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.
Variation in the surgical management of complicated diverticulitis: a cross-sectional study of European surgeons / Huo, Bright; Massey, Lisa H.; Seitidis, Georgios; Mavridis, Dimitris; Antoniou, Stavros A.; Null, Null; Uddin, Aba Khaled Mohammad Farid; Falcone, Agostino; Bannon, Aidan; Biloslavo, Alan; Arezzo, Alberto; Biondi, Alberto; Sartori, Alberto; Martínez-Pérez, Aleix; Bergna, Alessandro; Mazzotta, Alessandro D; Fassari, Alessia; Giordano, Alessio; Lucarini, Alessio; Chamzin, Alexandros; Karamanlidis, Alexandros; Mohamedahmed, Ali Yasen; Tursunovic, Amir; Andrea, Null; Balla, Andrea; Bottari, Andrea; Lucchi, Andrea; Luzzi, Andrea Pierre; Zanoni, Andrea; Guariniello, Anna; Thicopé, Antoine; Pesce, Antonio; Kechagias, Aristotelis; Panyko, Arpád; Cingi, Asim; Afzal, Asma; Syllaios, Athanasios; Dulskas, Audrius; Molteni, Beatrice; Pascotto, Beniamino; Casagranda, Biagio; Picardi, Biagio; Nardo, Bruno; Kontovounisios, Christos; Ferretti, Carlotta; Elena, Chitoran; Chouliaras, Christos; Dimitriou, Christos; Nicolescu, Cosmin; Amroch, Dan; Giuvara, Dan-Eduard; Clerc, Daniel; Krstic, Daniel; Felsenreich, Daniel Moritz; Delogu, Daniele; Bono, Dario; Singh-Ranger, Deepak; Coletta, Diego; Pournaras, Dimitri J; Kehagias, Dimitrios; Linardoutsos, Dimitrios; Ntourakis, Dimitrios; Bulian, Dirk R; Gada, Parth Bhavesh; Lesko, Dusan; Anestiadoy, Elissavet; Toma, Elena Adelina; Schembari, Elena; Colak, Elif; Reitano, Elisa; Monati, Erica; Deerenberg, Eva; Dimitrov, Evgeni; Cavallo, Fabio; Maggi, Federico; Agresta, Ferdinando; Carannante, Filippo; Iordache, Florin; Cabry, Francesca; Vescio, Francesca; Feroci, Francesco; Marchegiani, Francesco; Pata, Francesco; Roscio, Francesco; Vijgen, Ghej; Chatzimavroudis, Grigoris; Theodoropoulos, George; Dedemadi, Georgia; Kotoreni, Georgia; Koukoulis, Georgios; Tzikos, Georgios; Deiro, Giacomo; Pellino, Gianluca; Faria, Gil; Giraudo, Giorgio; Laracca, Giovanni Guglielmo; Merola, Giovanni; Tebala, Giovanni; Montori, Giulia; Vitiello, Giulia; Iacob, Giulio; Frazzetta, Giuseppe; Giuliani, Giuseppe; Luca, Giuseppe Massimiliano De; Hoi, Hannes; Galanis, Ioannis N.; Negoi, Ionut; Trébol, Jacobo; Jurgaitis, Jonas; Alexiou, Konstantinos; Perivoliotis, Konstantinos; Tsimogiannis, Konstantinos; Topgül, Koray; Lauka, Null; Antolino, Laura; Fortuna, Laura; Nicoleta, Leopa; Salvatierra, Leopoldo; Kokaine, Linda; Sartarelli, Lodovico; Gozzini, Lorenzo; Ghirardelli, Luca; Conte, Luigi Eduardo; Marano, Luigi; Aguilar, Luis Tallon; Harsányi, László; Didier, Mutter; Draga-Maria, Mandi; Mastronardi, Manuela; Inama, Marco; Bellini, Maria Irene; Capuano, Marianna; Morabito, Marika; Distler, Marius; Penna, Marta; Saverino, Marta; Svoboda, Martin; Ceolin, Martina; Bratu, Matei; Podda, Mauro; Frountzas, Maximos; Tanal, Mert; Kelly, Michael E; Ammendola, Michele; Muresan, Mihai-Stefan; Srdjan, Mijatovic; Ceranic, Miljan; Barone, Mirko; Abuahmed, Mohamed; Issa, Mohamed Talaat; Uzunoglu, Mustafa Yener; Aremu, Muyiwa; Curtis, Nathan; Smart, Neil; Silva, Nelson José; Petrucciani, Niccolo; Leone, Nicola; Katev, Nikolay; Yalkin, Omer; Ioannidis, Orestis; Rizzuto, Antonia; Kapsampelis, Panagiotis; Lainas, Panagiotis; Panaccio, Paolo; Ubiali, Paolo; Tejedor, Patricia; Botelho, Pedro; Milic, Petar; Kalinowski, Piotr; Major, Piotr; Daniel, Preda Silviu; Pach, Radoslaw; Chidambaranath, Rajesh; Pareek, Raju; Santos, Raquel Sánchez; Kohler, Remy; Colombari, Renan Carlo; Cammarata, Roberto; Vlad, Rotaru; Ramasamy, Sadhasivam; Barbaro, Salvatore; Narayanasamy, Sangara; Giovannini, Sara Capoccia; Jeri-McFarlane, Sebastian No; Hardon, Sem F; Meric, Serhat; Caringi, Silvio; Laurentiu, Simion; Papadakos, Stavros P; Papaeleftheriou, Stavroula; Olmi, Stefano; Cioffi, Stefano Piero Bernardo; Aktokmakyan, Talar Vartanoglu; Triantafyllou, Tania; Abdelhafiz, Tarig; Akaraviputh, Thawatchai; Carus, Thomas; Fontana, Tommaso; Delaune, Vaihere; Calu, Valentin; Surlin, Valeriu; Kyosev, Vasil; Liviu, Vasile; Turrado-Rodriguez, Victor; Vigorita, Vincenzo; Goh, Yan Mei. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - 39:2(2025), pp. 691-698. [10.1007/s00464-024-11456-9]
Variation in the surgical management of complicated diverticulitis: a cross-sectional study of European surgeons
Falcone, Agostino;Mazzotta, Alessandro DValidation
;Fassari, Alessia;Lucarini, Alessio;Balla, Andrea;Lucchi, Andrea;Coletta, Diego;Maggi, Federico;Pata, Francesco;Laracca, Giovanni Guglielmo;Merola, Giovanni;Giuliani, Giuseppe;Antolino, Laura;Bellini, Maria Irene;Morabito, Marika;Petrucciani, Niccolo;Cammarata, Roberto;Cioffi, Stefano Piero Bernardo;Fontana, Tommaso;
2025
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
