title: Minimally Invasive Management of Complicated Diverticular Disease: Current Status and Review of Literature.
abstract: BACKGROUND
  Diverticulitis is a common condition which carries significant morbidity and socioeconomic burden (McGillicuddy et al in Arch Surg 144:1157-1162, 2009). The surgical management of diverticulitis has undergone significant changes in recent years. This article reviews the role of minimally invasive approach in management of complicated diverticulitis, with a focus on recent concepts and advances.
  
  
  METHODS
  A literature review of past 10 years (January 2004 to September 2014) was performed using the electronic database MEDLINE from PubMed which included articles only in English.
  
  
  RESULTS
  We identified total of 139 articles, out of which 50 were excluded resulting in 89 full-text articles for review 16 retrospective studies, 7 prospective cohorts, 1 case-control series and 1 systematic review were included. These suggest that urgent surgery is performed for those with sepsis and diffuse peritonitis or those who fail to improve despite medical therapy and/or percutaneous drainage. In addition, 3 randomized control trials: DILALA, LapLAND and the Scandinavian Diverticulitis trial are working towards evaluating whether laparoscopic lavage is safe in management of complicated diverticular diseases. Growing trend toward conservative or minimally invasive treatment modality even in severe acute diverticulitis was noticed.
  
  
  CONCLUSIONS
  Laparoscopic peritoneal lavage has evolved as a good alternative to invasive surgery, yet clear indications for its role in the management of complicated diverticulitis need to be established. Recent evidence suggests that existing guidelines for optimal management of complicated diverticulitis should be updated. Non-resectional radiographic techniques are likely to play a prominent role in the initial treatment of complicated diverticulitis in the near future.
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Manu
authors.initials: M
authors.lastname: Kaushik
authors.affiliation: Department of Colorectal Surgery, University of Minnesota, Minneapolis, St Paul, MN, 55114, USA. drjsbhullar@gmail.com.
authors.forename: Jasneet Singh
authors.initials: JS
authors.lastname: Bhullar
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Sandiya
authors.initials: S
authors.lastname: Bindroo
authors.affiliation: Department of Internal Medicine, St Vincent Hospital, Toledo, OH, USA.
authors.forename: Hemindermeet
authors.initials: H
authors.lastname: Singh
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000601:surgery*; D003082:Colectomy; D019468:Disease Management; D004238:Diverticulitis / Q000150:complications / Q000601:surgery*; D004322:Drainage; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted
keywords: Clinical intestinal disorders; GI infections; Inflammatory disorders