The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis

PURPOSE: The aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease. METHODS: A comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated. RESULTS: Eleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427–4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020–0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202–1.0233, p = 0.0131) were significant in favor of the delayed elective approach. CONCLUSIONS: Delayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.