Operative management of diverticulitis in a tertiary care center

- Diverticulitis has largely become a medically managed disease process.
- Patients undergoing surgery nowadays typically have chronic, advanced disease.
- Primary anastomosis is feasible in most patients with a low leak rate.
- Laparoscopy can be used in selected cases, although there is a higher conversion rate.

BackgroundDiverticulitis has become a medically managed disease process; the indications and timing of surgical intervention have evolved.MethodsWe retrospectively reviewed all patients who underwent surgical intervention due to diverticular disease by the Division of Colon and Rectal Surgery from 2012 to 2014.ResultsNinety-eight surgeries were performed. Indications included colovesicular fistula, multiple recurrences of diverticulitis, medically refractory diverticulitis, stricture, abscess, colocutaneous fistula, and colovaginal fistula. Average length of stay was 5.7 ± 5.9 days (range, 1 to 51). Eighteen patients (18%) required an ostomy. Postoperative complications occurred in 18% of patients, including anastomotic leak (3.3%), wound infection (7.1%), acute kidney injury (5.1%), and urinary tract infection (2.0%). Thirty-day readmission rate was 7.2%; unplanned 30-day reoperation rate was 3.1%. There were no deaths.ConclusionsThe type of patient undergoing surgery for diverticulitis has changed, with selection bias toward chronic, advanced disease due to the proliferation of medical management strategies.