Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16609
Revised: August 15, 2014
Accepted: September 18, 2014
Published online: November 28, 2014
Diverticulitis is one of the leading indications for elective colon resection. Surgeons are trained to offer elective operations after a few episodes of diverticulitis in order to prevent future recurrences and potential emergency. However, most emergency surgery happens during the initial presentation. After recovery from an episode, much of the subsequent management of diverticulitis occurs in the outpatient setting, rendering inpatient “episode counting” a poor measure of the severity or burden of disease. Evidence also suggests that the risk of recurrence of diverticulitis is small and similar with or without an operation. Accordingly, contemporary evaluations of the epidemiologic patterns of treatments for diverticulitis have failed to demonstrate that the substantial rise in elective surgery over the last few decades has been successful at preventing emergency surgery at a population level. Multiple professional societies are calling to “individualize” decisions for elective colectomy and there is an international focus on “appropriate” indications for surgery. The rethinking of elective colectomy should come from a patient-centered approach that considers the risks of recurrence, quality of life, patient wishes and experiences about surgical and medical treatment options as well as operative morbidity and risks.
Core tip: Over the last decade, the relationship between elective and emergency surgery has come into question. With most emergency resections being performed in patients without a prior hospitalization, it has become apparent that diverticulitis recurrences are a poor predictor for future emergency operation at the population level. In addition, the rate of diverticulitis recurrence appears to be small and similar for those who do and do not undergo resection. This evidence suggests a need to rethink the factors that should be considered when deciding on elective colectomy for diverticulitis.