Quality of life after conservative versus elective surgical management of first-episode uncomplicated diverticulitis: a single-center prospective study

<title>Abstract</title> <bold>Background</bold> Optimal long-term management after a first episode of uncomplicated acute diverticulitis (AD) remains debated. Quality of life (QoL) is increasingly recognized as a key outcome to guide individualized decision-making between clinical surveillance and elective sigmoid resection. <bold>Methods</bold> This single-center prospective longitudinal observational study enrolled adults with a first episode of uncomplicated AD (Hinchey 0-1a). After recovery from the index episode, patients underwent either clinical follow-up (non-surgery group) or elective laparoscopic sigmoidectomy (surgery group) according to routine clinical decision-making. Diverticulitis-specific QoL was assessed using the DV-QoL questionnaire, retrospectively referring to the month before the index episode and prospectively at 1, 6, and 12 months after post-episode management. The primary aim was to describe and compare DV-QoL trajectories between groups. A DV-QoL score ≥ 3.2 was used to define a non-acceptable symptom state (PASS threshold). Predictors of non-acceptable QoL were explored in conservatively managed patients. <bold>Results</bold> A total of 137 patients were included: 96(70%) in the non-surgery group and 41(30%) in the surgery group. Baseline characteristics were comparable. Pre-episode DV-QoL scores were similar between groups (0.19 ± 0.29 vs 0.12 ± 0.33; p = 0.14). DV-QoL total scores were significantly higher (worse QoL) in the non-surgery group at 1 month (2.60 ± 2.70 vs 0.11 ± 0.15; p &lt; 0.001), 6 months (2.09 ± 2.24 vs 0.05 ± 0.12; p &lt; 0.001), and 12 months (1.92 ± 2.07 vs 0.02 ± 0.07; p &lt; 0.001). Non-acceptable QoL (PASS ≥ 3.2) occurred only in the non-surgery cohort at all time points, whereas no surgical patient exceeded PASS. Younger age independently predicted non-acceptable QoL in conservatively managed patients. <bold>Conclusion</bold> Elective laparoscopic sigmoidectomy after a first uncomplicated AD episode was associated with sustained improvements in disease-specific QoL compared with clinical follow-up. Routine DV-QoL assessment may help identify patients at risk of persistent impairment and optimize individualized surgical decision-making.