Long-term outcomes in recurrent diverticulitis: a systematic review of treatment strategies and recurrence rates.

BACKGROUND: Diverticulitis prevalence is on the rise, with recurrences occurring in up to one-third following an uncomplicated initial episode. While sigmoid resection was historically routine after a second episode, current guidelines recommend individualization. This review evaluates long-term outcomes for recurrent diverticulitis, comparing different treatment approaches. METHODS: A systematic review (PROSPERO ID CRD42024600674) adhering to PRISMA guidelines searched several electronic databases. Clinical trials and observational studies published in English over the past decade that reported outcomes for persistent or recurrent diverticulitis were sought. RESULTS: From 189 references, three retrospective cohort studies and one randomized control trial (RCT) were included, totaling 446 patients (42.1% male). Recurrence rates were 5.6-21.1% over follow-up durations ranging between 17 and 190 months. Definitions for recurrent diverticulitis varied across studies, with employed treatments including elective resection and nonoperative management. Outcomes evaluated included quality of life (QoL) assessments, reintervention rates, and recurrence risk. QoL showed greater improvement with surgery, but reintervention was more common after surgery (21%) than with nonoperative management. Recurrent or persistent diverticulitis demonstrated a higher recurrence risk, with increased incidence of surgery and comparable incidence of ostomy. CONCLUSIONS: Persistent or recurrent diverticulitis appears to be associated with higher rates of recurrence and surgery. However, contemporary literature detailing long-term outcomes is limited. Although surgical intervention may enhance QoL, it may also necessitate more reinterventions. Standardizing recurrent diverticulitis definitions would enable comparative analyses and inform guideline updates, facilitating evidence-based clinical decision-making.