AIM: To determine short and long-term outcomes following operative management of acute diverticulitis in immunosuppressed(IMS) compared to immunocompetent(IMC) patients.METHODS: PRISMA guidelines were followed in conducting this systematic review. We searched Pub Med(1946 to present), OVID MEDLINE(R) In-Process and Other Non-Indexed Citations, OVID MEDLINE(R) Daily and OVID MEDLINE(R)(1946 to present), EMBASE on OVID platform(1947 to present), CINAHL on EBSCO platform(1981 to present), and Cochrane Library using a systematic search strategy. There were no restrictions on publication date and language. We systematically reviewed all published cohort comparative studies, casecontrol studies, and randomized controlled trials that reported outcomes on operative management of acute episode of colonic diverticulitis in IMS in comparison to IMC patients. RESULTS: Seven hundred and fifty-five thousand five hundred and eighty-three patients were included in this systematic review; of which 1478 were IMS and 754105 were IMC patients. Of the nine studies included there was one prospective cohort, seven retrospective cohorts, one retrospective case-control study, and no randomized controlled trials. With the exception of solid organ transplant patients, IMS patients appeared to be older than IMC when they presented with an acuteepisode of diverticulitis. IMS patients presented with more severe acute diverticulitis and more insidious onset of symptoms than IMC patients. In the emergency setting, peritonitis was the main indication for operative intervention in both IMS and IMC patients. IMS patients were more likely to undergo Hartmann’s procedure and less likely to undergo reconstructive procedures compared to IMC patients. Furthermore, IMS patients had higher morbidity and mortality rates in the emergency setting compared to IMC patients. In the elective settings, it appeared that reconstruction with primary anastomosis with or without a diverting loop stoma is the procedure of choice in the IMS patients and carried minimal morbidity and mortality equivalent to IMC patients. CONCLUSION: Emergency operations for diverticulitis in IMS compared to IMC patients have higher morbidity and mortality, whereas, in the elective setting both groups have comparable outcomes. AIM: To determine short and long-term outcomes in the management of acute diverticulitis in immunosuppressed (IMS) compared to immunocompetent (IMC) patients. METHODS: PRISMA guidelines were followed in this systematic review. We searched Pub Med (1946 to present) , OVID MEDLINE (R) In-Process and Other Non-Indexed Citations, OVID MEDLINE (R) Daily and OVID MEDLINE (R) (1946 to present), EMBASE on OVID platform (1947 to present), CINAHL on EBSCO platform to present), and Cochrane Library using a systematic search strategy. There were no restrictions on the publication date and language. We systematically reviewed all published cohort comparative studies, casecontrol studies, and randomized controlled trials that reported outcomes on operative management of acute episode of colonic diverticulitis in IMS in comparison to IMC patients. RESULTS: Seven hundred and fifty-five thousand five hundred and eighty-three patients were included in this systematic review; of which 1478 were the IMS and 754105 were IMC patients. Of the nine studies included there was one prospective cohort, seven retrospective cohorts, one retrospective case-control study, and no randomized controlled trials. With the exception of solid organ transplant patients, IMS patients older than IMC when with an acute disease of diverticulitis. IMS patients presented with more severe acute diverticulitis and more insidious onset of symptoms than IMC patients. In the emergency setting, peritonitis was the main indication for operative intervention in both IMS and IMC patients. IMS patients were more likely to undergo reconstructive procedures compared to IMC patients. Furthermore, IMS patients had more morbidity and mortality rates in the emergency setting compared to IMC patients. In the elective settings, it primary anastomosis with or without a diverting loop stoma is the procedure of choice in the IMS patients and carried minimal morbidity and mortality equivalent to IMC patients. CONCLUSION: Emergency operations for diverticulitis in IMS compared to IMC patients have higher morbidity and mortality, than in the elective setting both groups have comparable outcomes.