TY - JOUR
T1 - EAES rapid guideline
T2 - surgical management of complicated diverticulitis - with ESCP participation
AU - Antoniou, Stavros A
AU - Huo, Bright
AU - Ortenzi, Monica
AU - Anteby, Roi
AU - Tryliskyy, Yegor
AU - Carrano, Francesco Maria
AU - Seitidis, Georgios
AU - Mavridis, Dimitris
AU - Hoek, Vincent T
AU - Serventi, Alberto
AU - Bemelman, Willem A
AU - Binda, Gian Andrea
AU - Duran, Rafael
AU - Doulias, Triantafyllos
AU - Forbes, Nauzer
AU - Francis, Nader K
AU - Grass, Fabian
AU - Jensen, Jesper
AU - Krogsgaard, Marianne
AU - Massey, Lisa H
AU - Morelli, Luca
AU - Oberkofler, Christian E
AU - Popa, Dorin E
AU - Schultz, Johannes Kurt
AU - Sultan, Shahnaz
AU - Tuech, Jean-Jacques
AU - Bonjer, Hendrik Jaap
N1 - © 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2025/2
Y1 - 2025/2
N2 - 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.
AB - 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.
KW - Anastomosis, Surgical
KW - Colectomy/methods
KW - Delphi Technique
KW - Diverticulitis, Colonic/surgery
KW - Diverticulitis/surgery
KW - Europe
KW - Humans
KW - Laparoscopy/methods
U2 - 10.1007/s00464-024-11445-y
DO - 10.1007/s00464-024-11445-y
M3 - Article
C2 - 39733172
SN - 0930-2794
VL - 39
SP - 673
EP - 686
JO - Surgical Endoscopy
JF - Surgical Endoscopy
IS - 2
ER -