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Volume 14
Issue 24
10.3390/jcm14248645
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Technical Principles in Elective Surgical Treatment of Left Colon Diverticular Disease: A Scoping Review

by
Luca Emanuele Amodio
1,
Gianluca Rizzo
1,
Federica Marzi
1,
Camilla Marandola
1,
Francesco Ferrara
2,* and
Vincenzo Tondolo
1
1
Digestive and Colo-Rectal Surgery Unit, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy
2
Unit of General and Oncologic Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (MePreCC), University of Palermo, “Paolo Giaccone” University Hospital, Via del Vespro 129, 90127 Palermo, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(24), 8645; https://doi.org/10.3390/jcm14248645 (registering DOI)
Submission received: 4 November 2025 / Revised: 29 November 2025 / Accepted: 5 December 2025 / Published: 5 December 2025
(This article belongs to the Special Issue Challenges in Minimally Invasive Colorectal and Abdominal Wall Surgery)
Versions Notes

Abstract

Left colon diverticular disease (LCDD) is prevalent in the aging populations of industrialized countries, with many patients requiring surgery. Elective surgery decisions should consider individual health conditions and quality of life. Typically, surgery is recommended six weeks after an acute episode. This scoping review, following PRISMA-ScR guidelines, analyzed the literature on elective LCDD surgery, focusing on inferior mesenteric artery (IMA) ligation, splenic flexure mobilization (SFM), surgical approach, and extent of resection. The databases searched included PubMed, Embase, and Cochrane Library up to May 2025. Twenty studies met the inclusion criteria: 2 randomized trials (RCTs), 6 systematic reviews, 3 prospective studies, and 9 retrospective cohorts. The findings suggest preserving the IMA and selectively omitting SFM may reduce minor complications without compromising safety. Resection should reach the rectosigmoid junction and include only the affected colon segment. Minimally invasive techniques, especially laparoscopic surgery improve outcomes, reduce morbidity, and are more cost-effective than open surgery. Robotic approaches offer new options for complex cases. Surgical strategies must be tailored to disease severity, patient comorbidities, and anatomy. Further prospective studies are needed to refine guidelines and support personalized surgical decisions in LCDD management.
Keywords: diverticular disease; sigmoid colectomy; left hemicolectomy; laparoscopy; robotic-assisted surgery; minimally invasive surgery; colorectal surgery diverticular disease; sigmoid colectomy; left hemicolectomy; laparoscopy; robotic-assisted surgery; minimally invasive surgery; colorectal surgery

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MDPI and ACS Style

Amodio, L.E.; Rizzo, G.; Marzi, F.; Marandola, C.; Ferrara, F.; Tondolo, V. Technical Principles in Elective Surgical Treatment of Left Colon Diverticular Disease: A Scoping Review. J. Clin. Med. 2025, 14, 8645. https://doi.org/10.3390/jcm14248645

AMA Style

Amodio LE, Rizzo G, Marzi F, Marandola C, Ferrara F, Tondolo V. Technical Principles in Elective Surgical Treatment of Left Colon Diverticular Disease: A Scoping Review. Journal of Clinical Medicine. 2025; 14(24):8645. https://doi.org/10.3390/jcm14248645

Chicago/Turabian Style

Amodio, Luca Emanuele, Gianluca Rizzo, Federica Marzi, Camilla Marandola, Francesco Ferrara, and Vincenzo Tondolo. 2025. "Technical Principles in Elective Surgical Treatment of Left Colon Diverticular Disease: A Scoping Review" Journal of Clinical Medicine 14, no. 24: 8645. https://doi.org/10.3390/jcm14248645

APA Style

Amodio, L. E., Rizzo, G., Marzi, F., Marandola, C., Ferrara, F., & Tondolo, V. (2025). Technical Principles in Elective Surgical Treatment of Left Colon Diverticular Disease: A Scoping Review. Journal of Clinical Medicine, 14(24), 8645. https://doi.org/10.3390/jcm14248645

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