Elective surgery for sigmoid diverticulitis

BackgroundAparadigm shift in therapeutic management of sigmoid diverticulitis has occurred with increasing reluctance regarding surgical treatment. While there is still aclear surgical indication in cases of complications such as strictures, fistulas, perforations or persistent bleeding, an elective indication for sigmoid resection is not clearly defined, especially in chronic-recurrent courses.ObjectivesThe main aspects of elective surgery for sigmoid diverticulitis are discussed.Materials and methodsRelevant studies were selected and the reference lists from those studies were also searched.ResultsAn uncomplicated form of acute diverticulitis (Classification of Diverticular Disease [CDD] type1a/b) is not an indication for surgery (exception: immunosuppressed patients). In acute complicated diverticulitis (except free perforation), elective surgery should only be recommended in case of amacroabscess (CDD type2b). In chronic recurrent, uncomplicated diverticulitis (CDD typ3a/b), indication for surgery should be individualized. However, indications for elective surgery are complications such as strictures or fistulas (CDD type3c). Recent data show that patients with type2b and 3 diverticulitis benefit from elective surgery, especially in terms of quality of life.ConclusionsAlthough the majority of patients with diverticulitis can be treated conservatively, elective surgery should also be considered in terms of better quality of life compared to conservative therapy.