Conflict-of-interest statement: Nil conflicts of interests, nil funding from grants.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christopher John Young, MBBS, MS, FRACS, FACS, FASCRS, Professor, Department of Colorectal Surgery, Royal Prince Alfred Hospital, Suite 415, 100 Carillon Ave, Sydney, NSW 2050, Australia. cyoungnsw@aol.com
Telephone: +61-2-95197576 Fax: +61-2-95191806
Received: August 6, 2017
Peer-review started: August 7, 2017
First decision: September 7, 2017
Revised: September 24, 2017
Accepted: October 16, 2017
Article in press: October 17, 2017
Published online: November 27, 2017
Abstract
AIM

To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.

METHODS

A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.

RESULTS

The response rate was 102 (50%). For 19 guideline-based scenarios, only 11 (58%) reached consensus (defined as > 70% majority opinion) and agreed with guidelines; while 3 (16%) reached consensus and did not agree with guidelines. The remaining 5 (26%) scenarios showed community equipoise (defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failure of conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based (Fisher’s exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis (79% vs 41%, P < 0.0001).

CONCLUSION

While there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs.

Keywords: Diverticulitis, Clinical practice guidelines, Consensus

Core tip: This study illustrates colorectal surgeon specialist consensus with clinical practice guidelines for diverticulitis. While consensus occurred with the majority of guideline recommendations, areas with lack of consensus and even consensus that disagrees with guidelines focuses where future research efforts should be placed.