Current urgent and emergent management of acute sigmoid diverticulitis … has the LADIES trial impacted change in surgical management at a single institution?

Abstract

Introduction: For perforated sigmoid diverticulitis, the "gold standard" has traditionally been the Hartmann's Procedure (HP). The LADIES trial published in 2019 suggested that primary anastomosis (PA) is safe. Our study aims to evaluate whether the LADIES trial has influenced the surgical management of perforated diverticulitis at our institution.

Methods: Retrospective cohort study of patients undergoing urgent or emergent colectomy for perforated diverticulitis, divided into Group 1 (2013-2019) and Group 2 (post LADIES Trial, 2020-2024). Inclusion criteria was similar to the LADIES trial and included patients 85 years or younger, not immunocompromised, and without preoperative vasopressor requirements.

Results: There were 88 patients total, 41 patients in Group 1 and 47 in Group 2. No significant difference was noted in procedure performed, though there was an upwards trend for performing PA (19.5 % vs 36.2 %, p = 0.084) and creation of protective ileostomy (7.3 % vs 19.2 %, p = 0.129) in Group2.

Conclusion: After publication in 2019, our institution demonstrated limited adoption of the LADIES trial for surgical management of perforated diverticulitis. Further study is required to better delineate surgeon continued reluctance for PA in this setting.

Keywords: Diverticulitis; Hartmann's; Hinchey; LADIES.