Laparoscopic Versus Open Surgery for Diverticular Disease: A Structured Review Across Clinical Settings and Operative Strategies.

Abstract

Laparoscopic surgery is increasingly used to treat colonic diverticulitis; however, its role in emergency, perforated, high-risk, and procedure-specific settings remains uncertain. This structured narrative review evaluated and synthesized comparative evidence by clinical setting, operative strategy, and patient risk profile to provide a clinical decision-making framework for identifying settings in which laparoscopy may offer meaningful benefits and those in which its role remains uncertain. In elective settings, randomized trials and observational studies generally demonstrated short-term advantages of laparoscopy, including reduced postoperative morbidity, less pain, faster recovery, and shorter hospitalization, although clear mid- or long-term superiority has not been established. In emergency, perforated, and high-risk settings, observational and nationwide database studies reported favorable short-term outcomes of laparoscopy; however, these findings were strongly influenced by patient selection, disease severity, and institutional expertise. Benefits were most consistent for resection-based procedures but were less clear for laparoscopic Hartmann procedures and inconsistent for lavage- or drainage-based strategies. Stoma creation rates tended to be lower after laparoscopy in selected cohorts, although this finding depended on disease severity and operative strategy. Evidence regarding intraoperative complications remains limited. Overall, laparoscopic surgery is associated with favorable short-term outcomes, with the most consistent evidence arising from elective diverticular surgery. In emergency surgery and perforated disease, however, the available evidence remains predominantly observational and susceptible to selection bias. These findings support a selective, context-dependent approach based on disease severity, patient condition, operative strategy, and institutional expertise, with careful surgical planning and timely conversion when necessary.