Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. The tenets of surgical treatment of diverticulitis are resection of the entire sigmoid and creation of a tension-free anastomosis in the upper rectum. ⋯ The Hartmann procedure should be reserved for perforated diverticulitis with severe septic complications; however, the final treatment decision for primary anastomosis or Hartmann's procedure should be dependent on the individual patient. There have been a number of recent publications on the use of laparoscopic peritoneal lavage for perforated sigmoid diverticulitis as an alternative to resection surgery. In cases of diverticular bleeding a subtotal colectomy should be performed if the diverticular bleeding site cannot be localized.