Tyler Watson, MD is a fellowship-trained minimally invasive general surgeon at Novant Health General Surgery & Bariatrics – Mount Pleasant. He specializes in robotic surgery with a focus on diverticulitis, complex hernia repair and anti-reflux operations. He also frequently uses the robotic approach to treat emergent surgical conditions.

Since the 1970s, diverticulitis management has moved through several phases: from routine elective colectomy after recurrent attacks to a more conservative era shaped by evidence that uncomplicated recurrences do not always increase the risk of free perforation. In this Q&A, Dr. Watson explains why he believes today’s clinical decision-making should be more individualized. With advances in minimally invasive and robotic surgery, referring physicians can now consider surgical consultation not only for complications, but also for patients whose recurrent disease, risk factors or quality-of-life limitations may make elective resection a reasonable option.

Emergent surgical consultation should always be obtained for patients with any type of perforation, peritonitis or obstruction from diverticulitis.

For patients with recurrent or frequent uncomplicated diverticulitis, when is it appropriate to discuss a surgical consultation?

Any patient who experiences multiple bouts of diverticulitis deserves a conversation with a surgeon to discuss the risks and benefits of watchful waiting versus operative resection, especially:

• Patients who require multiple rounds of antibiotics, ER visits or hospitalizations.
• Patients who are afraid to eat certain foods or avoid travel out of the country because of their diverticular disease.
• Younger patients, those with strong family history or anyone on immunosuppression.

How should quality-of-life concerns factor in the referral decision?

Quality of life is now considered a legitimate, independent indication for surgery. Persistent low-grade pain between attacks, dietary restriction, anxiety about recurrence, missed workdays and disruption of normal activities are real and measurable harms. If a patient's daily life is significantly constrained by diverticular disease, even without meeting a strict complication criterion, that's appropriate grounds for a surgical referral to at least discuss options.

The decision ultimately becomes a trade-off the patient makes with full information about surgical risks, rather than something the referring physician needs to determine based on episode count alone

What can referring clinicians tell patients who worry that seeing a surgeon means they are committing to surgery?

This is one of the most common misconceptions and worth addressing directly with patients: a surgical consultation is an evaluation, not a commitment. I frequently see patients for diverticular disease for whom I do not recommend surgery. It is important for patients to understand the risks and benefits of all treatment options, and a surgical consultation can help them feel comfortable with those options.

Also, because most surgeons take the ER call, we see (and can best describe) what the more emergent presentations of diverticulitis can look and feel like for the patient.

What should referring physicians and patients expect from the consultation process, including evaluation, care coordination and shared decision-making?

The consult is meant to leave the patient with clarity: either a concrete surgical plan or a clear rationale and follow-up plan for continuing nonoperative management. A typical consultation will include:

• Review of history: Number, severity and pattern of episodes; prior imaging and treatments; comorbidities and immune status
• Review or completion of imaging: CT to confirm complicated vs. uncomplicated disease and current anatomy
• Colonoscopy: to rule out malignancy and confirm the extent of diverticulosis if not already done after the acute episode has resolved (typically six to eight weeks out)
• Discussion of options: continued surveillance/medical management or elective resection, including risks, benefits and expected recovery
• Shared decision-making: the surgeon presents the trade-offs, but the patient's values, risk tolerance and goals drive the final choice
• Care coordination with referring physician/gastroenterologist: sharing findings, agreeing on a plan and defining what would trigger a change in approach (e.g., another flare, new symptoms). If surgery is chosen, a separate discussion of technique (laparoscopic/robotic or open), timing (elective, ideally six-plus weeks after an acute episode resolves) and anticipated recovery course.