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Variation in the surgical management of complicated diverticulitis: a cross-sectional study of European surgeons

  • 期刊论文

  • 发表日期：

    2024年12月24日

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  • Bright Huo,
  • Lisa H. Massey,
  • Georgios Seitidis,
  • Dimitris Mavridis,
  • Stavros A. Antoniou,
  • Aba Khaled Mohammad Farid Uddin,
  • Agostino Falcone,
  • Aidan Bannon,
  • Alan Biloslavo,
  • Alberto Arezzo,
  • Alberto Biondi,
  • Alberto Sartori,
  • Aleix Martínez-Pérez,
  • Alessandro Bergna,
  • Alessandro D Mazzotta,
  • Alessia Fassari,
  • Alessio Giordano,
  • Alessio Lucarini,
  • Alexandros Chamzin,
  • Alexandros Karamanlidis,
  • Ali Yasen Mohamedahmed,
  • Amir Tursunovic,
  • Andrea,
  • Andrea Balla,
  • Andrea Bottari,
  • Andrea Lucchi,
  • Andrea Pierre Luzzi,
  • Andrea Zanoni,
  • Anna Guariniello,
  • Antoine Thicopé,
  • Antonio Pesce,
  • Aristotelis Kechagias,
  • Arpád Panyko,
  • Asim Cingi,
  • Asma Afzal,
  • Athanasios Syllaios,
  • Audrius Dulskas,
  • Beatrice Molteni,
  • Beniamino Pascotto,
  • Biagio Casagranda,
  • Biagio Picardi,
  • Bruno Nardo,
  • Christos Kontovounisios,
  • Carlotta Ferretti,
  • Chitoran Elena,
  • Christos Chouliaras,
  • Christos Dimitriou,
  • Cosmin Nicolescu,
  • Dan Amroch,
  • Dan-Eduard Giuvara,
  • Daniel Clerc,
  • Daniel Krstic,
  • Daniel Moritz Felsenreich,
  • Daniele Delogu,
  • Dario Bono,
  • Deepak Singh-Ranger,
  • Diego Coletta,
  • Dimitri J Pournaras,
  • Dimitrios Kehagias,
  • Dimitrios Linardoutsos,
  • Dimitrios Ntourakis,
  • Dirk R Bulian,
  • Parth Bhavesh Gada,
  • Dusan Lesko,
  • Elissavet Anestiadoy,
  • Elena Adelina Toma,
  • Elena Schembari,
  • Elif Colak,
  • Elisa Reitano,
  • Erica Monati,
  • Eva Deerenberg,
  • Evgeni Dimitrov,
  • Fabio Cavallo,
  • Federico Maggi,
  • Ferdinando Agresta,
  • Filippo Carannante,
  • Florin Iordache,
  • Francesca Cabry,
  • Francesca Vescio,
  • Francesco Feroci,
  • Francesco Marchegiani,
  • Francesco Pata,
  • Francesco Roscio,
  • Ghej Vijgen,
  • Grigoris Chatzimavroudis,
  • George Theodoropoulos,
  • Georgia Dedemadi,
  • Georgia Kotoreni,
  • Georgios Koukoulis,
  • Georgios Tzikos,
  • Giacomo Deiro,
  • Gianluca Pellino,
  • Gil Faria,
  • Giorgio Giraudo,
  • Giovanni Guglielmo Laracca,
  • Giovanni Merola,
  • Giovanni Tebala,
  • Giulia Montori,
  • Giulia Vitiello,
  • Giulio Iacob,
  • Giuseppe Frazzetta,
  • Giuseppe Giuliani,
  • Giuseppe Massimiliano De Luca,
  • Hannes Hoi,
  • Ioannis N. Galanis,
  • Ionut Negoi,
  • Jacobo Trébol,
  • Jonas Jurgaitis,
  • Konstantinos Alexiou,
  • Konstantinos Perivoliotis,
  • Konstantinos Tsimogiannis,
  • Koray Topgül,
  • Lauka,
  • Laura Antolino,
  • Laura Fortuna,
  • Leopa Nicoleta,
  • Leopoldo Salvatierra,
  • Linda Kokaine,
  • Lodovico Sartarelli,
  • Lorenzo Gozzini,
  • Luca Ghirardelli,
  • Luigi Eduardo Conte,
  • Luigi Marano,
  • Luis Tallon Aguilar,
  • László Harsányi,
  • Mutter Didier,
  • Mandi Draga-Maria,
  • Manuela Mastronardi,
  • Marco Inama,
  • Maria Irene Bellini,
  • Marianna Capuano,
  • Marika Morabito,
  • Marius Distler,
  • Marta Penna,
  • Marta Saverino,
  • Martin Svoboda,
  • Martina Ceolin,
  • Matei Bratu,
  • Mauro Podda,
  • Maximos Frountzas,
  • Mert Tanal,
  • Michael E Kelly,
  • Michele Ammendola,
  • Mihai-Stefan Muresan,
  • Mijatovic Srdjan,
  • Miljan Ceranic,
  • Mirko Barone,
  • Mohamed Abuahmed,
  • Mohamed Talaat Issa,
  • Mustafa Yener Uzunoglu,
  • Muyiwa Aremu,
  • Nathan Curtis,
  • Neil Smart,
  • Nelson José Silva,
  • Niccolo Petrucciani,
  • Nicola Leone,
  • Nikolay Katev,
  • Omer Yalkin,
  • Orestis Ioannidis,
  • Antonia Rizzuto,
  • Panagiotis Kapsampelis,
  • Panagiotis Lainas,
  • Paolo Panaccio,
  • Paolo Ubiali,
  • Patricia Tejedor,
  • Pedro Botelho,
  • Petar Milic,
  • Piotr Kalinowski,
  • Piotr Major,
  • Preda Silviu Daniel,
  • Radoslaw Pach,
  • Rajesh Chidambaranath,
  • Raju Pareek,
  • Raquel Sánchez Santos,
  • Remy Kohler,
  • Renan Carlo Colombari,
  • Roberto Cammarata,
  • Rotaru Vlad,
  • Sadhasivam Ramasamy,
  • Salvatore Barbaro,
  • Sangara Narayanasamy,
  • Sara Capoccia Giovannini,
  • Sebastian no Jeri-McFarlane,
  • Sem F Hardon,
  • Serhat Meric,
  • Silvio Caringi,
  • Simion Laurentiu,
  • Stavros P Papadakos,
  • Stavroula Papaeleftheriou,
  • Stefano Olmi,
  • Stefano Piero Bernardo Cioffi,
  • Talar vartanoglu aktokmakyan,
  • Tania Triantafyllou,
  • Tarig Abdelhafiz,
  • Thawatchai Akaraviputh,
  • Thomas Carus,
  • Tommaso Fontana,
  • Vaihere Delaune,
  • Valentin Calu,
  • Valeriu Surlin,
  • Vasil Kyosev,
  • Vasile Liviu,
  • Victor Turrado-Rodriguez,
  • Vincenzo Vigorita,
  • Yan Mei Goh

摘要

Introduction

There are many options for the surgical management of complicated diverticulitis, and standards vary widely despite international practice recommendations. We conducted a survey to capture the variation in practice across Europe.

Methods

An online questionnaire was distributed to fellow and surgeon members of the European Association of Endoscopic Surgery (EAES) via email using the Opinio survey platform. Participants shared their demographic details. We asked members to rank the most likely intervention for patients with both stable and unstable Hinchey Class III, as well as Hinchey Class IV diverticulitis based on practice standards in their country. We used descriptive statistics, including counts and percentages, to characterize survey results. We created a heatmap to visualize the percentage of votes received for each intervention.

Results

We received 233 responses from surgeons and fellows across Europe from various countries, including Italy (35.6%), Greece (11.2%), and the United Kingdom (9.9%). Most members (79.4%) self-reported having expertise in colorectal surgery. For patients with stable Hinchey III diverticulitis, surgeons offered Hartmann’s resection (HR) (41.6%), primary resection and anastomosis (PRA) (18.5%), laparoscopic peritonea lavage (LPL) prior to HR (16.9%), or LPL prior to PRA (15.5%), or LPL only (8.6%). In total, 31.4% of respondents offered LPL prior to sigmoid resection (HR + PRA). For patients with unstable Hinchey III diverticulitis, respondents offered HR (73.9%), PRA (3.85%), LPL only (6.84%), or LPL followed by sigmoid resection (15.4%). For patients with stable Hinchey IV diverticulitis, surgeons offered HR (71.7%), PRA (4.7%), LPL only (1.3%), or LPL then sigmoid resection (22.3%). Finally, for patients with unstable Hinchey IV diverticulitis, surgeons offered HR (83.1%), PRA (1.3%), LPL only (3.5%), or LPL followed by sigmoid resection (12.1%).

Conclusion

Significant variation exists in the surgical management of complicated diverticulitis across Europe. Efforts must be made to increase the awareness and uptake of surgical guideline recommendations in clinical practice.