ABSTRACT
Colonic diverticulosis is an exceedingly common acquired abnormality in the United States and developed countries. The indications for surgery in diverticular disease are also somewhat controversial and have witnessed a pendulum-like effect over time. Adding additional complexity to the decision-making is the fact that the definition of complicated diverticulitis is ever-changing. As surgical technology and the understanding of post-operative physiology have evolved, so too has the surgical management of diverticulitis. Modern technology and a century of experience with the surgical management of diverticular disease have led to a number of accepted surgical therapies for diverticulitis, all with the ultimate common goal of patient safety, quality of life and bowel continuity. The ideal operation for sigmoid diverticulitis is a single-stage sigmoid colectomy, which by definition avoids the need for an ostomy. The medial-to-lateral approach may be useful in cases of complicated diverticulitis as it allows for early identification of the ureter, gonadal vessels and iliac vessels, allowing a safer lateral dissection.
