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28-12-2024 | Diverticulitis | Guidelines

EAES rapid guideline: surgical management of complicated diverticulitis – with ESCP participation

Authors: Stavros A. Antoniou, Bright Huo, Monica Ortenzi, Roi Anteby, Yegor Tryliskyy, Francesco Maria Carrano, Georgios Seitidis, Dimitris Mavridis, Vincent T. Hoek, Alberto Serventi, Willem A. Bemelman, Gian Andrea Binda, Rafael Duran, Triantafyllos Doulias, Nauzer Forbes, Nader K. Francis, Fabian Grass, Jesper Jensen, Marianne Krogsgaard, Lisa H. Massey, Luca Morelli, Christian E. Oberkofler, Dorin E. Popa, Johannes Kurt Schultz, Shahnaz Sultan, Jean-Jacques Tuech, Hendrik Jaap Bonjer

Published in: Surgical Endoscopy | Issue 2/2025

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Abstract

Background

The surgical management of complicated diverticulitis varies across Europe. EAES members prioritized this topic to be addressed by a clinical practice guideline through an online questionnaire.

Objective

To develop evidence-informed clinical practice recommendations for key stakeholders involved in the treatment of complicated diverticulitis; to improve operative and perioperative outcomes, patient experience and quality of life through a systematic evidence-to-decision approach by a diverse, multidisciplinary panel.

Methods

Informed by a linked individual participant data network meta-analysis of resection and primary anastomosis (PRA) versus Hartmann’s resection (HR) versus laparoscopic lavage (LPL), a panel of general and colorectal surgeons, patient partners, trialists, and fellows appraised the certainty of the evidence using GRADE and CINeMA. The panel discussed the evidence using the evidence-to-decision framework during a synchronous consensus meeting. An asynchronous modified Delphi survey was used to establish consensus.

Results

The panel suggests that patients with complicated diverticulitis without sepsis receive PRA over HR or LPL when there is availability of a surgeon with skills and experience in colorectal surgery. HR is suggested over PRA or LPL in the subgroups of septic, frail, as well as immunocompromised patients. These recommendations apply to patients with an indication for surgery. Surgeons and patients should first consider conditionally recommended interventions, then conditionally recommended against. Based on the evidence, the key benefit of PRA was a higher likelihood of not having a stoma at 1 year, with similar risks across comparisons. Conditional recommendations call for shared decision-making when considering management options. The full guideline with user-friendly decision aids is available in https://​app.​magicapp.​org/​#/​guideline/​7490.

Conclusion

This clinical practice guideline provides evidence-informed recommendations on the management of patients with complicated diverticulitis in accordance with the highest methodological standards through a structured framework informed by an international, multidisciplinary panel of stakeholders.
Appendix
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Metadata
Title
EAES rapid guideline: surgical management of complicated diverticulitis – with ESCP participation
Authors
Stavros A. Antoniou
Bright Huo
Monica Ortenzi
Roi Anteby
Yegor Tryliskyy
Francesco Maria Carrano
Georgios Seitidis
Dimitris Mavridis
Vincent T. Hoek
Alberto Serventi
Willem A. Bemelman
Gian Andrea Binda
Rafael Duran
Triantafyllos Doulias
Nauzer Forbes
Nader K. Francis
Fabian Grass
Jesper Jensen
Marianne Krogsgaard
Lisa H. Massey
Luca Morelli
Christian E. Oberkofler
Dorin E. Popa
Johannes Kurt Schultz
Shahnaz Sultan
Jean-Jacques Tuech
Hendrik Jaap Bonjer
Publication date
28-12-2024
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2025
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-11445-y