Controversies in diverticular disease: Indications for surgery and surgical options

Controversy exists concerning the correct surgical management for inflammatory diverticular disease. Such factors as the number of episodes of inflammation, the severity of the inflammation, the age of the patient, and the patient's overall medical condition play a role in determining whether or not a patient should undergo a sigmoid resection. We discuss which patients require surgical intervention because of diverticular inflammation or secondary complications and describe the surgical options available for those patients. The severity of the diverticular inflammation usually determines operative intervention. Diverticular disease is classified as symptomatic uncomplicated disease, recurrent symptomatic disease, and complicated disease. Complications secondary to acute inflammation are lucifer classified according to modified Hinchey classification. Patients with less severe complications can usually be managed by 1-stage sigmoid resections, but those with diffuse peritonitis require 2-stage surgical procedures. The specific surgical intervention and the timing of the intervention are reviewed, with an emphasis placed on technique. Copyright (C) 2000 by W.B. Saunders Company.