In the event of a colectomy performed to address diverticular disease, a laparoscopic approach is appropriate for select patients (Recommendation 1B). Laparoscopic colectomies may have some advantages over open colectomies, including less post-operative pain, fewer cosmetic considerations, and a shorter average length of hospitalization. However, there appears to be no significant difference in early or late

complication rates between the laparoscopic and open procedures [59, 60]. The cost and outcome of the laparoscopic approach are both learn more comparable to those of the open resection [61]. Laparoscopic surgery is recommended for elderly patients [62] and appears to be safe for select patients with complicated diverticulitis [63]. Emergency surgery is required for patients with acute diverticulitis associated with diffuse peritonitis as well as for patients with acute diverticulitis whose initial non-operative management has failed (Recommendation 1B). Hartmann’s resection

is recommended in the event of severe acute diverticulitis with generalized, purulent, or fecal peritonitis as well as for patients with poor prognostic criteria. In the event of diffuse peritonitis, resection with primary anastomosis and peritoneal lavage is a suitable approach for patients with promising prognostic criteria or for those whose non-operative management of acute diverticulitis has failed. Hartmann’s procedure has historically been the standard treatment for complicated acute diverticulitis [64]. However, bowel reconstruction following Hartmann’s procedure requires LY333531 supplier additional surgeries, which many patients cannot undergo due to complicated medical conditions; therefore, many of these patients remain with permanent stoma [65]. The optimal approach for treating left colonic perforation is a one-stage procedure involving primary anastomosis. In an emergency setting, intraoperative lavage either of the colon and primary anastomosis are safe procedures for addressing complicated diverticulitis,

though Hartmann’s procedure is still recommended for cases of diffuse or fecal peritonitis, immunocompromised patients, or patients experiencing septic shock and multiorgan failure [66]. Many studies have demonstrated that, for select patients, primary anastamosis can be safely performed in the presence of localized or diffuse peritonitis [67]. Primary anastomosis is not recommended for patients in high-risk categories [67–73]. In 2010, Quizartinib molecular weight Tabbara et al. reviewed the medical records of 194 patients with complicated acute diverticulitis from 1996 to 2006 who required a colectomy within 48 hours of hospital admission [74]. The independent criteria predictive of eventual resection with primary anastomosis included the following: age less than 55 years, period between hospital admission and surgery lasting longer than 4 hours, and a Hinchey score of I or II.