Khan RMA, et al. - This study aimed to investigate outcomes of early versus delayed surgery in patients with acute recurrent diverticulitis. The best available evidence suggested no difference between early elective and delayed elective surgery for acute recurrent diverticulitis regarding clinical outcomes. However, early elective surgery seemed associated with longer operative time and length of stay and higher conversion rate to open surgery associated that made the delayed elective surgery more cost-effective. The best available evidence were derived from non-randomised studies; therefore, there seemed a necessity for high quality randomised controlled trials to provide more robust basis for definite conclusions.

Methods

• A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.
• Electronic information sources were searched, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists to identify all randomised controlled trials (RCTs) and observational studies investigating outcomes of early versus delayed surgery in patients with acute recurrent diverticulitis.
• The Newcastle-Ottawa scale was used to determine the risk of bias of included studies.
• Authors used Random-effects models to calculate pooled outcome data.

Results

• Three retrospective and one prospective cohort studies enrolling a total of 1046 patients were identified.
• The included patients were similar regarding age, ASA score and Hinchey classifications (Hinchey I and II).
• Findings suggested no difference between two groups regarding surgical site infection [Odds ratio (OR) 1.61, 95% CI 0.79–3.27, P = 0.19], intra-abdominal abscess (OR 0.92, 95% CI 0.21–4.00, P = 0.91), anastomotic leak (OR1.27, 95% CI 0.50–3.25, P = 0.61), 30-day mortality [Risk difference (RD) 0.00 95% CI -0.01–0.01, P = 0.80], postoperative ileus (OR 1.35, 95% CI 0.50–3.66, P = 0.55), postoperative bleeding (OR 0.93, 95% CI 0.32–2.69, P = 0.89), ureteric injury (OR 0.62, 95% CI 0.08–5.07, P = 0.65), and overall morbidity (OR 1.42 95% CI 0.76–2.66, P = 0.27).
• There appeared an association of early surgery with longer operative time [Mean Difference (MD) 12.8, 95% CI 5.08–20.53, P = 0.001] and length of stay (MD 4.41, 95% CI -0.34–8.53, P = 0.03).
• Patients undergoing laparoscopic surgery in the early surgery group had higher conversion to open surgery (OR 2.71, 95% CI 1.36–5.40, P = 0.005).