Elective surgery for diverticulitis – What does the surgeon need to consider?

Despite less stringent indications, elective colectomy is still commonly performed in the treatment of diverticulitis. Rather than focusing on age-based criteria and number of diverticulitis episodes, current guidelines recommend an individualized approach to elective colectomy for diverticulitis, taking into consideration several patient and disease factors. Given the low risk for complicated recurrences or emergency surgery requiring an ostomy with long-term conservative management, quality of life should be the primary determinant of surgery. Pharmacologic therapies have proven ineffective in reducing the risk of diverticulitis recurrence; however, they may reduce chronic abdominal symptoms associated with diverticular disease. Furthermore, elective colectomy for diverticulitis carries a non-trivial risk for major morbidity, and as with other elective operations, proper patient selection is key. Immunosuppressed patients are a unique, high-risk subgroup with worse diverticulitis and postoperative outcomes, rendering the decision for surgery even more complex.