Who Needs Elective Surgery for Recurrent Diverticulitis?

Abstract

Diverticulitis a common condition encountered by the practicing surgeon. Currently, one of the more contentious topics in the management of diverticulitis is which patients with chronic or recurrent disease should be selected for elective sigmoid colectomy. Historic dogma dictated prophylactic colectomy after two episodes for uncomplicated diverticulitis, and after one episode in patients under 40, to reduce the risk of future emergency surgery with colostomy [1--5]. The use of CT scan to gauge severity of disease, construction of larger clinical databases, and the advent of less invasive techniques (percutaneous drainage, intraperitoneal lavage), has changed the way surgeons think and manage diverticulitis [6]. As a result, current guidelines recommend a more selective approach to sigmoid colectomy after an uncomplicated episode, and in the setting of chronic recurrent diverticulitis [7--9].