[Diverticular disease: When to operate?].

We present our experience with 431 patients suffering from diverticular disease. Indications for emergency and elective surgery are given. Immediate laparatomy is mandatory for severe diverticular bleeding, bowel obstruction and sigmoid perforation. Aggressive surgical management is appropriated for purulent and fecal peritonitis. Resection of the perforated sigmoid colon by the Hartmann procedure is the method of choice and helps to reduce mortality markedly. A resection with primary anastomosis can be performed in equal safety if there is only a localised peritonitis. One stage resection is most frequently performed for elective cases with recurrent attacks and bleeding, painful or obstructing diverticular disease, fistula and if a cancer cannot be excluded. Aggressive surgical treatment helps to lower mortality and morbidity and is the best tool in prevention of severe complications for diverticular disease.