Complicated diverticular disease: the changing paradigm for treatment

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Treatment

Background:

• Complicated diverticulitis involves bleeding, abscess, peritonitis, fistula, or obstruction.
• Treatment strategies for diverticulitis have significantly advanced.
• Minimally invasive techniques are increasingly utilized.

Purpose of the Study:

• To review current treatment modalities for complicated diverticulitis.
• To highlight the evolution of therapeutic algorithms.
• To emphasize the benefits of minimally invasive surgery.

Main Methods:

• Review of current literature on diverticulitis management.
• Analysis of treatment outcomes for various complications.
• Comparison of open versus minimally invasive surgical approaches.

Main Results:

• Hemorrhage is managed with angioembolization.
• Laparoscopic techniques, including resection and lavage, are key for peritonitis.
• Abscesses (Hinchey I-II) may be treated with antibiotics and/or drainage.
• Peritonitis (Hinchey III-IV) management includes resection, anastomosis, or laparoscopic lavage.
• Obstruction and fistula are typically treated with resection, preferably laparoscopic.

Conclusions:

• Minimally invasive algorithms decrease resections and stomas.
• Reduced morbidity and mortality are observed with modern approaches.
• Improved quality of life and cost-effectiveness are significant benefits.