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The surgical treatment of severe attacks of sigmoid diverticulitis and the indications for prophylactic surgery are currently matters of debate. We have analysed our experience in a university hospital, bringing new information into the discussion.All patients admitted to our department between 1995 and 2002 for an attack of sigmoid diverticulitis were reviewed. There were 222 who had had a first attack and these formed the basis of the study. Analysis of short- and long-term outcomes was made.Of the 222 patients, 66 underwent an operation during the first admission (mainly Hartmann's opertation) with no death. Twenty-five patients were operated during a subsequent admission, either for a deterioration of their symptoms or prophylaxis. One hundred and twenty-eight patients were managed conservatively, and were followed up for 5–12 years. Recurrence was observed in 43% of the patients with a trend to a higher incidence in patients under 50 years. Recurrent exacerbating diverticulitis were severe in 13% of cases.Complicated diverticulitis can be managed with a low mortality. Hartmann's operation was proven safe in our experience. The risk of recurrence was higher than observed in many recent studies but few reccurences were severe.