ArticleSurgical endoscopy2026
Practice patterns in the surgical management of Hinchey III and IV diverticulitis: results of a national survey.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionHinchey grade III (H3) and IV (H4) diverticulitis represent the operative spectrum of complicated diverticular disease, yet consensus on optimal management remains limited. We aimed to define current practice patterns and factors influencing operative decision-making to inform on future trials.
methodsWe conducted a cross-sectional survey of surgeons regarding management of H3/H4 diverticulitis. Respondents were provided clinical scenarios and asked to identify preferred operative approaches and provide free-text rationale. Surgeon demographics, training, and institutional characteristics were collected. Descriptive statistics, thematic analysis, and multivariable regression were performed.
resultsA total of 104 attending surgeons responded. Most practiced at academic centers (71.2%) and large hospitals (78.8%) with 24-h coverage (72.5%). Median practice duration was 8 years (IQR 3.75-14); 66.3% had trauma/critical care training. In unstable patients, nearly all (99%) selected open surgery, most commonly Hartmann's (52%) or resection in discontinuity (46%). Among discontinuity cases, 55.3% selected Hartmann's, while 40.4% chose delayed anastomosis with diverting loop ileostomy (DLI) at takeback. In stable patients, practice patterns diverged. Minimally invasive approaches were selected in over half of H3 cases, while most H4 cases (74%) were managed open. Surgeons were more likely to perform anastomosis in H3 than H4 (primary: 23.5% vs 7.9%; DLI: 45.1% vs 35.5%; p < 0.05). Laparoscopic approaches showed similar DLI use across groups. Qualitative analysis identified safety and leak avoidance as drivers of Hartmann's, protection and reversibility for DLI, and stoma avoidance for primary anastomosis. Regression analysis demonstrated that fewer years in practice and higher case volume predicted minimally invasive use.
conclusionsRespondents almost universally selected open surgery to manage unstable patients, with damage control resection nearly as common as Hartmann's. Management choices of stable patients demonstrated substantial variability, influenced by disease severity. Minimally invasive adoption was driven by surgeon experience and volume. These findings provide a foundation for future prospective trials.
Indexed as
Identifiers
42637940What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.