Elective resection for diverticular disease: an evidence-based review

Controversy exists as to the most appropriate management of patients following two episodes of diverticulitis. Despite a growing body of new evidence challenging the concept of elective sigmoid resection after a patient experiences two attacks of diverticulitis, we continue to base our practice on outdated studies carried out more than 30 years ago. The recommendation that patients undergo elective sigmoid resection after two attacks of acute diverticulitis should be re-evaluated as it is generally inappropriate and is not cost effective. Elective resection for uncomplicated diverticulitis does not alter outcome, nor does it decrease mortality or prevent complications of the disease. In fact, based on current literature, 18 patients would have to undergo elective operation to prevent one emergency surgery. This article aims to review the current evidence for elective resection following episodes of diverticular disease and addresses emerging controversies in the management of this disease.