There are controversies surrounding the indications, time and place for elective surgery, and role of multistage operations in the treatment of complicated diverticular disease. Most patients with uncomplicated diverticulitis can be managed non-operatively. Previous indications for elective surgery after two attacks of diverticulitis have been questioned. Evidence that patients are less likely to respond to medical therapy in subsequent attacks of diverticulitis is lacking. Decisions should be based on individual circumstances. The Hartmann procedure remains a safe option for patients with free perforation and generalised peritonitis. In experienced hands, a one-stage procedure can be as successful as a two-stage procedure in an emergency setting in selected patients. When possible, an operation should be converted from an emergency to a semi-elective one using techniques such as radiologically or laparoscopically guided drainage of collections.
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