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Evidence indicates delayed elective sigmoid resection can reduce conversion rates and operative and hospitalization time, and may improve health economics. Individualized timing should integrate symptom burden, recurrence pattern, risk profiles, and patient-reported outcomes to optimize quality of life, avoid emergency surgery, and support cost-effective 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Reassessing elective sigmoidresection in recurrent diverticulitis  \nMomina Inayat, MBBS, Aleeza Khalid, MBBS, Muddassir Khalid, MBBS*  \nDear Editor,  \nGlobally, recurrent diverticulitis still poses a problem for clinical judgment and healthcare systems. The management of diverticular disease has grown in importance as a public health concern due to the aging population and its increasing prevalence. Recurrence occurs in about 25% of patients with diverticular disease, and it is more common in people over 60 years of age (50%)[1] . In Germany, hospitalizations for diverticular disease topped 130 000 cases annually, and in the US, the annual cost is estimated to be USD 2.5 billion. These numbers highlight the worldwide burden of illness and the pressing need to improve the timing of elective sigmoid resection, a choice that has a direct bearing on morbidity, quality of life, and the distribution of healthcare resources.  \nIn laparoscopic sigmoidectomy for diverticular disease, conversion rates and results are strongly influenced by the stage of the disease and the timing of the procedure. The best time to operate on patients with complex acute or chronic diverticulitis is when there is no inflammation. Due to a lack of randomized controlled evidence, European and American societies have differing recommendations regarding the best time to perform resection. According to a recent meta-analysis, delayed elective resection has lower conversion rates and shorter operating and hospitalization times than early surgery. Furthermore, when compared to traditional laparoscopy, recent developments like robotic colectomy have demonstrated promise in lowering conversion to open surgery and postoperative complications [2] .  \nElective sigmoid resection has been shown to improve quality of life in patients with recurrent, complicated, or persistent symptomatic diverticulitis. While surgical risks must be balanced against benefits, evidence suggests comparable complication rates between initial conservative management and elective surgery. Health-economic analyses also support delayed surgery, with colectomy after the fourth rather than the second episode in patients aged 50 years or  \nDepartment of Medicine, Nishtar Medical University, Multan, Pakistan Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of Medicine, Nishtar Medical University, Nishtar Road, Multan 60000, Pakistan. Tel.: +923330333544.  \n[E-mail: dr.muddassirkhalid@gmail.com](E-mail: dr.muddassirkhalid@gmail.com) (M. Khalid).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This isan open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  \nAnnals of Medicine & Surgery (2026) 88:1066–1067  \nReceived 11 November 2025; Accepted 13 November 2025  \nPublished online 3 December 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004425](http://dx.doi.org/10.1097/MS9.0000000000004425)  \nolder, resulting in fewer deaths, fewer colostomies, and cost savings of over USD 1000 per patient[3] . In younger patients, delaying surgery until after the fourth episode leads to fewer colostomies and savings exceeding USD 5000. The LASER randomized clinical trial (2025) further demonstrated that, although elective resection reduces recurrence rates, it does not significantly improve long-term quality of life compared to conservative treatment. These findings highlight the importance of individualized surgical timing guided by symptom burden, recurrence pattern, and overall quality of life [4] . These results emphasize the significance of individualized surgical scheduling based on burden symptoms, recurrence patterns, and general quality of life.  \nAccording to recent surveys o","cbCaiqIJHfX85y2X","https://ap.wps.com/l/cbCaiqIJHfX85y2X","pdf",150716,"English","# Letter to the Editor\n## Clinical burden and need for optimal timing\n## Evidence on delayed vs early elective resection\n## Individualized decision-making and follow-up strategy","[{\"question\":\"Why is determining the right time for elective sigmoid resection important in recurrent diverticulitis?\",\"answer\":\"Recurrent diverticulitis creates ongoing morbidity and healthcare burden, and operative timing affects morbidity, quality of life, conversion rates, and how healthcare resources are used.\"},{\"question\":\"What does the evidence suggest about delayed vs early elective surgery?\",\"answer\":\"Meta-analytic findings indicate delayed elective resection is associated with lower conversion rates and shorter operating and hospitalization times than early surgery.\"},{\"question\":\"How should clinicians individualize surgical timing for elective sigmoid resection?\",\"answer\":\"A personalized, evidence-informed framework should consider symptom burden, recurrence pattern, overall quality of life, clinical risk profiles, and patient-reported outcomes, supported by appropriate monitoring during observation.\"}]","When is right time? - Reassessing elective sigmoid resection in recurrent diverticulitis | PDF",1790690350]