Technical Principles in Elective Surgical Treatment of Left Colon Diverticular Disease: A Scoping Review

Left colon diverticular disease (LCDD) is prevalent in the aging populations of industrialized countries, with many patients requiring surgery. Elective surgery decisions should consider individual health conditions and quality of life. Typically, surgery is recommended six weeks after an acute episode. This scoping review, following PRISMA-ScR guidelines, analyzed the literature on elective LCDD surgery, focusing on inferior mesenteric artery (IMA) ligation, splenic flexure mobilization (SFM), surgical approach, and extent of resection. The databases searched included PubMed, Embase, and Cochrane Library up to May 2025. Twenty studies met the inclusion criteria: 2 randomized trials (RCTs), 6 systematic reviews, 3 prospective studies, and 9 retrospective cohorts. The findings suggest preserving the IMA and selectively omitting SFM may reduce minor complications without compromising safety. Resection should reach the rectosigmoid junction and include only the affected colon segment. Minimally invasive techniques, especially laparoscopic surgery improve outcomes, reduce morbidity, and are more cost-effective than open surgery. Robotic approaches offer new options for complex cases. Surgical strategies must be tailored to disease severity, patient comorbidities, and anatomy. Further prospective studies are needed to refine guidelines and support personalized surgical decisions in LCDD management.