Elective vs. early elective surgery in diverticular disease: a retrospective study on the optimal timing of non-emergency treatment

  • Felix Benjamin Warwas
  • Berthold Schneider
Original Article



This study set out to compare the in-hospital outcomes of early elective and elective laparoscopic sigmoidectomy due to diverticulitis.


We examined the data for 378 diverticulitis patients who received an elective laparoscopic sigmoid resection between 2008 and 2012. We divided the patients into two groups: elective (group A, n = 278) and early elective (group B, n = 100). Patients in group A received surgery during the inflammation-free interval, and those in group B immediately after treating the attack with IV antibiotics for a mean period of 8 days (IQR = 3).


Overall mortality was 0%. The mean operation duration was the same in both groups being 77.5 and 80 min respectively. There was no significant difference in the outcomes between the two groups, measured using the Clavien-Dindo classification of surgical complication (CCSC; p = 0.992). A revision due to complications was necessary in 16 cases (group A) and six cases (group B) (p = 0.820). The conversion rate to open surgery was low (six individuals in group A, vs. four in group B; p = 0.331). Patients in group B suffered significantly fewer diverticulitis attacks (three in group A, vs. two in group B; p = 0.026).


Our study showed no difference in outcome between elective and early elective cases. Operation durations were optimal in both cases and were 50% shorter than those recorded in the literature. An early elective operation represents a good treatment option, especially for patients suffering from complicated diverticulitis.


Diverticular disease Sigmoidectomy Laparoscopic Elective Early elective 



The authors would like to thank Markus Warwas and Karl Schulze-Hagen for general advice, Pius Korner for advanced statistical analysis, Brian Hillcoat for translating from the German, and Andrew Richford for English language editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this kind of study formal, consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Finney JMT (1928) Diverticulitis and its surgical treatment. Proc Interstate Post-Grad Med Assembly North Am 55:57–65Google Scholar
  2. 2.
    Etzioni DA, Mack TM, Beart RW, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217CrossRefPubMedGoogle Scholar
  3. 3.
    Hjern F, Josephson T, Altman D, Holmström B, Mellgren A, Pollack J, Johansson C (2007) Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory? Scand J Gastroenterol 42(1):41–47CrossRefPubMedGoogle Scholar
  4. 4.
    Schug-Pass C, Geers P, Hügel O, Lippert H, Köckerling F (2010) Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Color Dis 25(6):751–759CrossRefGoogle Scholar
  5. 5.
    Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K, Group AS (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99(4):532–539CrossRefPubMedGoogle Scholar
  6. 6.
    de Korte N, Kuyvenhoven JP, van der Peet DL, Felt-Bersma RJ, Cuesta MA, Stockmann HBC (2012) Mild colonic diverticulitis can be treated without antibiotics. a case-control study. Color Dis 14(3):325–330CrossRefGoogle Scholar
  7. 7.
    Mueller MH, Glatzle J, Kasparek MS, Becker HD, Jehle EC, Zittel TT, Kreis ME (2005) Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon. Eur J Gastroenterol Hepatol 17(6):649–654CrossRefPubMedGoogle Scholar
  8. 8.
    Hall JF, Roberts PL, Ricciardi R, Read T, Scheirey C, Wald C, Marcello PW, Schoetz DJ (2011) Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon rectum 54(3):283–288Google Scholar
  9. 9.
    Viszeralchirurgie DGfrA-u. S2k Leitlinie Divertikelkrankheit/Divertikulitis. 2012Google Scholar
  10. 10.
    Collins D, Winter DC (2015) Modern concepts in diverticular disease. J Clin Gastroenterol 49(5):358–369CrossRefPubMedGoogle Scholar
  11. 11.
    Siewert J, Huber F, Brune I (1995) Frühelektive Chirurgie der akuten Divertikulitis des Colons. Chirurg 66(12):1182–1189PubMedGoogle Scholar
  12. 12.
    Reissfelder C, Buhr HJ, Ritz J-P (2006) What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection? Dis Colon rectum 49(12):1842–1848Google Scholar
  13. 13.
    Hoffmann H, Dell-Kuster S, Kettelhack C, Genstorfer J, Langer I, Rosenthal R, et al.. Chirurgische Behandlung der Sigmadivertikulitis: Frühelektive vs. spätelektive Operation. Warum lange warten? 2011Google Scholar
  14. 14.
    Reissfelder C, Buhr HJ, Ritz JP (2006) Can laparoscopically assisted sigmoid resection provide uncomplicated management even in cases of complicated diverticulitis? Surg Endosc 20(7):1055–1059CrossRefPubMedGoogle Scholar
  15. 15.
    Little JP (1995) Consistency of ASA grading. Anaesthesia 50(7):658–659PubMedGoogle Scholar
  16. 16.
    Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251CrossRefPubMedGoogle Scholar
  17. 17.
    Hansen O, Stock W (1999) Prophylaktische Operation bei der Divertikelkrankheit des Kolons–Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir 115Google Scholar
  18. 18.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Smith TR, Cho KC, Morehouse HT, Kratka PS (1990) Comparison of computed tomography and contrast enema evaluation of diverticulitis. Dis Colon rectum 33(1):1–6Google Scholar
  20. 20.
    Ritz J-P, Lehmann KS, Frericks B, Stroux A, Buhr HJ, Holmer C (2011) Outcome of patients with acute sigmoid diverticulitis: multivariate analysis of risk factors for free perforation. Surgery 149(5):606–613CrossRefPubMedGoogle Scholar
  21. 21.
    Benn PL, Wolff BG, Ilstrup DM (1986) Level of anastomosis and recurrent colonic diverticulitis. Am J Surg 151(2):269–271CrossRefPubMedGoogle Scholar
  22. 22.
    Bergamaschi R, Arnaud JP (1998) Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid. Surg Endosc 12(9):1149–1151CrossRefPubMedGoogle Scholar
  23. 23.
    Team CR (2015) A language and environment for statistical computing: R Foundation for Statistical Computing, Vienna, AustriaGoogle Scholar
  24. 24.
    Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Color Dis 23(3):265–270CrossRefGoogle Scholar
  25. 25.
    Pendlimari R, Touzios JG, Azodo IA, Chua HK, Dozois EJ, Cima RR, Larson DW (2011) Short-term outcomes after elective minimally invasive colectomy for diverticulitis. Br J Surg 98(3):431–435CrossRefPubMedGoogle Scholar
  26. 26.
    Gaertner WB, Kwaan MR, Madoff RD, Willis D, Belzer GE, Rothenberger DA, Melton GB (2013) The evolving role of laparoscopy in colonic diverticular disease: a systematic review. World J Surg 37(3):629–638CrossRefPubMedGoogle Scholar
  27. 27.
    Klarenbeek BR, Samuels M, van der Wal MA, van der Peet DL, Meijerink WJ, Cuesta MA (2010) Indications for elective sigmoid resection in diverticular disease. Ann Surg 251(4):670–674CrossRefPubMedGoogle Scholar
  28. 28.
    Venara A, Toque L, Barbieux J, Cesbron E, Ridereau-Zins C, Lermite E et al (2015) Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance. J Visc Surg 152(4):211–215CrossRefPubMedGoogle Scholar
  29. 29.
    Schildberg C, Schellerer V, Croner R, Oberländer H, Hohenberger W (2013) Operationsindikation der Sigmadivertikulitis in Deutschland: Sind alle Operationen gerechtfertigt? Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und GefäßchirurgieGoogle Scholar
  30. 30.
    Kaser SA, Glauser PM, Basilicata G, Muller DA, Maurer CA (2012) Timing of rectosigmoid resection for diverticular disease: the patient’s view. Color Dis 14(3):e111–e116CrossRefGoogle Scholar
  31. 31.
    Ambrosetti P, Grossholz M, Becker C, Terrier F, Morel P (1997) Computed tomography in acute left colonic diverticulitis. Br J Surg 84(4):532–534CrossRefPubMedGoogle Scholar
  32. 32.
    Pugliese R, Di Lernia S, Sansonna F, Scandroglio I, Maggioni D, Ferrari C et al (2004) Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases. Surg Endosc 18(9):1344–1348CrossRefPubMedGoogle Scholar
  33. 33.
    Rafferty J, Shellito P, Hyman NH, Buie WD, Surgeons, the Standards Committee of The American Society of C, et al. (2006) Practice Parameters for Sigmoid Diverticulitis. Diseases of the Colon & Rectum 49(7):939–944Google Scholar
  34. 34.
    Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3(3)Google Scholar
  35. 35.
    Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the sigma trial. Ann Surg 249(1):39–44CrossRefPubMedGoogle Scholar
  36. 36.
    Gervaz P, Inan I, Perneger T, Schiffer E, Morel P (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252(1):3–8CrossRefPubMedGoogle Scholar
  37. 37.
    Raue W, Paolucci V, Asperger W, Albrecht R, Büchler MW, Schwenk W et al (2011) Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial. Langenbeck’s Arch Surg 396(7):973–980CrossRefGoogle Scholar
  38. 38.
    Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck THK, Bruch HP (2004) Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients. Langenbeck’s Arch Surg 389(2):97–103CrossRefGoogle Scholar
  39. 39.
    Natarajan S, Ewings EL, Vega RJ (2004) Laparoscopic sigmoid colectomy after acute diverticulitis: when to operate? Surgery 136(4):725–730CrossRefPubMedGoogle Scholar
  40. 40.
    Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, Michelassi F, Charlson ME, Milsom JW (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257(1):108–113CrossRefPubMedGoogle Scholar
  41. 41.
    Bhakta A, Tafen M, Glotzer O, Canete J, Chismark AD, Valerian BT et al (2015) Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg EndoscGoogle Scholar
  42. 42.
    Perniceni T, Burdy G, Gayet B, Dubois F, Boudet MJ, Levard H (2000) Results of elective segmental colectomy done with laparoscopy for complicated diverticulosis. Gastroenterol Clin Biol 24(2):189–192PubMedGoogle Scholar
  43. 43.
    Garrett KA, Champagne BJ, Valerian BT, Peterson D, Lee EC (2008) A single training center's experience with 200 consecutive cases of diverticulitis: can all patients be approached laparoscopically? Surg Endosc 22(11):2503–2508CrossRefPubMedGoogle Scholar
  44. 44.
    Anania G, Vedana L, Santini M, Scagliarnini L, Giaccari S, Resta G et al (2014) Complications of diverticular disease: surgical laparoscopic treatment. G Chir 35:126–128PubMedPubMedCentralGoogle Scholar
  45. 45.
    Faynsod M, Stamos MJ, Arnell T, Borden C, Udani S, Vargas H. A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg 2000;66(9):841–843Google Scholar
  46. 46.
    Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon rectum 45(10):1309–1315Google Scholar
  47. 47.
    Lawrence DM, Pasquale MD, Wasser TE (2003, 69) Laparoscopic versus open sigmoid colectomy for diverticulitis. Am Surg (6):499–503 discussion-4Google Scholar
  48. 48.
    Gonzalez R, Smith CD, Mattar SG, Venkatesh KR, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ (2004) Laparoscopic vs open resection for the treatment of diverticular disease. Surg Endosc 18(2):276–280CrossRefPubMedGoogle Scholar
  49. 49.
    Alves A, Panis Y, Slim K, Heyd B, Kwiatkowski F, Mantion G (2005) French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease. Br J Surg 92(12):1520–1525CrossRefPubMedGoogle Scholar
  50. 50.
    Le Moine MC, Fabre JM, Vacher C, Navarro F, Picot MC, Domergue J (2003) Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease. Br J Surg 90(2):232–236CrossRefPubMedGoogle Scholar
  51. 51.
    van de Wall BJ, Draaisma WA, van Iersel JJ, Consten EC, Wiezer MJ, Broeders IA (2013) Elective resection for ongoing diverticular disease significantly improves quality of life. Dig Surg 30(3):190–197CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Hospital BonnBonnGermany
  2. 2.Department of General and Visceral SurgerySt. Marienhospital BonnBonnGermany

Personalised recommendations