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Traditionally, recurrent diverticulitis indicates an elective sigmoid resection toprevent a future urgent operation. Recent data have challenged this concept. We aimed to investigate risk factors for urgent operations (US), to better define indications for elective surgery (ES).All patients who underwent surgery for sigmoid diverticulitis from 1997 to 2009 were retrospectively identified. Preoperative data of US and ES were compared using multivariate logistic regression analysis models.One hundred and three US and 136 ES patients underwent surgery. 69% of US patients have not experienced aprevious episode of diverticulitis. US was significantly associated with older age (66.7 ± 14.7 vs 59.2 ± 12.5 years, OR: 1.05, 95% CI: 1.01-1.09), immunosuppression (3.73, 1.07-12.95) and lack ofprevious episodes (55.56, 17.86-166.67). Gender, co-morbidities, and smoking history were comparable. US had higher mortality (6% vs 0%, P = 0.006) and medical complications rates (34% vs 19%, P = 0.009). Surgical complications rates were similar. Stoma rates were significantly higher in US (79% vs 5%, P = 0.0001). Immunosuppression was significantly associated with increased morbidity and mortality in US group.Recurrent diverticulitis and young age are not risk factors for an urgent operation and therefore should not serve as a sole indication for elective surgery. Elective surgery is justified in patients under immunosuppression.