Minimally Invasive Surgery in Complicated Diverticulitis: Clinical Impact, Technical Limitations, and Gaps in the Standardization

Abstract

Introduction: Diverticulitis is an inflammation of colonic diverticula. Diagnosis is primarily made through computed tomography, which also helps assess complications and classify severity according to the modified Hinchey scale. Objective: To analyze the evidence regarding the use of minimally invasive surgical techniques. Methodology: Qualitative cohort study; databases such as WoS and PubMed were reviewed. Results: The clinical management of diverticulitis has evolved significantly in recent years, with a progressive shift toward the adoption of minimally invasive surgeries (MIS), including laparoscopic and robotic approaches. These have been associated with reductions in specific complications, a lower incidence of surgical site infections, and shorter hospital stays. Laparoscopic peritoneal lavage is not recommended in patients classified as Hinchey IV or those with severe systemic conditions, as it is associated with higher 30-day in-hospital mortality. Hartmann’s procedure is considered appropriate only for patients with hemodynamic instability, severe comorbidities, immunosuppression, or high anesthetic risk.  Discussion: Minimally invasive techniques have demonstrated better outcomes compared to open approaches in terms of postoperative morbidity, reduced surgical site infections, and shorter hospital stays, in addition to faster functional recovery. The high rate of conversion from laparoscopic to open surgery—particularly in Hartmann’s procedure—suggests technical limitations that may be addressed through improved surgical training and standardized protocols. Conclusion: Available evidence suggests that MIS is safe and effective in high-risk populations, such as patients with elevated BMI or advanced age, thereby expanding its clinical applicability.