Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.155
Peer-review started: October 9, 2014
First decision: November 14, 2014
Revised: December 4, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: March 28, 2015
AIM: To determine short and long-term outcomes following operative management of acute diverticulitis in immunosuppressed (IMS) compared to immunocompetent (IMC) patients.
METHODS: PRISMA guidelines were followed in conducting this systematic review. We searched PubMed (1946 to present), OVID MEDLINE(R) In-Process and Other Non-Indexed Citations, OVID MEDLINE(R) Daily and OVID MEDLINE(R) (1946 to present), EMBASE on OVID platform (1947 to present), CINAHL on EBSCO platform (1981 to present), and Cochrane Library using a systematic search strategy. There were no restrictions on publication date and language. We systematically reviewed all published cohort comparative studies, case-control studies, and randomized controlled trials that reported outcomes on operative management of acute episode of colonic diverticulitis in IMS in comparison to IMC patients.
RESULTS: Seven hundred and fifty-five thousand five hundred and eighty-three patients were included in this systematic review; of which 1478 were IMS and 754105 were IMC patients. Of the nine studies included there was one prospective cohort, seven retrospective cohorts, one retrospective case-control study, and no randomized controlled trials. With the exception of solid organ transplant patients, IMS patients appeared to be older than IMC when they presented with an acute episode of diverticulitis. IMS patients presented with more severe acute diverticulitis and more insidious onset of symptoms than IMC patients. In the emergency setting, peritonitis was the main indication for operative intervention in both IMS and IMC patients. IMS patients were more likely to undergo Hartmann’s procedure and less likely to undergo reconstructive procedures compared to IMC patients. Furthermore, IMS patients had higher morbidity and mortality rates in the emergency setting compared to IMC patients. In the elective settings, it appeared that reconstruction with primary anastomosis with or without a diverting loop stoma is the procedure of choice in the IMS patients and carried minimal morbidity and mortality equivalent to IMC patients.
CONCLUSION: Emergency operations for diverticulitis in IMS compared to IMC patients have higher morbidity and mortality, whereas, in the elective setting both groups have comparable outcomes.
Core tip: Immunosuppressed (IMS) patients present with more severe episodes of diverticulitis compared to immunocompetent patients and are at increased risk of an emergency operation. However, IMS patients have a vague disease presentation with insidious onset. The postoperative morbidity and mortality following emergency operations for diverticulitis is worse in the IMS patient population, whereas, in the elective setting, the morbidity and mortality is comparable to the general population.