As the surgical treatment of colonic diverticulitis has evolved to more selective resection, repeated episodes of diverticulitis may cause fibrosis and chronic inflammation, making elective surgery technically challenging. While laparoscopic resection has become the standard approach, surgeons should be familiar with all minimally invasive techniques in addition to the traditional open technique to provide safe and effective patient care. Regardless of the technique used, there are a number of surgical principles that must be adhered to. Complex disease, including enteral fistulas, requires a flexible approach and familiarity with multiple techniques for successful treatment.