Acar T, Sür Y, Acar N, Tekindal MA, Dilek ON. Does localization change management in complicated right and left-sided diverticulitis? World J Gastrointest Surg 2025; 17(12): 111450 [DOI: 10.4240/wjgs.v17.i12.111450]
Corresponding Author of This Article
Yunus Sür, MD, Department of General Surgery, İzmir Katip Celebi University, Atatürk Training and Research Hospital, İzmir Atatürk Eğitim ve Araştırma Hastanesi Basın Sitesi Mah. Hasan Tahsin Cad No. 143 Karabağlar, İzmir 35150, Türkiye. dr.yunus.sur@gmail.com
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Surgery
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Acar T, Sür Y, Acar N, Tekindal MA, Dilek ON. Does localization change management in complicated right and left-sided diverticulitis? World J Gastrointest Surg 2025; 17(12): 111450 [DOI: 10.4240/wjgs.v17.i12.111450]
World J Gastrointest Surg. Dec 27, 2025; 17(12): 111450 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.111450
Does localization change management in complicated right and left-sided diverticulitis?
Turan Acar, Yunus Sür, Nihan Acar, Mustafa Agah Tekindal, Osman Nuri Dilek
Turan Acar, Department of General Surgery, Fenerbahçe University, İzmir Medicana International Hospital, İzmir 35170, Türkiye
Yunus Sür, Nihan Acar, Department of General Surgery, İzmir Katip Celebi University, Atatürk Training and Research Hospital, İzmir 35150, Türkiye
Mustafa Agah Tekindal, Department of Biostatistics, Faculty of Medicine, İzmir Katip Celebi University, İzmir 35360, Türkiye
Osman Nuri Dilek, Department of General Surgery, İzmir Medical Park Hospital, İzmir 35230, Türkiye
Co-corresponding authors: Yunus Sür and Osman Nuri Dilek.
Author contributions: Sür Y and Dilek ON contribute equally to this study as c-corresponding authors; Acar T, Sür Y, Acar N, and Dilek ON participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Acar T and Acar N wrote the manuscript; Tekindal MA accessed and verified the study data and reviewed the statistical analysis; all authors critically reviewed and provided final approval of the manuscript; all authors were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Izmir Katip Çelebi University Non-Interventional Research Ethics Committee (Approval No. 619).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yunus Sür, MD, Department of General Surgery, İzmir Katip Celebi University, Atatürk Training and Research Hospital, İzmir Atatürk Eğitim ve Araştırma Hastanesi Basın Sitesi Mah. Hasan Tahsin Cad No. 143 Karabağlar, İzmir 35150, Türkiye. dr.yunus.sur@gmail.com
Received: July 1, 2025 Revised: July 20, 2025 Accepted: October 11, 2025 Published online: December 27, 2025 Processing time: 178 Days and 7.9 Hours
Abstract
BACKGROUND
Distribution of the colonic diverticula differs in different populations, and right-sided colon diverticulitis (RCD) and left-sided colon diverticulitis (LCD) manifest distinct clinical features. Complicated diverticulitis (CD) mostly requires hospitalization and can be treated within a spectrum from observation to surgery. Treatment choice is formed depending on the patient’s general condition, the presence of diffuse peritonitis, the localization of diverticulitis, Hinchey stage, and responsiveness to the prior treatment. Clinical disparities regarding right and LCD also led to the differences in the incidences of both emergency surgery and future elective surgery.
AIM
To evaluate the clinical features of CD, display the differences according to colonic localizations, and present treatment approaches.
METHODS
This was a retrospective study from a single centre analysing data from a prospective database. The 253 patients with history of hospitalization for CD were included and divided into two groups: RCD and LCD. To compare the differences between the two groups, the Student’s t-test was used when the parametric test prerequisites were fulfilled, and the Mann-Whitney U test was used when such requirements were not fulfilled.
RESULTS
The 208 (82.2%) patients were found to have LCD, and 45 (17.8%) had RCD. The majority of the patients had Hinchey 1A diverticulitis (49.8%). Male gender was significantly more common in patients who underwent surgery for LCD. While persistent abdominal pain was the main prior finding in the conservative treatment of both localizations, surgery was most performed due to abscess in RCD and perforation in LCD. The presence of an accompanying malignancy during colonoscopy was significantly more common in LCD cases who underwent surgery. Hartmann’s procedure was the most performed technique in emergency settings (56.3%), while laparoscopic colectomy with anastomosis was in elective settings (53.9%). In addition, surgery was found to prolong the mean length of hospital stay in LCD patients.
CONCLUSION
Although diverticulitis is a benign condition, the need for an individualized and evidence-based approach makes management challenging. Localization of the disease has an important role in determining the appropriate treatment.
Core Tip: Diverticular disease has a globally increasing incidence. Most of the current studies on diverticulitis refer to left colonic diverticulitis. However, right-sided colon diverticulitis (RCD) and left-sided colon diverticulitis (LCD) manifest distinct features. This retrospective study consisted of 253 patients with complicated diverticulitis and compared the characteristics and treatment approaches of RCD and LCD. Age, Charlson comorbidity index, prior complication, Hinchey stage, number of episodes, and the mean length of hospital stay were significantly different between RCD and LCD. The presence of an accompanying lesion during elective colonoscopy was statistically significant among LCD. Although conservative treatment was adequate in most RCD, there is still no standard treatment management in LCD, since the course of the disease differs among individuals.
