Open treatment of acute diverticulitis

Optimal surgical treatment of diverticulitis remains poorly defined. Although minimally invasive techniques are becoming increasingly common, the majority of colon resections for diverticulitis are still performed through a standard laparotomy. Based on high-quality evidence, laparoscopic resection with primary anastomosis is considered the preferred approach to elective colectomy for diverticulitis if adequate expertise is available. In perforated diverticulitis with generalized peritonitis and hemodynamic instability, an open surgical approach is preferred and nonrestorative resection or damage control strategy seems to be the only option. In hemodynamically stable patients, the role and outcomes of the type of operations, such as Hartmann’s procedure or resection and primary anastomosis, as well as the approach, laparoscopic or open, remain unclear. Based on the current evidences, the surgical management of diverticular disease and its complications remains challenging, with the needs to be tailored and individualized based on the severity and stage of disease, patient’s comorbidities, surgeon’s skills, and hospital resources.