# Acute Left-Side Colonic Diverticulitis: A Historical Cohort Study on the Optimization of Non-Operative Management Outcomes and Anastomosis Rate After Sigmoid Resection

## TL;DR

This study examines how following updated surgical guidelines improves outcomes for patients with acute diverticulitis, focusing on non-operative management and anastomosis rates.

## Contribution

The study evaluates clinical outcomes before and after implementing evidence-based guidelines for diverticulitis management, highlighting improved surgical practices.

## Key findings

- Non-operative management failure rates decreased after guideline implementation.
- Primary anastomosis rates increased significantly in eligible patients.
- Damage Control Surgery improved outcomes for unstable patients.

## Abstract

Background: The guidelines proposed by the World Society for Emergency Surgery (WSES) in 2020 for the management of Acute Diverticulitis (AD) emphasize the safety of non-operative management (NOM) in selected patients and recommend sigmoid resection (SR) with primary anastomosis (PA) as the surgical technique of choice. Aim: To analyze the clinical outcomes following the implementation of an evidence-based clinical pathway developed by an Acute Care Surgery Unit (ACSu) at a reference center. Methods: For analysis, patients were divided into two groups: pre-guidelines (2018–2019) and post-guidelines (2020–2023), following the May 2020 WSES publication. Patients were classified according to the WSES classification. Results: NOM failure and PA after SR rates by groups were as follows (NOM failure not applicable to III–IV): 0-IA, 2.7% and 94.7%; IB–IIA, 16% and 85.2%; IIB, 7.1% and 50%; III–IV, 75.6%. The global stoma-free rate was 78.8%, with a 15.7% anastomotic leak rate and 14.2% significant morbidity, with an increased rate of anastomosis in unstable patients thanks to Damage Control Surgery (DCS). A logistic regression model was performed to identify factors associated with postoperative morbidity. Patients who underwent primary anastomosis had a lower risk of postoperative morbidity compared to those treated with Hartmann’s procedure (OR = 0.22 (0.04–1.25), p = 0.088). Conclusions: Excellent outcomes in AD healthcare may be achieved if evidence-based recommendations are followed. The ACSu plays a key role in designing and promoting these protocols.