Evolution in Tactics and Management of Complicated Diverticulitis: Our Experience with Minimally Invasive Techniques

Abstract

Introduction: Over the past two decades, the interest in diverticular disease has increased significantly. For the first time, a rise in its incidence was described in the literature during the Industrial Revolution, when differences in prevalence between Western and Eastern populations were demonstrated—differences that persist to this day.  The risk of a patient with diverticulosis developing diverticulitis is estimated at less than 5%. Diverticulitis, in turn, leads to complications in approximately 12% of cases. The most frequent complications are abscesses or phlegmons (about 70%), followed by peritonitis, obstruction, and fistula formation. Historically, laparotomy with resection of the affected colonic segment was considered the cornerstone in the treatment of complicated diverticulitis; however, in recent years, it has largely been replaced by less invasive and less aggressive therapeutic approaches.

Aim: The aim of our study was to analyze the outcomes of treating complicated forms of diverticulitis through the use of minimally invasive methods.

Materials and Methods: We reviewed a 13-year period (May 2012–May 2025) of patients treated for complicated diverticular disease at the Department of Surgery, Eurohospital University Hospital, Plovdiv. During this period, 208 patients were treated. In 72 cases, diverticular perforation with varying degrees of infectious spread was identified. Non-operative management was applied in 11 cases, including antibiotic therapy, dietary regimen, and percutaneous drainage. Emergency surgery was required in 61 patients.

Results: Of the 61 surgically treated patients, 35 underwent laparoscopic procedures (57.38%). The conversion rate was 8.57% (3 cases). The remaining 26 patients were treated conventionally (42.62%). Postoperative complications such as wound infections, stoma-related issues, and anastomotic leaks were documented and compared between the minimally invasive and open surgery groups. Patients in the laparoscopic group demonstrated shorter operative times, reduced hospital stay, and shorter duration of antibiotic use.

Conclusion: The management of acute diverticulitis has changed significantly in recent years due to modern diagnostic modalities and non-operative interventional methods. Careful patient selection, an individualized approach, and the application of minimally invasive surgery represent the preferred treatment strategy. Our study fully confirms the findings reported in the literature. The use of modern surgical techniques results in shorter hospital stays, reduced operative times, lower rates of postoperative complications, decreased overall treatment costs, and improved quality of life for patients.