Management of elective surgery for diverticulitis

One discussion this week was on the management of elective surgery for acute diverticulitis.

Reference: Wieghard N, Geltzeiler CB, Tsikitis VB. Trends in the surgical management of diverticulitis. Annals of Gastroenterology. 2015 Jan-Mar;28(1):25-30.

Summary: Wieghard et al (2015) state that sigmoid diverticulitis is an increasingly common Western disease associated with a high morbidity and cost of treatment. Improvement in the understanding of the disease process, along with advances in the diagnosis and medical management has led to recent changes in treatment recommendations. The natural history of diverticulitis is more benign than previously thought and despite current recommendations of more restrictive indications for surgery, practice trends indicate an increase in elective operations for the treatment of diverticulitis. Due to diversity in disease presentation, in many cases, optimal surgical treatment of acute diverticulitis remains unclear with regard to patient selection, timing, and technical approach in both elective and urgent settings.

The table below (Wieghard et al, 2015, p.28) provides direct comparison between ASCRS and ACPGBI recommendations for surgical treatment:

diverticulitis 1

diverticulitis 2

Additional Reading: Xai J, Paul Olson TJ, Rosen SA. Robotic-assisted surgery for complicated and uncomplicated diverticulitis: a single-surgeon case series. Journal of Robotic Surgery. 2019 Jan 23. doi: 10.1007/s11701-018-00914-x. [Epub ahead of print]

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