Roughly 20% of patients affected by diverticulitis experience recurrent symptoms after being treated conservatively, without surgery. This is complicated by the fact that persistent symptoms of diverticulitis can be difficult to distinguish from other conditions such as irritable bowel syndrome (IBS), a functional condition. The DIRECT trial (n=109) compared the effect of elective sigmoidectomy on quality of life (QOL) in patients with recurrent diverticulitis and/or ongoing complaints to conservative treatment in a randomized fashion. Although the study was prematurely terminated due to issues with patient accrual, this trial demonstrated a significantly higher QOL at 6 months of follow-up after elective sigmoidectomy as compared to conservative management. The aim of this study was to evaluate and compare QOL at 5 years of follow-up. QOL was measured using the Gastrointestinal Quality of Life Index (GIQLI). Researchers found that at 5 years of follow-up the mean GIQLI score was significantly higher in the operative group (mean difference 9.7, 95% CI 1.7 to 17.7). Secondary QOL outcomes were also significantly better in the operative group, as assessed using the SF-36 physical (p=0.030) and mental score (p=0.010), Visual Analogue Score (VAS) pain score (p=0.011) and EQ5D score (p=0.016). Furthermore 26% of patients in the conservative group ultimately required surgery due to severe ongoing complaints. Of those treated operatively, 11% experienced anastomotic leakage and reinterventions were required in 15% of patients. This study therefore shows that elective sigmoidectomy results in significantly increased long-term QOL at 5 years of follow-up compared with conservative management in patients with recurring diverticulitis and/or ongoing complaints.
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