Quality of Life (QOL) After Elective Sigmoidectomy for Diverticular Diseases (DIVERTI)
Quality of Life (QOL) After Elective Sigmoidectomy for Diverticular Diseases (DIVERTI)
Acute diverticulitis of the left colon is among the most common abdominal disorders. To date,
 both conservative therapy in uncomplicated stages and emergency surgery in perforated disease
 with peritonitis are consensual. The best treatment strategy for other situations (i.e.,
 smoldering, healed abscesses, recurrences) is still under debate. On the other hand, the best
 treatment strategy for complicated disease as well as for recurrent stages is still under
 debate. In these cases, elective surgery can be proposed on a case-by-case basis. Current
 French guideline recommendations have been updated in 2017. In theory, the objective of
 elective surgical treatment is to prevent the recurrence and/or complication of the
 diverticulitis, that might lead to the creation of a stoma. In France, nearly 12,000
 prophylactic colectomies for diverticulitis are performed per year. Importantly, elective
 surgical treatment is associated with the relevant intrinsic morbidity (9.6% major
 complications within the Sigma Trial), the potential need for unplanned stoma formation of
 1%-14% and a significant risk of persisting postoperative complaints. Up to 25% of patients
 who have undergone a scheduled sigmoid colectomy suffer from ongoing abdominal symptoms.
 Levack et al found the risk of faecal incontinence to be 24.8% after a sigmoidectomy.
 Moreover, faecal urgency occurred in 19.6% of patients, and incompleteness of emptying
 occurred in 20.8%., altering their quality of life (QOL).

 To out knowledge, few data are available in the literature concerning the evaluation of QOL
 after elective sigmoid colectomy. Although QOL was significantly improved after surgery
 compared to conservative medical treatment, these results were questionable due to the
 heterogeneity of the studies and the lack of direct comparison of the two therapeutic
 approaches. Only one recent randomized study reported similar results but this one was
 prematurely stopped due to inclusion difficulties. The evaluation of digestive and
 genitourinary functional sequelae is based only on short series, most often retrospective. In
 summary, evidence on disease-specific characteristics influencing postoperative quality of
 life is lacking.

 The aim of this prospective multicenter study is : (i) to evaluate the QOL and functional
 sequelae at 6 and 12 months in patients operated on for elective left colectomy and, (ii) to
 compare them to a population of non-operating diverticulitis patients.
Design The DIVERTI-QOL study is a prospective, multicentre, and observational study. The
 study will start in February 2021. Recruitment will be completed in July 2021. Overall, the
 inclusion of 110 patients in each arm is planned. 37 french hospitals agreed to participate
 in this study.

 Allocation for surgery

 The allocation to conservative or surgical therapy will be performed at the inclusion in the
 study. Possible indications for surgery are listed below :

 -  Persisting abdominal complaints (smouldering diverticular disease) after uncomplicated
 diverticulitis (Classification of Diverticular Disease (CDD) Stage 1, modified Hinchey
 0+Ia).

 -  Persisting abdominal complaints after covered perforation and/or pericolic
 'microabscesses' (1cm) (CDD Stage 2b).

 -  Chronic or recurrent diverticulitis with persisting abdominal complaints

 -  diverticulitis complicated by an abscess >1 cm

 -  divericulitisin a patient requiring long-term immunosuppressive therapy (with the
 exception of a neoplastic disease undergoing treatment)
inclusion criteria:

 -  Patient who has received informed information and has not expressed opposition to
 participation

 -  Francophone patient

 -  Patient affiliated to a social security or equivalent system

 -  Patient taken in charge for :

 -  smoldering DS after DS Hinchey I

 -  persistence of symptoms after DS complicated by a peri-sigmoid abscess <1cm with
 resolution of inflammation

 -  DS complicated with an abscess >1cm (Hinchey II)

 -  Recurrent episodes of DS

 -  DS in a patient requiring long-term immunosuppressive therapy (except for
 neoplastic disease undergoing treatment)

 -  Patient operated between 01/02/2021 and 30/07/2021, in elective situation of sigmoid
 diverticulitis (surgical experimental group) or patient not operated and medically
 treated (medical control group)

 Exclusion Criteria:

 Subjects meeting only one of the following non-inclusion criteria may not be eligible to
 participate in the research:

 -  Patient who is a minor or over 70 years of age

 -  Patient undergoing emergency surgery for sigmoid diverticulitis due to a complication
 (peritonitis, hemorrhage, failure of drainage diverticular abscess)

 -  diverticulitis complicated by fistula and/or symptomatic stenosis

 -  Colorectal resection protected by an ostomy or Hartmann's intervention

 -  Discovery of colorectal cancer on the operating room

 -  Patient operated on for diverticulitis of the right colon

 -  Neoplastic disease under treatment and/or evolving