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Conservative treatment of uncomplicated right-sided diverticulitis: a systematic review and meta-analysis

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Abstract

Purpose

Right-sided diverticulitis has different epidemiologic features compared to left-sided diverticulitis. However, data on the appropriate treatment of right-sided diverticulitis are lacking. This systematic review aimed to examine the outcomes of conservative treatment for uncomplicated right-sided diverticulitis.

Methods

MEDLINE, Embase, and the Cochrane Library were searched for articles published from January 1, 1990, to May 31, 2020. A total of 21 studies were included in the systematic review. We calculated proportions and 95% confidence intervals (CIs) to assess the outcomes of individual studies and pooled the results using a random effects model.

Results

A total of 2811 patients (59.1% men; mean and median age, 37–54 years) with right-sided diverticulitis were included. The pooled rate of treatment failure was 2.5% (95% CI 1.2–4.3%; p <0.01; I2 = 64.0%). The recurrence rate ranged from 0 to 26.9%, and the pooled recurrence rate was 10.9% (95% CI 8.1–14.1%; p <0.01; I2 = 78.2%). The pooled rate of complicated diverticulitis at recurrence was 4.4% (95% CI 1.4–9.0%; p = 0.84; I2 = 0%). The pooled rate of emergency surgery at recurrence was 9.0% (95% CI 4.6–14.7%; p = 0.12; I2 = 30.3%).

Conclusions

Conservative treatment of uncomplicated right-sided diverticulitis results in a low rate of recurrence and complicated diverticulitis at recurrence. Based on these results, unnecessary surgery may be avoided and a new treatment paradigm for uncomplicated right-sided diverticulitis may be introduced.

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Acknowledgements

We are thankful to medical librarian Hyun Jung Yi.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea

    Jun Ho Lee, Byung Kyu Ahn & Kang Hong Lee

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Contributions

Jun Ho Lee, Byung Kyu Ahn, and Kang Hong Lee conceived and designed the study. Jun Ho Lee and Kang Hong Lee collected and interpreted the data. Jun Ho Lee and Kang Hong Lee drafted the article. All authors approved the final manuscript.

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Correspondence to Kang Hong Lee.

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Lee, J.H., Ahn, B.K. & Lee, K.H. Conservative treatment of uncomplicated right-sided diverticulitis: a systematic review and meta-analysis. Int J Colorectal Dis 36, 1791–1799 (2021). https://doi.org/10.1007/s00384-021-03913-x

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