Population Based Analysis of Surgical Care for Diverticulitis

The surgical treatment of diverticulitis is likely variable based on a number of factors including patient comorbidity, patient wishes, disease factors, and surgeon factors. Elective prophylactic colectomy has historically been recommended for patients with multiple bouts of diverticulitis, with or without complicated disease, but guidelines have changed considerably [1]. The newest ASCRS practice parameters suggest the old model of diverticulitis as a progressive disease, in which recurrences predict poor outcomes, may be outdated [2,3]. As such, elective colectomy for younger patients (<50 years) with one attack of diverticulitis is no longer recommended [2]. In addition, though non-operative treatment with antibiotics is still recommended, the newest ASCRS guidelines acknowledge that the necessity of antibiotics has been called into question by recent research [2,4-6]. Although new data have led to some of these shifts in recommendations, variation in disease presentation and clinical course as well as provider judgment rather than any generalized protocol are likely to lead to confusion regarding care paths [2,7]. Thus, given the lack of clear consensus guidelines for surgery, the surgical care of diverticulitis is likely to be variable and nonstandard. Mounting evidence suggests that recurrence rates among diverticulitis patients with uncomplicated disease are lower than previously reported, supporting the notion that indications for elective colectomy should be reconsidered [8,9]. There is also evidence that the risks of readmission and emergency surgery are lower than previously reported for patients whose uncomplicated diverticulitis is non-operatively managed, similarly supporting non-operative care in this population [10]. New evidence suggests that there is no increased risk of conversion from laparoscopy among patients whose colectomies were delayed [11]. In addition, others have advocated for less invasive management for even complicated diverticulitis in hemodynamically stable patients [12,13].