Surgery Beneficial for Recurrent Diverticulitis Without Added Risk:JAMA
Researchers have found in a new study that among patients with recurrent diverticulitis, surgery may offer a viable option to prevent future episodes and enhance quality of life, without increasing the risk of complications. The study was published in JAMA Surgery by Alexandre S. and colleagues. This outcome is based on the 4-year follow-up data of the Laparoscopic Elective Sigmoid Resection Following Diverticulitis (LASER) randomized clinical trial.
The trial, which was carried out in six hospitals in Finland, randomized 90 patients between October 2014 and October 2018. All the patients were followed up for four years, and the outcomes were compared between October 2023 and November 2024. The primary objective was to determine whether surgical intervention has significant advantages over conservative approaches, particularly in long-term environments.
The LASER trial was an open-label randomized controlled trial of 90 adult patients (mean age ~55.6 years; 31% male and 69% female) with a clinical diagnosis of recurrent, chronic painful, or complicated diverticulitis. Patients were randomly allocated in a 1:1 ratio to either receive elective laparoscopic sigmoid resection or remain on conservative treatment. Quality of life was assessed by the Gastrointestinal Quality of Life Index (GIQLI), and recurrence and complication rates were monitored over a time frame of four years by intention-to-treat and per-protocol analyses.
Key Findings
• 90 patients were recruited (28 men [31%], 62 women [69%]; mean age ~55.6 years).
• 45 patients were allocated to surgery; 45 to conservative management.
• 32% (14 of 44) in the conservative group switched over to surgery within 4 years.
• GIQLI scores at 4 years: 115.3 (surgery) vs 109.8 (conservative); mean difference 5.54 (95% CI, −2.98 to 14.06), not statistically significant.
• Recurrence of diverticulitis: 6 of 38 (16%) in the surgery group (10% post-surgery), vs 34 of 37 (92%) in conservative group.
• Severe complications: 4 patients (10%) in the surgery group vs 5 patients (11%) in conservative group.
Elective sigmoid resection in patients with recurrent or complicated diverticulitis greatly lowers the risk of recurrence without a rise in severe complications. Yet, it does not provide a substantial improvement in long-term quality of life over conservative management. These results indicate that patients with severely compromised QOL can gain more from initial surgery, whereas conservative management is still a valid choice for patients with milder symptoms or intact QOL.
Reference:
Santos A, Mentula P, Pinta T, et al. Sigmoid Resection vs Conservative Treatment After Diverticulitis: Prespecified 4-Year Analysis of the LASER Randomized Clinical Trial. JAMA Surg. Published online April 09, 2025. doi:10.1001/jamasurg.2025.0572
