In summary, the LASER trial’s 4-year analysis indicates that while elective sigmoid resection is highly effective in preventing diverticulitis recurrence, it does not offer a sustained QOL advantage over conservative treatment in the long term. The study’s strengths include rigorous randomization, high follow-up adherence (92%), and intention-to-treat/per-protocol analyses.

However, limitations such as premature termination, small sample size (n = 90), lack of blinding, and heterogeneity in inclusion criteria (recurrent vs. persistent pain) temper generalizability. Comparisons with the DIRECT trial reveal discrepancies in outcomes, likely due to differing baseline patient profiles (e.g., higher recurrent diverticulitis prevalence in LASER). These findings underscore the importance of individualized treatment, balancing recurrence risk against surgical morbidity.

Reza Lankarani

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