Management Approaches for Acute Diverticulitis: Survey of Italian Surgeons

Overview

A national survey by the Italian Society of Colorectal Surgery (SICCR) assessed current clinical practices in acute diverticulitis (AD) management among Italian surgeons. The study highlights variability in adherence to guidelines and differences in approach based on surgeon experience, reflecting evolving diagnostic and therapeutic strategies.

Background

Acute diverticulitis (AD), once considered a disease of the elderly, is increasingly affecting younger populations worldwide with rising incidence and significant morbidity. Diagnosis and severity assessment have shifted from intraoperative classifications to preoperative CT-based evaluations, though the classic Hinchey classification remains widely used despite limitations. Advances in imaging, antibiotic regimens, minimally invasive drainage, and laparoscopic surgery have expanded management options. However, clinical practice often lags behind guidelines due to resource availability and defensive medicine tendencies.

Data Highlights

The survey included 39 items covering demographics, workplace experience, management of uncomplicated and complicated AD, imaging, elective colectomy, and surgical techniques. Responses were stratified by surgeon experience (≤50 vs. ≥51 colectomies; ≤5 vs. >5 years post-residency). Data were collected via an online questionnaire from November 2022 to February 2023 and analyzed using SPSS, R, and Winpepi software.

Key Findings

• There is considerable heterogeneity in AD management approaches among Italian surgeons, particularly in borderline and emergency cases.
• Experienced surgeons (>5 years or >50 colectomies) tend to follow updated guidelines more closely compared to less experienced colleagues.
• CT imaging remains pivotal for AD severity assessment, with the Wasvary-modified Hinchey classification used throughout the survey.
• Minimally invasive techniques and imaging-guided drainage are increasingly adopted but not uniformly available across centers.
• Antibiotic regimens and laparoscopic emergency surgery are reshaping treatment paradigms but face implementation barriers in peripheral hospitals.
• Defensive medicine and limited multidisciplinary collaboration contribute to deviations from recommended practices.

Clinical Implications

Clinicians should recognize the evolving landscape of AD management, emphasizing the importance of CT-based severity assessment and individualized treatment strategies. Efforts to standardize care, enhance access to minimally invasive technologies, and promote guideline adherence—especially among less experienced surgeons—are essential to optimize patient outcomes. Multidisciplinary collaboration and education may reduce variability and improve emergency management.

Conclusion

This survey reveals ongoing variability in acute diverticulitis management among Italian surgeons, influenced by experience and resource availability. Bridging the gap between guidelines and practice requires targeted interventions to support evidence-based, flexible approaches in diverse clinical settings.

References

1. SICCR Survey 2023 -- Management Approaches for Acute Diverticulitis in Italy