BACKGROUND: 

There are currently no guidelines on the management of right colon diverticulitis. Treatment options have been extrapolated from the management of left-sided diverticulitis. Gaining knowledge of the risk and morbidity of diverticulitis recurrence is integral to weighing the benefit of elective surgery for right-sided diverticulitis.

OBJECTIVE: 

The purpose of this study was to summarize the recurrence rate and the morbidity of recurrence of Hinchey classification I/II, right-sided diverticulitis following nonoperative management.

DATA SOURCES: 

PubMed, EMBASE, and Cochrane Database of Collected Reviews were searched up to June 2019.

STUDY SELECTION: 

Observational cohort studies evaluating outcomes following nonoperative management were reviewed. No randomized controlled trials were available.

INTERVENTIONS: 

Intravenous antibiotics with or without percutaneous drainage of associated abscess were administered.

MAIN OUTCOME MEASURES: 

The primary outcomes measured were the recurrence rate and morbidity associated with recurrence. Two independent investigators extracted data. The rates of recurrence were pooled by using a random-effects model.

RESULTS: 

There were 1584 adult participants from a total of 11 studies (9 retrospective cohort and 2 prospective cohort studies) included in the analysis. Over a median follow-up period of 34.2 months, the pooled recurrence rate was 12% (95% CI, 10%–15%). Twenty of 202 patients (9.9%) required urgent surgery at the time of first recurrence. There was no mortality. Subset analysis excluding 3 studies that included percutaneous drainage as a nonoperative treatment option did not change the recurrence rate (12% (95% CI, 9%–15%)) or heterogeneity. Funnel plot assessment revealed no publication bias.

LIMITATIONS: 

There were no randomized controlled trials available. The statistical heterogeneity was moderate (I² = 46%).

CONCLUSIONS: 

Nonoperative management of Hinchey I/II right-sided diverticulitis is safe and feasible. The recurrence rate is relatively low, and complications that require urgent operation are uncommon.

PROSPERO: 

CRD42019131673

中文翻译：

---

非手术治疗后急性右结肠憩室炎的复发：系统评价和荟萃分析。

背景： 

目前尚无治疗右 结肠 憩室炎的指南。治疗方法已从左侧憩室炎的治疗中推算出来。获得的风险和发病率的知识憩室炎 复发是不可分割的称重择期手术的好处的权-sided憩室炎。

目的： 

这项研究的目的是总结的复发率和发病复发Hinchey分级I / II，中右-sided憩室以下非手术管理。

数据源： 

截至2019年6月，已搜索PubMed，EMBASE和Cochrane收集的评论数据库。

研究选择： 

回顾性队列研究评估非手术治疗后的结局。没有随机对照试验。

干预措施： 

静脉注射抗生素或不经皮引流相关脓肿。

主要观察指标： 

测量的主要结果是复发率和与复发相关的发病率。两名独立调查员提取了数据。通过使用随机效应模型汇总复发率。

结果： 

分析包括总共11项研究（9项回顾性队列研究和2项前瞻性队列研究）中的1584名成年参与者。在34.2个月的中位随访期内，合并复发率为12％（95％CI，10％-15％）。初次复发时有20例患者（9.9％）需要紧急手术。没有死亡。子集分析不包括3项研究，这些研究包括经皮引流作为非手术治疗选择，并没有改变复发率（12％（95％CI，9％–15％））或异质性。漏斗图评估显示没有发布偏倚。

局限性： 

没有随机对照试验。统计异质性中等（I ² = 46％）。

结论： 

非手术Hinchey I / II的管理权-sided憩室炎是安全可行的。的复发率比较低，而需要紧急手术并发症并不常见。

PROSPERO： 

CRD42019131673