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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EPatients with mild or moderate diverticulitis who experience recurrence appear to benefit more from surgery than conservative treatment, in terms of validated ratings of quality of life and pain 6 months after start of treatment.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ediverticulitis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esurgery\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elaparoscopy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Equality of life\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erecurrence\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDIRECT trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENTR1478\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egastroenterology clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe multicenter, randomized, controlled DIRECT trial [NTR1478] comparing surgical vs conservative treatment of diverticulitis in 109 patients revealed a significant benefit of surgery at 6 months.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Marguerite Stam, MD, Meander Medical Center, Amersfoort, The Netherlands, first cases of diverticulitis overwhelmingly (90% of cases) are mild. In the aftermath, 30% to 40% of patients will report no complaints, 30% will be persistently symptomatic, and 30% will experience recurrences.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EFor those with symptoms and recurrence, the decision of whether to operate or not is controversial. Little evidence for decision making is available, with only 1 small prospective study [Forgione A et al. \u003Cem\u003EAnn Surg\u003C\/em\u003E. 2009] and 1 retrospective study [Pasternak I et al. \u003Cem\u003EInt J Colorectal Dis\u003C\/em\u003E. 2012] published. The DIRECT trial sought to provide further clarification.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EFrom mid-2010 to mid-2014, patients from 27 centers in The Netherlands were randomized to conservative or operative treatment of their diverticulitis. The primary end point was quality of life measured by the Gastrointestinal Quality of Life Index (GIQLI), SF-36 Healthy Survey Update (SF-36), EuroQOL 5-dimension questionnaire (EQ-5D), and a visual analog scale ranking of pain. Secondary outcomes included mortality and morbidity at 6 months.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EInclusion criteria included patients aged 18-75 years, persistent abdominal complaints (continuing lower left abdominal pain, altered bowel habits, and persistence of symptoms for \u0026gt;\u20053 months), frequent recurrence of diverticulitis, signs of inflammation, and American Society of Anesthesiology ranking I, II, or III. Exclusion criteria were prior sigmoidectomy, stenosis, perforation, fistula, malignancy, and inability to complete questionnaires.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe target number of patients in the intention-to-treat analysis was 214. However, accrual was slow and challenging because of preferences for surgery or conventional treatment. As a result, and considering the clinical relevance of the study, enrollment was ended early.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe 109 enrolled patients were randomized to surgery (n\u2005=\u200553), with 47 patients ultimately receiving surgery and 6 electing to receive conservative treatment, or conservative treatment (n\u2005=\u200556), with 43 patients choosing this option and 13 opting instead for surgery. At baseline, the surgery and conservative treatment groups were comparable for age, body mass index, sex, number of recurrences, and duration of ongoing symptoms.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EMost of the surgical treatments were laparoscopy involving primary anastomosis. Complications in the surgery group included anastomotic leakage (13%), stenosis (4%), surgical site infection (9%), ileus \u0026gt;\u20057 days after surgery (8%), and cardiovascular\/pulmonary events (4%). Among the 13 patients randomized to conservative treatment who elected surgery, recurrences occurred in 5.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAt 6 months, the primary end points of GIQLI, active physical health component of SF-36, EQ-5D, and pain favored surgery (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0001, \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0106, \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0013, and \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001, respectively). In the aforementioned 13 patients, the outcomes with surgery were not significantly different from baseline rankings.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ERecurrence of symptoms in all patients receiving surgery comprised 8 cases, all occurring prior to surgery.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe DIRECT trial revealed significant quality of life benefit of elective resection over conventional treatment for patients with diverticulitis. The results are important in the counseling of patients concerning treatment.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/14\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlhre\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}