Abstract Diverticulitis remains a significant and increasingly common health burden in North America. Historically, elective colectomy was recommended based on rigid criteria, typically after more than two episodes of uncomplicated diverticulitis or a single episode of complicated disease. However, emerging guidelines now support a more individualized, symptom-based approach that incorporates disease severity, comorbidities, and quality-of-life considerations. Evidence indicates that recurrent uncomplicated diverticulitis often follows a benign course, with most patients avoiding surgery even after multiple episodes. In contrast, chronic conditions such as smoldering diverticulitis or symptomatic uncomplicated diverticular disease may mimic acute recurrence but require careful diagnostic evaluation. Although randomized controlled trials have demonstrated that elective resection can improve gastrointestinal quality of life in select patients, these benefits must be weighed against the risks of perioperative complications and potential long-term bowel dysfunction. For complicated diverticulitis, surgery remains clearly indicated in the presence of fistulas or strictures, whereas the role of elective colectomy following successful treatment of diverticular abscess remains controversial. Ultimately, surgical decision-making should be anchored to shared discussions that consider patient preferences, symptom burden, and individualized risk profiles.
Sharma et al. (Wed,) studied this question.