From:  Surgical interventions: new approaches in diverticulitis treatment

 Treatment selection criteria in diverticulitis.

Surgical interventionIdeal candidateLess favoured condition
Percutaneous drainageLocalized diverticular abscess formation > 3 cm; patients who are critically ill or unsuitable for surgery.Ineffective for extensive abscesses or diffuse peritonitis.
Open colectomyComplicated diverticulitis with perforation and peritonitis; critically ill patients with multiple comorbidities.Limited abscess, significant comorbidities; preference for minimally invasive techniques in stable patients.
Hartmann procedureSevere comorbidities or hemodynamic instability; patients requiring a safe approach in complicated conditions.Stable patients who can tolerate primary anastomosis; patients wishing to avoid a permanent stoma.
Primary anastomosisStable patients with perforated diverticulitis and low risk of anastomotic leaks.Severe intra-abdominal contamination; presence of sepsis or septic shock.
Primary anastomosis with diversion stomaInfected cases where restoration of bowel continuity is easier than Hartmann’s procedure.Severe contamination and comorbidities in hemodynamically unstable patients.
Laparoscopic approachComplications such as abscess formation, perforation, or obstruction; preference for reduced postoperative pain and quicker recovery.Patients unsuitable for laparoscopic surgery due to comorbidities, extensive disease, or severe intra-abdominal contamination, and hemodynamically unstable patients.
Robot-assisted approachEnhanced precision for complex procedures; suitable for patients requiring delicate dissection or suturing.High cost; patients with contraindications for pneumoperitoneum or those with extensive contamination and hemodynamic instability.
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