[Sigmoid diverticulitis -- indications for surgery and choice of procedure]

The first attack of uncomplicated diverticulitis is treated conservatively. Sigmoid resection is indicated for recurrent diverticulitis, in patients with manifest stenosis or fistula and for such emergencies as perforation, ileus or bleeding. Early surgery after the first episode is recommended for patients under 50 years of age, or immunocompromised patients. This is particularly true for patients with radiological signs of severe diverticulitis. Today elective sigmoid resection is a laparoscopic procedure. Properly carried out, the operation effects a definitive cure. The morbidity and mortality of the operation is low, and re-operations for recurrent diverticulitis are the exception. In the emergency situation a two-stage procedure is often necessary.