Minimally Invasive Approach to Acute Diverticulitis

Abstract

Colonic diverticulosis and diverticulitis are common disease entities, responsible for approximately 300,000 annual hospital admissions, and impose considerable economic burden and consume substantial healthcare resources. Though the mainstays of therapy include antibiotics and operative intervention, equipoise exists regarding if and for whom operative intervention should be offered, particularly in the context of balancing risk/benefit ratios. Knowing that the majority of patients with acute uncomplicated diverticulitis respond with medical therapy alone, nonoperative therapy is an appropriate initial measure. However, the data suggest that even moderate disease (Hinchey I and II) possesses higher recurrence and complication rates, and thus, elective operative intervention, preferably laparoscopic, should be offered to those patients deemed of appropriate risk. However, in the context of complicated diverticulitis, the tenets of emergency general surgery predominate, emphasizing expeditious resuscitation and reversal of shock and elimination of continued sources of contamination and sepsis. Collectively these data support a more algorithmic acute care surgical approach that is tailored to the specific phenotype of the interaction between patient and disease and thereby proffers improved morbidity and mortality.