Diverticulitis Treatment: 4-Year LASER Trial Results on Sigmoid Resection vs Conservative Care

Elective sigmoid resection effectively prevents recurrent diverticulitis without increasing the risk of complications, according to a new 4-year analysis of the LASER randomized clinical trial conducted across 6 Finnish hospitals published in JAMA Surgery. However, the study also shows that patients with relatively normal quality of life (QOL) may fare just as well with conservative management.

The trial enrolled 90 patients with recurring, complicated, or persistently painful diverticulitis, randomizing them equally to upfront laparoscopic sigmoid resection or conservative treatment. Results showed that nearly one-third of patients initially managed conservatively eventually opted for surgery due to persistently low QOL. Among those who remained on conservative treatment, quality-of-life outcomes were similar to those who had surgery.

At 4 years, patients who underwent early surgery experienced significantly fewer recurrences—only 16% compared to 92% among conservatively treated patients. Yet both groups reported similar Gastrointestinal Quality of Life Index (GIQLI) scores: 115.3 in the surgery group versus 109.8 in the conservative group. Severe complication rates remained comparable between groups, reinforcing the safety of either approach.

Researchers concluded that elective sigmoid resection is a valuable option for patients with compromised quality of life, offering a durable solution to prevent recurrence without raising surgical risk. Conversely, patients with satisfactory baseline QOL may prefer a watch-and-wait approach, avoiding surgery unless symptoms worsen over time.

Reference
Santos A, Mentula P, Pinta T, et al. Sigmoid resection vs conservative treatment after diverticulitis: prespecified 4-year analysis of the LASER randomized clinical trial. JAMA Surg. Published online: April 09, 2025. doi:10.1001/jamasurg.2025.0572