***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Recently , excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy . The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis ( LOLA-arm ) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis ( DIVA-arm : perforated DIVerticulitis : sigmoidresection with or without Anastomosis ) . Methods / Design In this multicentre r and omised trial all patients with perforated diverticulitis are included . Upon laparoscopy , patients with purulent peritonitis are treated with laparoscopic lavage and drainage , Hartmann 's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 ( LOLA-arm ) . Patients with faecal peritonitis will be r and omised 1:1 between Hartmann 's procedure and resection with primary anastomosis ( DIVA-arm ) . The primary combined endpoint of the LOLA-arm is major morbidity and mortality . A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25 % in resectional groups compared to 10 % in the laparoscopic lavage group ( two sided alpha = 5 % , power = 90 % ) . Endpoint of the DIVA-arm is stoma free survival one year after initial surgery . In this arm 212 patients are needed to significantly demonstrate a difference of 30 % ( log rank test two sided alpha = 5 % and power = 90 % ) in favour of the patients with resection with primary anastomosis . Secondary endpoints for both arms are the number of days alive and outside the hospital , health related quality of life , health care utilisation and associated costs . Discussion The Ladies trial is a nationwide multicentre r and omised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy for both purulent and faecal generalised peritonitis . Trial registration Nederl and s Trial Register Background Elective laparoscopic sigmoid resection for diverticulitis has proven short-term benefits , but little data are available from prospect i ve r and omized trials regarding long-term outcome , quality of life , and functional results . Methods Of 113 patients r and omized to undergo laparoscopic ( LAP ) versus open ( OP ) sigmoid resection for diverticulitis , 105 ( 93 % , LAP = 54 , OP = 51 ) patients were examined and answered the Gastrointestinal Quality of Life Index ( GIQLI ) question naire , with a median follow-up of 30 ( range , 9–63 ) months after surgery . Results Incisional hernias were detected in five ( 9.8 % ) patients in the OP group versus seven ( 12.9 % ) in the LAP group , P = 0.84 ) . Overall satisfaction with the operation on a scale of 0 ( very poor ) to 10 ( excellent ) was 9 ( range , 2–10 ) in the OP group versus 9 ( range , 2–10 ) in the LAP group ( P = 0.78 ) . Median GIQLI score was 115 ( range , 57–144 ) in the OP group versus 110 ( range , 61–134 ) in the LAP group ( P = 0.17 ) . Overall satisfaction with the cosmetic aspect of the scar on a scale of 0 ( very poor ) to 10 ( excellent ) was 8 ( range , 1–10 ) in the OP group versus 9 ( range , 0–10 ) in the LAP group ( P = 0.01 ) . Finally , median hospital cost ( including reoperations for hernias ) was 11,606 ( 5,230–147,982 ) CHF in the LAP group versus 12,138 ( 6,098–39,786 ) CHF in the OP group ( P = 0.47 ) . Conclusions Both open and laparoscopic approaches for sigmoid resection achieve good long-term results in terms of gastrointestinal function , quality of life , and patients ’ satisfaction . Significant long-term benefits of laparoscopic surgery are restricted to cosmetic ( Clinical Trials.gov protocol # NCT00453830 ) Background / Aims : We evaluated the efficacy of mesalamine ( Asacol ) in reducing gastrointestinal symptoms after an acute attack of diverticulitis . Methods : This was a 1-year double-blind , r and omized , placebo-controlled study in which patients with computed tomography scan confirmed acute diverticulitis received placebo , mesalamine , or mesalamine+Bifidobacterium infantis 35624 ( Align ) for 12 weeks and followed for 9 additional months . Efficacy was assessed using a global symptom score ( GSS ) of 10 symptoms ( abdominal pain , abdominal tenderness , nausea/vomiting , bloating , constipation , diarrhea , mucus , urgency , painful straining , and dysuria ) . Patients were required to have a GSS≥12 at baseline , including an abdominal pain score > 2 . Results : One hundred seventeen patients ( placebo , 41 ; mesalamine , 40 ; mesalamine+probiotic , 36 ) were r and omized and treated . GSS decreased in all groups during treatment without a statistically significant difference between mesalamine and placebo , however ; scores were consistently lower for mesalamine at all time points . The rate of complete response ( GSS=0 ) was significantly higher with mesalamine than placebo at weeks 6 and 52 ( P<0.05 ) , and was particularly high for rectosigmoid symptoms at weeks 6 , 12 , 26 , and 52 . Recurrence of diverticulitis was low and comparable across groups . Probiotic in combination with mesalamine did not provide additional efficacy . Conclusions : In the first US r and omized placebo-controlled trial of anti-inflammatory treatment after a documented case of diverticulitis , mesalamine demonstrated a consistent trend in reducing symptoms . Addition of probiotic did not increase mesalamine efficacy . This study supports further investigation into the use of anti-inflammatory agents , such as mesalamine , in the long-term management of diverticulitis . Clinical Trials.gov NCT00554099 CONTEXT Patients with diverticular disease are frequently advised to avoid eating nuts , corn , popcorn , and seeds to reduce the risk of complications . However , there is little evidence to support this recommendation . OBJECTIVE To determine whether nut , corn , or popcorn consumption is associated with diverticulitis and diverticular bleeding . DESIGN AND SETTING The Health Professionals Follow-up Study is a cohort of US men followed up prospect ively from 1986 to 2004 via self-administered question naires about medical ( biennial ) and dietary ( every 4 years ) information . Men reporting newly diagnosed diverticulosis or diverticulitis were mailed supplemental question naires . PARTICIPANTS The study included 47,228 men aged 40 to 75 years who at baseline were free of diverticulosis or its complications , cancer , and inflammatory bowel disease and returned a food-frequency question  naire . MAIN OUTCOME MEASURES Incident diverticulitis and diverticular bleeding . RESULTS During 18 years of follow-up , there were 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding . We found inverse associations between  nut and popcorn consumption and the risk of diverticulitis . The multivariate hazard ratios for men with the highest intake of each food ( at least twice per week ) compared with men with the lowest intake ( less than once per month ) were 0.80 ( 95 % confidence interval , 0.63 - 1.01 ; P for trend = .04 ) for nuts and 0.72 ( 95 % confidence interval , 0.56 - 0.92 ; P for trend = .007 ) for popcorn . No associations were seen between corn consumption and diverticulitis or between nut , corn  , or  popcorn  consumption and diverticular bleeding or uncomplicated diverticulosis . CONCLUSIONS In this large , prospect i ve study of men without known diverticular disease , nut , corn , and popcorn consumption did not increase the risk of diverticulosis or diverticular complications . The recommendation to avoid these foods to prevent diverticular complications should be reconsidered To examine the association between  dietary fiber  ,  sources of fiber , other nutrients , and the diagnosis of  symptomatic diverticular disease , we analyzed data from a prospect i ve cohort of 47,888 US men . During 4 y of follow-up we documented 385 new cases of symptomatic diverticular disease .  Total dietary fiber intake  was inversely associated with the risk of diverticular disease after adjustment for age , energy-adjusted total fat intake , and physical activity [ relative risk ( RR ) 0.58 ; 95 % CI 0.41 , 0.83 ; P for trend = 0.01 for men in the highest as compared with the lowest quintile of dietary fiber ] . This inverse association was primarily due to fruit and vegetable fiber . For men on a high-total-fat , low-fiber diet , the RR was 2.35 ( 95 % CI 1.38 , 3.98 ) compared with those on a low-total-fat , high-fiber diet , and for men on a high-red-meat , low-fiber diet the RR was 3.32 ( 95 % CI 1.46 , 7.53 ) compared with those on a low-red-meat , high-fiber diet . These prospect i ve data support the hypothesis that a diet low in  total dietary fiber  increases the incidence of symptomatic diverticular disease . They also provide evidence that the combination of high intake of total fat or red meat and a diet low in total dietary fiber particularly augments the risk BACKGROUND & AIMS Studies of obesity and diverticular complications are limited . We assessed the relationship between body mass index ( BMI ) , waist circumference , and waist-to-hip ratio and diverticulitis and diverticular bleeding . METHODS A prospect i ve cohort study of 47,228 male health professionals ( 40 - 75 years old ) who were free of diverticular disease in 1986 ( baseline ) was performed . Men reporting newly diagnosed diverticular disease on biennial follow-up question naires were sent supplemental question naires .  Weight was recorded every 2 years , and data on waist and hip circumferences were collected in 1987 . RESULTS We documented 801 incident cases of diverticulitis and 383 incident cases of diverticular bleeding during 18 years of follow-up . After adjustment for other risk factors , men with a BMI > or= 30 kg/m(2 ) had a relative risk ( RR ) of 1.78 ( 95 % confidence interval [ CI ] , 1.08 - 2.94 ) for diverticulitis and 3.19 ( 95 % CI , 1.45 - 7.00 ) for diverticular bleeding compared with men with a BMI of < 21 kg/m(2 ) . Men in the highest quintile of waist circumference , compared with those in the lowest , had a multivariable RR of 1.56 ( 95 % CI , 1.18 - 2.07 ) for diverticulitis and 1.96 ( 95 % CI , 1.30 - 2.97 ) for diverticular bleeding . Waist-to-hip ratio was also associated with the risk of diverticular complications when the highest and lowest quintiles were compared , with a multivariable RR of 1.62 ( 95 % CI , 1.23 - 2.14 ) for diverticulitis and 1.91 ( 95 % CI , 1.26 - 2.90 ) for diverticular bleeding . Adjustment for BMI did not change the associations seen for waist-to-hip ratio . CONCLUSIONS In this large prospect i ve cohort , BMI , waist circumference , and waist-to-hip ratio significantly increased the risks of diverticulitis and diverticular bleeding Introduction Guidelines for the treatment of complicated sigmoid diverticulitis recommend Hartmann ’s procedure or anastomosis with protective colostomy for Hinchey stage III diverticulitis and Hartmann ’s procedure only for Hinchey stage IV diverticulitis . We evaluated the outcome of patients with perforated sigmoid diverticulitis Hinchey III/IV undergoing one-stage colon resection and primary anastomosis without protective colostomy .  Methods After implementation of a protocol to treat Hinchey III/IV diverticulitis with primary anastomosis without protective ileocolostomy , the patients ’ data were recorded prospect ively between August 2001 and August 2003 and analyzed retrospectively from a computer-related data base . Results Of 41 patients , 34 ( 81%% ) underwent one-stage sigmoid resection and primary anastomosis , 3 of 41 patients ( 7%% ) underwent primary anatomosis with protective ileostomy , and 5 of 41 patients ( 12%% ) had a Hartmann ’s procedure . The mortality was 11%% in patients undergoing primary anastomosis and 60%% in patients with Hartmann ’s procedure . 
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For example , the use of antibiotics  tends to decrease ; surgery is now less invasive , percutaneous drainage is preferred , peritoneal lavage is encouraged .