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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
What paradigm shifts occurred in the management of acute diverticulitis during the COVID-19 pandemic? A scoping review
Gaetano Gallo, Monica Ortenzi, Ugo Grossi, Gian Luca Di Tanna, Francesco Pata, Mario Guerrieri, Giuseppe Sammarco, Salomone Di Saverio
Gaetano Gallo, Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro 88011, Italy
Monica Ortenzi, Mario Guerrieri, Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona 60121, Italy
Ugo Grossi, 2nd Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Treviso 31100, Italy
Gian Luca Di Tanna, The George Institute for Global Health, University of New South Wales, Sydney 2050, NSW, Australia
Francesco Pata, Department of General Surgery, Ospedale Nicola Giannettasio, Corigliano-Rossano 87064, Italy
Francesco Pata, La Sapienza University, Roma 00185, Italy
Giuseppe Sammarco, Department of Health Sciences, University "Magna Graecia" Medical School, University of Catanzaro, Catanzaro 88100, Italy
Salomone Di Saverio, Department of General Surgery, University of Insubria, University Hospital of Varese, Varese 21100, Italy
Author contributions: Gallo G, Ortenzi M, and Grossi U designed and performed the research; Ortenzi M, Grossi U, and Di Tanna GL analyzed the data; Gallo G, Ortenzi M, Grossi U, and Pata F wrote the paper; Guerrieri M, Sammarco G, and Di Saverio S supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest, and no funding from any organization for the submitted work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Gaetano Gallo, MD, Academic Research, Surgeon, Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, Catanzaro 88011, Italy. gaethedoctor@alice.it
Received: February 2, 2021
Peer-review started: February 7, 2021
First decision: March 6, 2021
Revised: April 15, 2021
Accepted: July 7, 2021
Article in press: July 7, 2021
Published online: August 16, 2021
Processing time: 183 Days and 23.7 Hours
BACKGROUND
Acute colonic diverticulitis (ACD) is common in Western countries, with its prevalence increasing throughout the world. As a result of the coronavirus disease 2019 (COVID-19), elective surgery and in-patients’ visits have been cancelled or postponed worldwide.
AIM
To systematically explore the impact of the pandemic in the management of ACD.
METHODS
MEDLINE, Embase, Scopus, MedxRiv, and the Cochrane Library databases were searched to 22 December 2020. Studies which reported on the management of patients with ACD during the COVID-19 pandemic were eligible. For cross sectional studies, outcomes of interest included the number of hospital admission for ACD, as well as key features of disease severity (complicated or not) across two time periods (pre- and during lockdown).
RESULTS
A total of 69 papers were inspected, and 21 were eligible for inclusion. Ten papers were cross sectional studies from seven world countries; six were case reports; three were qualitative studies, and two review articles. A 56% overall decrease in admissions for ACD was observed during lockdown, peaking 67% in the largest series. A 4%-8% decrease in the rate of uncomplicated diverticulitis was also noted during the lockdown phase. An initial non-operative management was recommended for complicated diverticulitis, and encouraged to an out-of-hospital regimen. Despite initial concerns on the use of laparoscopy for Hinchey 3 and 4 patients to avoid aerosolized contamination, societal bodies have progressively mitigated their initial recommendations as actual risks are yet to be ascertained.
CONCLUSION
During the COVID-19 pandemic, fewer patients presented and were diagnosed with ACD. Such decline may have likely affected the spectrum of uncomplicated disease. Established outpatient management and follow up for selected cases may unburden healthcare resources in time of crisis.
Core Tip: Acute colonic diverticulitis is one of the most common conditions encountered by surgeons in the acute setting. As a result of the pandemic, elective surgery and in-patients’ visits have been cancelled or postponed worldwide. Conservative strategies for surgical diseases, such as acute appendicitis and acute cholecystitis, have been furtherly supported. The primary aim of this review is to systematically explore the impact of the pandemic in the diagnosis and management of acute colonic diverticulitis.
