Recommendations for surgery in the setting of recurrent diverticulitis have evolved over time towards a more individualized and patient-centered approach. Following successful medical management of an initial attack of acute diverticulitis, careful consideration is required weighing the risk of recurrent or progressive disease against the risk of elective surgery. Patient preference is also an important factor in this decision, with quality of life being one of the most important considerations in determining when to recommend elective resection for recurrent diverticulitis. Once the decision is made to proceed with elective resection, surgery should ideally be performed during a quiescent phase with the intent of resecting the sigmoid colon down to the rectosigmoid junction. In addition to the small risk of recurrent disease after surgical resection, persistent abdominal symptoms may be an undesired outcome of surgical resection.