Patients with perforated diverticulitis suffer high morbidity and mortality. For decades, sigmoid colectomy with colostomy (Hartman’s procedure) has been considered the standard surgical management. Over the past several years, less-morbid alternatives have been advocated. Laparoscopic lavage showed promise in retrospective studies. However, recent prospective randomized clinical trials have suggested that outcomes may not be better compared with the Hartman’s procedure. A critical analysis of the literature leads the authors to the conclusion that there is still a role for laparoscopic lavage in selected patients, as a bridge to elective colectomy or, in some cases, as definitive management.