Surgical Decision-Making for the Treatment of Acute Diverticulitis: A Single-Center Retrospective Study
by
, , , and
Davide Inversini
1, 
Sara El Adla
1,
Andrea Vigezzi
1,
Simone Gianazza
2,*,
Marika Morabito
1,
Andrea Rizzi
2,
Andrea Palillo
1,
Giuseppe Ietto
1
and
Giulio Carcano
1 1
Department of Medicine and Technological Innovation, University of Insubria ASST-Settelaghi, 21100 Varese, Italy
2
Department of General Surgery, Ospedale L Galmarini Tradate—ASST Settelaghi, 20149 Tradate, Italy
*
Author to whom correspondence should be addressed.
Emerg. Care Med. 2025, 2(3), 33; https://doi.org/10.3390/ecm2030033
Submission received: 13 May 2025
/
Revised: 5 July 2025
/
Accepted: 9 July 2025
/
Published: 14 July 2025
Abstract
Background: Several studies have suggested that laparoscopic peritoneal lavage for the treatment of diverticulitis might be associated with an increased event rate. The WSES (World Society of Emergency Surgery) guidelines recommend performing laparoscopic peritoneal lavage only in highly selected patients; however, selection criteria remain poorly described. This study, based on a single-center retrospective cohort of patients presenting with acute diverticulitis and undergoing surgery, aimed to assess the complication and long-term outcomes of the lavage group and to report our experience with the treatment of acute diverticulitis. Methods: Operative management of acute sigmoid diverticulitis was involved, in particular, laparoscopic peritoneal lavage, primary resection, and the Hartmann procedure. Results: Six-month follow-ups showed the occurrence of Clavien–Dindo complications in ≥2 in 21.9% of patients in the sigmoidectomy group versus 61.1% of patients in the lavage group (p = 0.0028). Among the 11 patients with complications after laparoscopic lavage, 9 required a second surgery. After a comparison between the patients with complications and those without who were managed with laparoscopic lavage, descriptive differences were found regarding the BMI (95% CI, 21.7–24.3 vs. 95% CI, 24.7–31.3, p = 0.0419). In analysis, a BMI of ≥27 kg/m2 (OR, 16 p = 0.049) was associated with short- and long-term complications in the lavage group. There was no evidence for an association between complications and a BMI of ≥27 kg/m2 in the primary resection (OR, 1.61 p = 1) or the Hartmann procedure group (OR, 4.25 p = 0.1438). Perforated colonic diverticulitis treated with laparoscopic peritoneal lavage was associated with a high morbidity rate. Conclusions: The choice of surgical strategy for acute diverticular pathology is complex, influenced by various conditions. BMI could be a prognostic factor for long-term outcomes, including recurrent diverticulitis and the occurrence of abscesses.
1. Introduction
Its incidence is likely rising due to the increasing median age of the population and changes in lifestyle. Inflammatory pathology tends to localize on the left colon, particularly the sigmoid colon. Acute left-sided colonic diverticulitis can be treated medically or surgically; however, surgical treatment is usually reserved for cases of complicated diverticulitis with the onset of peritonitis and/or perforation, or in the case of non-punctured abscesses [3].
The surgical treatment of acute diverticulitis includes three different options: Hartmann’s resection, open or laparoscopic sigmoidectomy with primary anastomosis, and open or laparoscopic peritoneal lavage. Currently, the choice of surgery depends on many factors. Each intervention has advantages and disadvantages, and the appropriate patient selection is essential to reduce complications. Hartmann’s resection is characterized by reduced operating times and a low risk of complications; however, it can reduce the patient’s quality of life [4]. Sigmoidectomy with primary anastomosis is recommended by the most recent guidelines for hemodynamically stable patients without comorbidities and can be performed with or without a fecal diversion. Finally, peritoneal lavage offers a conservative approach and shortens the postoperative stay. Several prospective randomized trials have been conducted to confirm the validity of this method; however, they have shown discordant results compared to reports of early experiences. Due to the results obtained from the LADIES study and other works (DILALA and SCANDIV), current guidelines are more reluctant to recommend the use of laparoscopic lavage compared to previous years, and it is not considered an alternative to sigmoid resection with or without anastomosis. They suggest peritoneal lavage only in highly selected cases of diverticulitis with diffuse purulent peritonitis; however, the selection criteria have not yet been defined by the Surgical Society [4,5,6,7,8,9].
The purpose of this project is to study the selection criteria considered by surgeons to guide the surgical management of acute diverticulitis and to assess whether peritoneal lavage can still be a valid alternative for a selected group.
2. Materials and Methods
This retrospective study included adult patients aged 18 to 90 years who underwent emergency surgical treatment for acute sigmoid diverticulitis at the Emergency and Transplant Surgery unit of the Hospital of Varese from 2018 to 2022. The diagnosis was based on clinical presentation, laboratory tests, and CT imaging. All patients underwent diagnostic laparoscopy to assess disease severity, and those with intraoperative neoplasia or septic shock were excluded. Patients with septic shock underwent Hartmann’s procedure (HP), which precluded comparison to other approaches.
The study examined three surgical procedures for treating diverticular disease: Hartmann’s resection, sigmoidectomy with primary anastomosis (PA) with or without fecal diversion, and peritoneal lavage (LPL). Patients were categorized into three groups based on the surgical intervention they received, and complications were recorded. Clinical, laboratory, radiological, and anatomopathological data were collected retrospectively. The results were analyzed using descriptive statistics, Fisher’s exact test for categorical variables, and Student’s t-test for continuous variables. The significance level was set at p < 0.05, and the statistical analyses were performed using XLSTAT. Given the non-parametric distribution of some variables and small subgroups, Fisher’s exact test was prioritized for categorical comparisons. The retrospective design and small LPL subgroup increased the risk of Type II errors. Multivariate analysis was precluded due to the sample size. The radiological findings of each patient were analyzed by the surgical team and a radiologist, who reported the WSES and Hinchey classification. The surgeon then applied one of the three surgical interventions. After surgery, an empirically designed antibiotic regimen was used, with duration dependent on laboratory tests, infection severity, and resistance profiles. All patients underwent a 6-month follow-up that included surgical evaluations, biochemical analyses, colonoscopy, and radiological examinations.
Surgical decisions were made by a multidisciplinary team based on international guidelines, hemodynamic status, and intraoperative findings. Procedures were performed by eight senior consultants, each with >5 years of experience in colorectal surgery; as previously stated, standardized criteria (WSES/Hinchey Classification) guided surgical decisions. However, due to the emergency/urgent nature of the procedure, it was not possible to standardize the selection of surgeons, which may have constituted a selection bias. The operating surgical team depended on which surgeons were on duty the day of the procedure.
The primary goals were to identify factors predicting positive outcomes in peritoneal lavage patients, determine if diverticular disease and comorbidity classification can guide surgical approach, and analyze complication rates in different treatment groups. The secondary goal was to correlate the type of intervention and complication incidence with descriptive study variables. The study considered only postoperative complications ranked at least a Clavien–Dindo grade 2.
A post-hoc power analysis was conducted to evaluate the study’s ability to detect clinically meaningful differences. For the primary outcome (Clavien–Dindo ≥2 complications across the HP, PA, and LPL groups), the observed effect size (Cohen’s *w* = 0.35) and total sample size (*n* = 91) yielded 80% power (α = 0.05, chi-square test). However, subgroup analyses were underpowered. While the overall comparisons were robust, the LPL subgroup results should be interpreted as exploratory due to the limited sample size and instability of effect estimates. The Bonferroni correction was applied for multiple comparisons.
Due to heterogeneous variances and non-normal distributions, group differences were assessed via Welch’s t-tests with the Bonferroni adjustment. While ANOVA is standard for 3-group comparisons, our focus on pairwise clinical contrasts and small subgroup sizes justified this approach.
3. Results
During the study, our team operated on 101 patients for acute diverticulitis. However, 7 patients were excluded due to colorectal cancer, and 3 were excluded due to septic shock and hemodynamic instability, leaving 91 patients who met the inclusion criteria.
These 91 patients included 49 males and 42 females. Among them, 37 underwent HP, 36 underwent resection with PA, and 18 underwent LPL. Table 1 shows the general characteristics of the three patient groups.
3.1. Hartmann Resection vs. Resection with Primary Anastomosis
First, individual differences between subjects undergoing HP and subjects undergoing PA were evaluated. The data relating to the postoperative course, the clinical outcomes, and the surgical parameters are summarized in Table 2.
The following differences between HP and PA were found: operative times (149.29 ± 43.27 vs. 179 ± 59.05 min; p > 0.137), postoperative stay (19.86 ± 26.21 vs. 10.08 ± 8.55 days, p < 0.0361) and time for canalization (4.18 ± 2.69 vs. 2.33 ± 1.65 days; p < 0.0001). Approximately 75% (n = 28) of patients undergoing HP had a colostomy 12 months after surgery, compared to 3% (n = 1) of patients in the PA group due to an anastomosis leakage.
There were no significant differences between the two groups in the number of severe complications (10 vs. 6, p = 0.39).
Table 3 shows the number of complications stratified according to the ASA, Hinchey, and WSES scores, where no significant differences were found.
The retrospective data analysis compared the HP and PA patients, revealing that the PA patients were younger than the HP patients. Additionally, C-reactive protein was higher in the HP group but also remained elevated in the PA group. As expected from the literature, the PA group had lower Charlson Comorbidity Index and ASA scores compared to the HP group. Therefore, the choice of surgical procedure was strongly influenced by patient comorbidity, suggesting that surgery should be tailored to the preoperative characteristics of the patient.
In our study, a statistically significant difference was found between the Hinchey and WSES classification groups. Specifically, 13 out of 15 (87%) Hinchey 4 patients underwent HP, compared to only 2 out of 15 (13%) who underwent PA. The presence of stercoraceous peritonitis seems to be an important factor in treatment selection.
3.2. Sigmoidectomy vs. Peritoneal Lavage
Later, we compared sigmoidectomy (HR + PA) vs. LPL.
Statistical analysis revealed significant differences regarding the Hinchey and WSES scores. Specifically, 34% (n = 25) of patients undergoing sigmoidectomy had Hinchey equal to 3 vs. 72% (n = 13) of patients undergoing LPL, and 9% (n = 7) of patients in the first group had a WSES 2b score vs. 39% (n = 7) of patients in the LPL group. Table 4 summarizes the results, while Table 5 shows the clinical outcomes and the operative course of the two groups. In the LPL group, severe complications observed included the persistence of a septic state and peritonitis (n = 1), intra-abdominal abscess (n = 2), and recurrence of symptoms associated with diverticulitis (n = 6). Table 6 shows the number of complications stratified according to the ASA, Hinchey, and WSES scores, revealing a statistically significant difference between ASA 2 (5/31 vs. 5/6, p = 0.003) and Hinchey 3 (5/25 vs. 8/13, p = 0.027).
3.3. Hartmann Resection vs. Peritoneal Lavage
Table 2 details the clinical outcomes and postoperative stay. Significant differences were observed in the number of severe complications (10/37 vs. 11/18), the necessity for a second surgery (4/37 vs. 9/18), the recurrence of diverticular episodes (0/37 vs. 3/18), and the need for re-admission (0/37 vs. 5/18).
Lastly, Table 3 illustrates the number of complications stratified by ASA grade, Hinchey and WSES score. Differences in complications rates were noted between the two different groups within the ASA 2 (3/13 vs. 5/6) and Hinchey 3 (3/19 vs. 8/13) categories.
3.4. Primary Anastomosis vs. Peritoneal Lavage
Table 2 shows the data on clinical outcomes and the postoperative course, highlighting differences between the two groups in terms of severe complications (6/36 vs. 11/18), the need for re-operation (2/36 vs. 9/18), recurrence of diverticular episodes (0/36 vs. 3/9), and the need for re-admission (0/36 vs. 5/18). Table 3 shows the number of complications stratified by ASA, Hinchey, and WSES score. Significant differences were identified in the number of complications in the ASA category 2 (2/18 vs. 5/6).
3.5. Peritoneal Lavage Analysis—Patients with and Without Complications
Due to the greater number of complications in the LPL group, a case-control study was performed. Patients undergoing LPL were divided according to the occurrence of complications (Clavien–Dindo ≥ 3). In the group of complicated patients, we used a Clavien–Dindo score of ≥3 as an inclusion criterion, considering the need for a second surgery. Note that in Table 5 and the following Table 7 and Table 8, a Clavien–Dindo score of ≥2 was considered (present in 11 cases), but in this case, a Clavien–Dindo score of ≥3 was used. Two patients considered in the “uncomplicated” group experienced medical complications: the first had a post-operative course complicated by acute pulmonary embolism, while the second by symptomatic pulmonary atelectasis. The parameters compared are summarized in Table 7.
There were no significant differences except for BMI (23.98 ± 2.92 kg/m2 in patients with no complications vs. 28.53 ± 5.41 kg/m2 in patients with complications, p-value = 0.0419). Due to these findings, we applied the Bonferroni correction, adjusting the significance threshold to *p* < 0.017. The BMI finding (*p* = 0.0419) did not retain significance post-correction. The OR was calculated for a BMI of ≥25 kg/m2: 1.6 (p = 1). Furthermore, the OR was evaluated for a BMI of ≥27 kg/m2 with a result of 16 (p = 0.0498) (Figure 1).
The two groups showed no significant differences in patient sex, age, surgical history, or number of prior acute diverticulitis episodes. Notably, most patients in both groups had experienced their first episode of diverticular inflammation. There were also no significant differences in preoperative laboratory data, Hinchey and WSES classification, or ASA and Charlson Comorbidity Index between patients in the complicated and uncomplicated groups. This suggests the ASA classification alone is inadequate for patient selection. Our analysis found that BMI alone is statistically significant in differentiating the two groups. Evaluating BMI as a risk factor, an OR of 1.6 was calculated with a cut-off of BMI of ≥25, and an OR of 16 with a cut-off of BMI of ≥27 (p-value = 0.049). The data on BMI of ≥27 as a risk factor for complications of laparoscopic peritoneal lavage, though limited by the small sample size, appear to be a new finding not yet reported in the literature (Table 8).
The association between a BMI of ≥27 and LPL complications, while nominally significant, should be interpreted cautiously due to multiple testing, and it requires validation in larger cohorts.
3.6. Hartmann’s Resection—Patients with and Without Complications
Patients undergoing HP were divided according to the occurrence of complications (Clavien–Dindo ≥ 3), to verify if there were significant differences even in the two populations of patients undergoing HP, as in the LPL groups. A case-control study was performed, comparing the individual characteristics of the patients, radiological parameters, and the intraoperative findings. The two populations were substantially homogeneous (Table 8).
To exclude overweight and obesity as risk factors for Clavien–Dindo complications of ≥3 in this group, the odds ratio (OR) for a BMI of greater than 25 and 27 kg/m2 was calculated; however, the analysis did not reach statistical significance (Figure 2).
3.7. Sigmoidectomy with Primary Anastomosis—Patients with and Without Complications
As in the previous group, a case-control study was performed analyzing the same parameters (Table 9). The two study populations were substantially homogeneous. Likewise, we calculated the odds ratio for BMIs of greater than 25 and 27 kg/m2 (Figure 3); however, the analysis did not reach statistical significance.
4. Discussion
There is still no international consensus among surgeons on the best way to treat uncomplicated and complicated diverticulitis. Guidelines from major surgical organizations [4,10,11,12,13] indicate that the choice of the most appropriate surgical intervention is not clearly defined. Research has shown that primary anastomosis is a safe operation that can be performed on hemodynamically stable, immunocompetent patients [6,14,15,16,17]. Current guidelines allow for choosing between Hartmann’s procedure and PA, but the selection criteria are not well-established.
The WSES suggests primary anastomosis for hemodynamically stable patients without other medical conditions, while other guidelines do not clearly outline the factors to consider when making an appropriate choice [4]. The ASCRS trusts the surgeon to assess the potential risk of anastomotic leakage before deciding on the surgical approach, also stating that the choice should be based on the surgeon’s experience and skills [10]. In contrast, the EAES and ACPGBI indicate the possibility of choosing between the two surgical options without specifying a selection criterion.
For a long time, the standard treatment for diverticulitis with stercoraceous peritonitis was HP [4,6,17,18,19,20]. However, over the past 20 years, this intervention has been increasingly abandoned in patients with good health statuses [21,22,23,24,25,26]. Our study found that surgeons take in consideration as fundamental both a high ASA score and Hinchey 4 status when choosing the most invasive surgical option.
As shown in Figure 4, Figure 5 and Figure 6 the incidence of complications appears to increase with higher ASA scores in the PA group compared to the HP group. Similarly, an evaluation of the difference in complication frequency between the two groups based on Hinchey and WSES scores does not show a markedly different trend; the study data indicate a higher incidence of complications with increasing ASA scores and Charlson Comorbidity Index scores, rather than Hinchey and WSES classifications.
The LADIES Trial [16] and the DIVERTI Trial [3] indicated that the incidence of complications in stercoraceous peritonitis did not depend on randomization in the HP or PA groups. Instead, it seemed to depend on the preoperative comorbidities. Considering the existing literature and ongoing discussions on diverticulitis treatment, the analysis focused on the peritoneal lavage group. First, the peritoneal lavage group was compared to the overall sigmoid resection group, then to the individual treatment groups.
According to the WSES and ASCRS guidelines, when analyzing the differences between patients undergoing sigmoidectomy and peritoneal lavage based on preoperative classifications, in accordance with WSES and ASCRS guidelines, peritoneal lavage was not performed on Hinchey 4 patients. Hinchey 3 was the most representative class for peritoneal lavage. The same statistically significant consideration was found when comparing the peritoneal lavage group to the primary anastomosis group.
An analysis of the complications of sigmoidectomy vs. LPL reveals that severe complications (Clavien–Dindo > 2) occurred more frequently in the LPL group, with nine cases requiring a second surgery (Clavien–Dindo > 3). This trend was also observed in the individual comparisons between patients in the LPL and HP groups, as well as the LPL and PA groups.
The most common complication associated with peritoneal lavage was intra-abdominal abscess. Additionally, 5 out of 18 patients experienced another episode of diverticulitis necessitating hospitalization, with a mean of 8.4 ± 7.92 months between episodes. These findings are consistent with the existing literature [5,7,15]. Notably, the LADIES Trial study was terminated prematurely due to the development of distant postoperative abscesses.
The LADIES study and our own series indicate that approximately 11% of patients undergoing peritoneal lavage developed distant abscesses. After 3 years, the LOLA study found that 21% of patients with peritoneal lavage had distant postoperative abscesses, and 27% had a recurrence of the condition. However, 52% of the patients benefited from the minimally invasive LPL treatment, avoiding reoperation and the return of diverticular inflammatory symptoms.
The results of the LADIES [15] study and other work [7] have led to the current guidelines recommending more cautious use of laparoscopic lavage. Evidence suggests that while this procedure is associated with low mortality, fewer surgical wound infections, and lower costs, it also carries a high risk of reoperation and postoperative complications. The heterogeneity across studies complicates a reliable interpretation of these results, as factors such as patient demographics, anesthesia, non-standardized surgery, and other intraoperative elements may significantly influence the outcomes [10]. Current guidelines, therefore, advocate for the judicious use of this surgical procedure in highly selected patients, although inclusion criteria for LPL remain undefined.
Several studies suggest that obesity and excess weight may increase the risk of short-term complications, depending on the surgical procedure. While many reviews have focused on the impact of high BMI on cancer surgery [27,28,29,30,31,32], there are no major studies evaluating the role of BMI in the risk of complications after surgical treatment of benign conditions like diverticulitis. Obesity is believed to be a risk factor for infectious complications, particularly surgical wound infection. More data are needed to determine if BMI could be a predictive factor for complications in patients treated with laparoscopic peritoneal lavage. The association between a BMI of ≥27 and LPL failure may reflect both technical and biological factors. Laparoscopic lavage in obese patients is hindered by reduced operative field visibility and thicker omentum, which can trap contaminated fluid. Additionally, adipose tissue exacerbates systemic inflammation via cytokine release (e.g., IL-6), potentially increasing abscess risk [33,34]. These factors collectively undermine LPL’s efficacy in patients with obesity. Different studies [35,36] have identified additional factors for selecting patients for peritoneal lavage, including immunosuppression, an ASA score of ≥3, and age. However, this study’s limitations include its retrospective design, small sample size, and lack of prior research on BMI and surgical treatment of benign conditions. In our study, the observed OR for a BMI of ≥27 (OR = 16) reflects a strong signal but is limited by sample size. Future studies must control for confounders (e.g., visceral adiposity, operative technique). The study’s power analysis revealed adequate sensitivity (80%) for detecting group-level differences among HP, PA, and LPL. However, the small LPL subgroup (*n* = 18) limited the reliability of its associated findings, including the putative association between a BMI of ≥27 kg/m2 and complications (OR = 16, *p* = 0.0419). This effect, while clinically plausible, was statistically fragile (power ~ 60%) and did not withstand correction for multiple testing. The retrospective design and sparse subgroups (e.g., no Hinchey 4 cases in the LPL group) further constrained multivariate adjustments. Future prospective studies with larger LPL cohorts (*n* ≥ 50) are needed to validate BMI’s prognostic role.
5. Conclusions
Our data analysis sought to identify the surgical indication for complicated acute diverticulitis, with a specific focus on peritoneal lavage.
The choice of surgical strategy for acute diverticular pathology is complex, influenced by various conditions. At our center, the selection criteria considered during the surgical decision-making process are, first, the patient’s general status and, only secondarily, the classifications of diverticular pathology. Despite previously cited limitations, we can affirm that a patient’s BMI is a predictive factor of complications requiring a second surgery when undergoing peritoneal lavage. In this manuscript, we have elaborated on the significance of our initial observation linking a BMI of ≥27 to LPL failure, emphasizing its potential as a novel and clinically relevant predictor. There remains a critical need for larger studies with multivariate analysis to confirm these insights and enhance generalizability.
Author Contributions
Conceptualization, D.I., S.E.A., A.R. and G.C.; methodology, D.I., A.V. and. S.G.; software, S.E.A. and M.M.; validation, D.I. and G.I.; formal analysis, S.E.A., A.V. and A.P.; investigation, S.G. and A.P.; resources, S.G. and M.M.; data curation, S.E.A. and D.I.; writing—original draft preparation, S.E.A. and A.V.; writing—review and editing, S.G. and M.M.; visualization, G.I.; supervision, A.R. and G.C. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study was granted exemption by the Institutional Review Board at the University of Insubria because our institution does not require submission and approval for retrospective observational studies.
Informed Consent Statement
Informed consent was waived for this retrospective study as it involved anonymized data collected from routine clinical practice, and the research posed no additional risk to participants. This exemption was approved by the Institutional Review Board of the University of Insubria in accordance with national regulations (Italy) and the Declaration of Helsinki.
Data Availability Statement
The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding author.
Conflicts of Interest
The authors declare no conflict of interest.
Abbreviations
| ACPGBI | Association of Coloproctology of Great Britain and Ireland |
| ASA | American Society of Anesthesiologists |
| ASCRS | American Society of Colon and Rectal Surgeons |
| BMI | Body Mass Index |
| CRP | C-reactive protein |
| EAE | European Association for Endoscopic Surgery |
| HP | Hartmann’s procedure |
| LPL | Laparoscopic peritoneal lavage |
| MOF | Multi-organ failure |
| PA | Primary anastomosis |
| WSES | World Society of Emergency Surgery |
| WBC | White blood cell |
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Figure 1.
Data used to calculate the OR for a BMI of ≥25 and a BMI of ≥27 in the LPL group.
Figure 2.
Data used to calculate the OR for a BMI of ≥25 and a BMI of ≥27 in the HP group.
Figure 3.
Data used to calculate the OR for a BMI of ≥25 and a BMI of ≥27 in the PA group.
Figure 4.
Frequency of complications in relation to ASA score.
Figure 5.
Frequency of complications in relation to Hinchey score.
Figure 6.
Frequency of complications in relation to WSES classification.
Table 1.
General characteristics of the patients of the three different groups.
| Characteristics | HP (n = 37) | PA (n = 36) | LPL (n = 18) |
|---|---|---|---|
| Sex ratio (male to female) | 18:19 | 19:17 | 12:6 |
| Age (years, mean ± SD) | 69.89 ± 10.73 | 60.22 ± 12.76 | 61.33 ± 14.33 |
| BMI (kg/m2, mean ± SD) | 26.56 ± 4.77 | 26.66 ± 4.15 | 26.25 ± 4.83 |
| Previous abdominal surgery (n) | |||
| None | 16 | 11 | 8 |
| N° > 1 | 21 | 25 | 10 |
| Previous episodes of diverticulitis (n) | |||
| None | 33 | 11 | 15 |
| N° = 1 | 4 | 14 | 3 |
| N° > 1 | 0 | 11 | 0 |
| Charlson Comorbidity Index (mean ± SD) | 4.45 ± 2.44 | 2.08 ± 1.91 | 2.55 ± 2.93 |
| WBC (109/L, mean ± SD) | 15.11 ± 12.66 | 12.25 ± 14.21 | 17.24 ± 5.72 |
| CRP (mg/L, mean ± SD) | 188.94 ± 152.88 | 60.03 ± 80.22 | 124.85 ± 90.86 |
| American Society of Anesthesiologists (ASA) | |||
| 1 | 4 | 15 | 9 |
| 2 | 13 | 18 | 6 |
| 3 | 17 | 3 | 3 |
| 4 | 3 | 0 | 0 |
| Hinchey classification | |||
| 0 | 0 | 3 | 0 |
| 1a | 1 | 17 | 0 |
| 1b | 0 | 3 | 0 |
| 2 | 4 | 5 | 5 |
| 3 | 19 | 6 | 13 |
| 4 | 13 | 2 | 0 |
| WSES classification | |||
| 0 | 0 | 14 | 0 |
| 1a | 1 | 8 | 4 |
| 1b | 0 | 3 | 1 |
| 2a | 7 | 2 | 1 |
| 2b | 4 | 3 | 7 |
| 3 | 2 | 2 | 2 |
| 4 | 23 | 4 | 3 |
Table 2.
Comparison of clinical outcomes.
| Outcome | HP (n = 37) | PA (n = 36) | LPL (n = 18) | p Value (HP vs. PA) | p Value (HP vs. LPL) | p Value (PA vs. LPL) |
|---|---|---|---|---|---|---|
| Severe complications (Clavien–Dindo ≥ 2) | 10 | 6 | 6 | 0.3975 | 0.0199 | 0.0017 |
| Patients alive with stoma | 28 | 1 | 0 | <0.0001 | 0.0004 | 1 |
| Secondary reoperations | 4 | 2 | 9 | 0.6741 | 0.0025 | 0.0003 |
| Antibiotic therapy (days, mean ± SD) | 13.24 ± 7.91 | 12.83 ± 13.37 | 19.72 ± 19.74 | 0.8730 | 0.0874 | 0.1348 |
| Operative time (minutes, mean ± SD) | 149.29 ± 43.27 | 179 ± 59.05 | 68.94 ± 20.69 | 0.0137 | <0.0001 | <0.0001 |
| Canalization (days, mean ± SD) | 4.18 ± 2.69 | 2.33 ± 1.65 | 4 ± 9.38 | <0.001 | 0.9097 | 0.3019 |
| Total hospital stay (days, mean ± SD) | 19.86 ± 26.21 | 10.08 ± 8.55 | 14.33 ± 14.78 | 0.0361 | 0.4098 | 0.1861 |
| Diverticulitis recurrence | 0 | 0 | 5 | 1 | 0.0025 | 0.0027 |
| Readmissions | 0 | 0 | 5 | 1 | 0.0025 | 0.0027 |
Table 3.
Stratification of complications.
| Complications | HP (n = 10) | PA (n = 6) | LPL (n =11) | p Value (HP vs. LPL) | p Value (PA vs. LPL) | p Value (HP vs. PA) |
|---|---|---|---|---|---|---|
| American Society of Anesthesiologists (ASA) | ||||||
| 1 | 0/4 | 2/15 | 4/9 | 0.2280 | 0.1501 | 1 |
| 2 | 3/13 | 2/18 | 5/6 | 0.0408 | 0.0027 | 0.6254 |
| 3 | 6/17 | 2/3 | 2/3 | 0.2154 | 1 | 0.5368 |
| 4 | 1/3 | 0 | 0 | 1 | 1 | 1 |
| Hinchey Classification | ||||||
| 0 | 0/0 | 1/3 | 0 | 1 | 1 | 1 |
| 1a | 0/1 | 1/17 | 0 | 1 | 1 | 1 |
| 1b | 0/0 | 0/3 | 0 | 1 | 1 | 1 |
| 2 | 0/4 | 1/5 | 3/5 | 0.1667 | 1 | 1 |
| 3 | 3/19 | 2/6 | 8/13 | 0.0205 | 0.3498 | 0.5623 |
| 4 | 7/13 | 1/2 | 0 | 1 | 1 | 1 |
| WSES Classification | ||||||
| 0 | 0/0 | 1/14 | 0 | 1 | 1 | 1 |
| 1a | 0/1 | 1/8 | 3/4 | 0.4000 | 0.0667 | 1 |
| 1b | 0/0 | 1/3 | 1/1 | 1 | 1 | 1 |
| 2a | 1/7 | 0/2 | 0/1 | 1 | 1 | 1 |
| 2b | 1/4 | 0/3 | 4/7 | 0.5455 | 0.2000 | 1 |
| 3 | 1/2 | 1/2 | 1/2 | 1 | 1 | 1 |
| 4 | 7/23 | 2/4 | 2/3 | 0.2677 | 1 | 0.5815 |
Table 4.
Sigmoidectomy vs. LPL: comparison of descriptive data.
| Characteristic | HP + PA (n = 73) | LPL (n = 18) | p Value |
|---|---|---|---|
| Sex ratio (male to female) | 37:36 | 12:6 | 0.2939 |
| Age (years, mean ± SD) | 65.12 ± 12.62 | 61.33 ± 14.33 | 0.2698 |
| BMI (kg/m2, mean ± SD) | 26.61 ± 4.44 | 26.25 ± 4.83 | 0.7629 |
| Previous abdominal surgery (n) | |||
| None | 27 | 8 | 0.5962 |
| N° > 1 | 46 | 10 | 0.5962 |
| Previous episodes of diverticulitis (n) | |||
| None | 44 | 15 | 0.0976 |
| N° = 1 | 18 | 3 | 0.5507 |
| N° > 1 | 11 | 0 | 0.1127 |
| Charlson Comorbidity Index (mean ± SD) | 3.28 ± 2.49 | 2.55 ± 2.93 | 0.2842 |
| WBC (109/L, mean ± SD) | 13.70 ± 13.43 | 17.24 ± 5.72 | 0.2786 |
| CRP (mg/L, mean ± SD) | 125.39 ± 137.94 | 124.85 ± 90.86 | 0.9874 |
| American Society of Anesthesiologists (ASA) | |||
| 1 | 19 | 9 | 0.0842 |
| 2 | 31 | 6 | 0.5958 |
| 3 | 20 | 3 | 0.5456 |
| 4 | 3 | 0 | 1 |
| Hinchey classification | |||
| 0 | 3 | 0 | 1 |
| 1a | 18 | 0 | 0.0185 |
| 1b | 3 | 0 | 1 |
| 2 | 9 | 5 | 0.1415 |
| 3 | 25 | 13 | 0.0065 |
| 4 | 15 | 0 | 0.0358 |
| WSES classification | |||
| 0 | 14 | 0 | 0.0636 |
| 1a | 9 | 4 | 0.2790 |
| 1b | 3 | 1 | 1 |
| 2a | 9 | 1 | 0.6800 |
| 2b | 7 | 7 | 0.0056 |
| 3 | 4 | 2 | 0.3390 |
| 4 | 27 | 3 | 0.1605 |
Table 5.
Sigmoidectomy vs. LPL: comparison of clinical outcomes.
| Outcome | HP + PA (n = 73) | LPL (n = 18) | p Value |
|---|---|---|---|
| Severe complications (Clavien–Dindo ≥ 2) | 16 | 11 | 0.0028 |
| Patients alive with stoma | 29 | 0 | 0.0005 |
| Secondary reoperations | 6 | 9 | 0.0002 |
| Duration of antibiotic therapy (days, mean ± SD) | 13.04 ± 10.84 | 19.72 ± 19.74 | 0.0543 |
| Operative time (minutes, mean ± SD) | 164.37 ± 53.55 | 68.94 ± 20.69 | <0.0001 |
| Canalization (days, mean ± SD) | 3.27 ± 2.47 | 4 ± 9.38 | 0.5557 |
| Total hospital stay (days, mean ± SD) | 15.04 ± 20.08 | 14.33 ± 14.78 | 0.8888 |
| Diverticulitis recurrence | 0 | 5 | 0.0002 |
| Readmissions | 0 | 5 | 0.0002 |
Table 6.
Sigmoidectomy vs. LPL: stratification of complications.
| Complications | HP + PA (n = 16) | LPL (n = 11) | p Value |
|---|---|---|---|
| American Society of Anesthesiologists (ASA) | |||
| 1 | 2/19 | 4/9 | 0.0638 |
| 2 | 5/31 | 5/6 | 0.0030 |
| 3 | 8/20 | 2/3 | 0.5596 |
| 4 | 1/3 | 0 | 1 |
| Hinchey classification | |||
| 0 | 1/3 | 0 | 1 |
| 1a | 1/18 | 0 | 1 |
| 1b | 0/3 | 0 | 1 |
| 2 | 1/9 | 3/5 | 0.0949 |
| 3 | 5/25 | 8/13 | 0.0279 |
| 4 | 8/15 | 0 | 1 |
| WSES classification | |||
| 0 | 1/14 | 0 | 1 |
| 1a | 1/9 | 3/4 | 0.0517 |
| 1b | 1/3 | 1/1 | 1 |
| 2a | 1/9 | 0/1 | 1 |
| 2b | 1/7 | 4/7 | 0.2657 |
| 3 | 2/4 | 1/2 | 1 |
| 4 | 9/27 | 2/3 | 0.5367 |
Table 7.
Case-control study of patients treated with LPL.
| NON-COMPLICATED (n = 9) | Characteristic | COMPLICATED (n = 9) | p Value |
|---|---|---|---|
| 6:3 | Sex ratio (male to female) | 6:3 | 1 |
| 64.55 ± 18.29 | Age (years, mean ± SD) | 58.11 ± 8.86 | 0.3556 |
| 23.98 ± 2.92 | BMI (kg/m2, mean ± SD) | 28.53 ± 5.41 | 0.0419 |
| Previous abdominal surgery (n) | |||
| 5 | None | 3 | 0.6372 |
| 4 | N° > 1 | 6 | 0.6372 |
| Previous episodes of diverticulitis (n) | |||
| 7 | None | 8 | 1 |
| 2 | N° = 1 | 1 | 1 |
| 0 | N° > 1 | 0 | 1 |
| 2.00 ± 1.87 | Charlson Comorbidity Index (mean ± SD) | 3.11 ± 3.75 | 0.4386 |
| 17.92 ± 5.67 | WBC (109/L, mean ± SD) | 16.56 ± 6.03 | 0.6286 |
| 123.25 ± 92.04 | CRP (mg/L, mean ± SD) | 126.45 ± 95.21 | 0.9431 |
| American Society of Anesthesiologists (ASA) | |||
| 3 | 1 | 4 | 1 |
| 5 | 2 | 3 | 0.6372 |
| 1 | 3 | 2 | 1 |
| 0 | 4 | 0 | 1 |
| Hinchey classification | |||
| 0 | 0 | 0 | 1 |
| 0 | 1a | 0 | 1 |
| 0 | 1b | 0 | 1 |
| 2 | 2 | 3 | 1 |
| 7 | 3 | 6 | 1 |
| 0 | 4 | 0 | 1 |
| WSES classification | |||
| 0 | 0 | 0 | 1 |
| 2 | 1a | 2 | 1 |
| 0 | 1b | 1 | 1 |
| 1 | 2a | 0 | 1 |
| 3 | 2b | 3 | 1 |
| 2 | 3 | 1 | 1 |
| 1 | 4 | 2 | 1 |
| 67.55 ± 14.62 | Operative time (minutes, mean ± SD) | 70.33 ± 26.30 | 0.7854 |
| 0 | Use of immunosuppressive drugs | 2 | 0.4706 |
| 4 | Smoker | 1 | 0.2941 |
| 2.89 ± 1.36 | Reintroduction of foods (days, mean ± SD) | 3.50 ± 1.41 | 0.3791 |
Table 8.
Case-control study of patients treated with HP.
| NON-COMPLICATED (n = 32) | Characteristic | COMPLICATED (n = 5) | p Value |
|---|---|---|---|
| 15:17 | Sex ratio (male to female) | 3:2 | 0.6599 |
| 69.53 ± 10.89 | Age (years, mean ± SD) | 72.20 ± 10.47 | 0.6122 |
| 26.49 ± 4.68 | BMI (kg/m2, mean ± SD) | 26.92 ± 5.98 | 0.8556 |
| Previous abdominal surgery (n) | |||
| 13 | None | 3 | 0.6339 |
| 19 | N° > 1 | 2 | 0.6339 |
| Previous episodes of diverticulitis (n) | |||
| 30 | None | 3 | 0.0800 |
| 2 | N° = 1 | 2 | 0.0800 |
| 0 | N° > 1 | 0 | 0.0800 |
| 4.25 ± 2.47 | Charlson Comorbidity Index (mean ± SD) | 5.80 ± 1.92 | 0.1913 |
| 29.60 ± 84.49 | WBC (109/L, mean ± SD) | 10.25 ± 4.89 | 0.6160 |
| 177.39 ± 138.30 | CRP (mg/L, mean ± SD) | 263.18 ± 232.73 | 0.2487 |
| American Society of Anesthesiologists (ASA) | |||
| 4 | 1 | 0 | 1 |
| 12 | 2 | 1 | 0.6378 |
| 14 | 3 | 3 | 0.6443 |
| 2 | 4 | 1 | 0.3616 |
| Hinchey classification | |||
| 0 | 0 | 0 | 1 |
| 1 | 1a | 0 | 1 |
| 0 | 1b | 0 | 1 |
| 4 | 2 | 0 | 1 |
| 18 | 3 | 1 | 0.1797 |
| 9 | 4 | 4 | 0.0423 |
| WSES classification | |||
| 0 | 0 | 0 | 1 |
| 1 | 1a | 0 | 1 |
| 0 | 1b | 0 | 1 |
| 7 | 2a | 0 | 1 |
| 4 | 2b | 0 | 1 |
| 1 | 3 | 1 | 0.2553 |
| 19 | 4 | 4 | 0.6303 |
| 146.56 ± 43.27 | Operative time (minutes, mean ± SD) | 166.80 ± 43.52 | 0.3377 |
Table 9.
Case-control study of patients treated with PA.
| NON-COMPLICATED (n = 34) | Characteristic | COMPLICATED (n = 2) | p Value |
|---|---|---|---|
| 18:16 | Sex ratio (male to female) | 1:1 | 1 |
| 60.35 ± 12.98 | Age (years, mean ± SD) | 58.00 ± 7.07 | 0.8028 |
| 26.67 ± 4.24 | BMI (kg/m2, mean ± SD) | 26.91 ± 2.35 | 0.9364 |
| Previous abdominal surgery (n) | |||
| 11 | None | 0 | 1 |
| 23 | N° > 1 | 2 | 1 |
| Previous episodes of diverticulitis (n) | |||
| 11 | None | 0 | 1 |
| 14 | N° = 1 | 0 | 1 |
| 9 | N° > 1 | 2 | 1 |
| 2.00 ± 1.93 | Charlson Comorbidity Index (mean ± SD) | 3.50 ± 0.70 | 0.2889 |
| 12.23 ± 14.63 | WBC (109/L, mean ± SD) | 12.50 ± 0.70 | 0.9800 |
| 61 ± 82.02 | CRP (mg/L, mean ± SD) | 43.65 ± 51.40 | 0.7710 |
| American Society of Anesthesiologists (ASA) | |||
| 13 | 1 | 1 | 1 |
| 18 | 2 | 0 | 0.4857 |
| 1 | 3 | 1 | 0.1095 |
| 0 | 4 | 0 | 1 |
| Hinchey classification | |||
| 2 | 0 | 1 | 0.1619 |
| 16 | 1a | 1 | 1 |
| 3 | 1b | 0 | 1 |
| 5 | 2 | 0 | 1 |
| 6 | 3 | 0 | 1 |
| 2 | 4 | 0 | 1 |
| WSES classification | |||
| 13 | 0 | 1 | 1 |
| 7 | 1a | 1 | 0.4000 |
| 3 | 1b | 0 | 1 |
| 2 | 2a | 0 | 1 |
| 3 | 2b | 0 | 1 |
| 2 | 3 | 0 | 1 |
| 4 | 4 | 0 | 1 |
| 178.41 ± 59.99 | Operative time (minutes, mean ± SD) | 204.50 ± 44.54 | 0.5514 |
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Inversini, D.; El Adla, S.; Vigezzi, A.; Gianazza, S.; Morabito, M.; Rizzi, A.; Palillo, A.; Ietto, G.; Carcano, G. Surgical Decision-Making for the Treatment of Acute Diverticulitis: A Single-Center Retrospective Study. Emerg. Care Med. 2025, 2, 33. https://doi.org/10.3390/ecm2030033
AMA Style
Inversini D, El Adla S, Vigezzi A, Gianazza S, Morabito M, Rizzi A, Palillo A, Ietto G, Carcano G. Surgical Decision-Making for the Treatment of Acute Diverticulitis: A Single-Center Retrospective Study. Emergency Care and Medicine. 2025; 2(3):33. https://doi.org/10.3390/ecm2030033
Chicago/Turabian StyleInversini, Davide, Sara El Adla, Andrea Vigezzi, Simone Gianazza, Marika Morabito, Andrea Rizzi, Andrea Palillo, Giuseppe Ietto, and Giulio Carcano. 2025. "Surgical Decision-Making for the Treatment of Acute Diverticulitis: A Single-Center Retrospective Study" Emergency Care and Medicine 2, no. 3: 33. https://doi.org/10.3390/ecm2030033
APA StyleInversini, D., El Adla, S., Vigezzi, A., Gianazza, S., Morabito, M., Rizzi, A., Palillo, A., Ietto, G., & Carcano, G. (2025). Surgical Decision-Making for the Treatment of Acute Diverticulitis: A Single-Center Retrospective Study. Emergency Care and Medicine, 2(3), 33. https://doi.org/10.3390/ecm2030033
