What to know about diverticulitis surgery
There are several types of surgery that can treat diverticulitis. A doctor will take a person's health, risk factors, and other symptoms into consideration when suggesting a type.
In this article, we describe the types of diverticulitis surgery, including the procedures involved, possible complications, and recovery.
When should a person have diverticulitis surgery?
Diverticulitis occurs when one or more pouches in the colon become inflamed.
Diverticulitis happens when one or more pouches in the colon, called diverticula, become inflamed. This can cause the following signs and symptoms:
Most people with diverticulitis will not need surgery. The condition can usually be treated with antibiotics, fiber, and probiotics. When these treatments fail to reduce symptoms, doctors may recommend surgical removal of the infected part of the colon.
Surgery is only necessary when other treatments fail, or when an emergency colon perforation does not respond to alternative treatments.
When someone has an acute diverticulitis attack, they may need to be hospitalized. They may receive fluids intravenously or pain medication before undergoing surgery.
Diverticulitis surgery can be risky. The American Society of Colon and Rectal Surgeons (ASCRS) recommend it only in the following circumstances:
- When the colon has ruptured, causing the abdomen to leak or develop serious inflammation. This is called peritonitis and requires emergency surgery.
- When an abscess cannot be drained or has become infected after drainage.
- When symptoms are severe, and other treatments, including intravenous antibiotics, have not worked.
- When the person has a weakened immune system, possibly because they are on chemotherapy or have recently received an organ transplant.
- When a person has had two uncomplicated diverticulitis attacks or one complicated attack, they may choose to have surgery. Complicated diverticulitis causes other serious symptoms, such as a hole in the colon or bleeding in the abdomen.
Types of diverticulitis surgery
A person will undergo this surgery under general anesthesia, which means that they will be unconscious.
The right surgical technique depends on the location of the diverticulitis in the colon, the individual's overall health, and a surgeon's comfort and experience.
Common types of diverticulitis surgery include:
This is minimally invasive, and typically requires 3 to 5 small cuts in the abdomen, while traditional surgery involves one large incision.
This is the most common type of surgery for diverticulitis. A surgeon cuts into the colon, removes the damaged pockets or pouches, then reattaches the remaining segments of the colon.
The surgeon may reattach the colon to the rectum or create a colostomy. A colostomy is a small hole that allows stool to exit through the stomach and requires the person to use a colostomy bag.
While people usually prefer not to have a colostomy, reattaching the colon to the rectum can fail and require subsequent surgery.
This also involves removing the infected segment of colon. The surgeon will then create a temporary hole in the abdomen for waste to pass through, using a piece of the small intestine. This passageway is called a stoma.
A few months later, the surgeon will remove the stoma and reconnect the intestines, allowing stool to pass normally.
Loop ileostomy can be a good alternative for people who want to avoid having a colostomy. However, because it involves two surgeries, it carries a higher risk.
Laparoscopic washout is a newer technique. A surgeon will examine the stomach and colon, drain any swelling and pus, and wash the abdomen. This can kill the infection, prevent the abdomen from swelling, and remove the need for a resection.
This technique is common among people with an infection or hole in the colon. However, because laparoscopic washout involves leaving the damaged portion of the colon in the body, the risk of future attacks is increased.
Preparing for surgery
Before a person undergoes surgery, a doctor may prescribe antibiotics to reduce the risk of infection.
Before undergoing diverticulitis surgery, it is important to discuss the risks and benefits of each procedure with a doctor. It may also be helpful to get a second opinion.
- A doctor may prescribe antibiotics to reduce the risk of infection.
- Blood work will be performed.
- A doctor or surgeon may request imaging scans of the colon.
- On the day of surgery, the colon must be emptied, usually with laxatives, enemas, or both.
- In the hours before surgery, a person must refrain from eating.
Failing to follow these and other precautions may make surgery dangerous or impossible.
A person will need to inform the surgeon of any medications or supplements they are taking. Some, such as blood thinners and vitamin E, are not safe to take in the days before surgery.
A person is encouraged to walk around shortly after the procedure, as this reduces the risk of a blood clot.
A person is encouraged to walk around shortly after the procedure to reduce the risk of a blood clot. Some pain is expected in the days following surgery.
Most people are able to return to their normal activities within 1–2 weeks. A follow-up appointment is usually scheduled in the second week after surgery.
Infection may lead to a longer recovery or additional surgery. It may also be necessary to have a liquid diet or eat foods rich in fiber.
The success of diverticulitis surgery depends on many factors, including the health of the colon, the person's age and general health, and the skill of the surgeon.
The ASCRS estimate that being acutely ill from diverticulitis increases the risk of a colon leakage to 6–19 percent, compared to the 5 percent risk in those less badly affected.
Anyone with diverticulitis may have another attack, even after surgery. It is possible to reduce the risk by eating a diet high in fiber, and by taking probiotics and drugs such as mesalamine.
A person should follow instructions concerning dietary and other restrictions and inform a doctor of any unusual symptoms, including pain or rectal bleeding.
Risks and complications of diverticulitis surgery
A 2014 review of research found that 5–22 percent of people who underwent diverticulitis surgery experience a future attack.
The most common complications of diverticulitis surgery include:
- a leak in the colon
- injury to surrounding organs
When the surgeon is unable to reattach the colon during surgery, or when ongoing bleeding occurs, a person may need a permanent colostomy.
An individual may develop a blood clot in the leg following surgery. The clot can break loose and travel to other areas, causing serious complications. In some cases, it may be fatal. Clots are more common in people with sedentary lifestyles or cardiovascular health problems.
Anesthesia can also cause complications, as with any surgery. People in poor health, children, and older adults have a higher risk.
Also, some people experience urinary tract infections after surgery.
Recovery can be painful, and the time span varies. A doctor can provide detailed estimations. In rare cases, diverticulitis surgery is fatal.
What causes diverticulitis?
Diverticulitis is a complication associated with a normally harmless condition called diverticulosis, which causes small sacs or pouches to develop in the colon or large intestine.
Diverticulosis usually requires no treatment. It is common in people over 30, and the ASCRS estimate that diverticulosis affects 30–40 percent of people over 60, and more than half of those over 80.
Diverticulitis does not always cause symptoms, but those that occur may be painful. In many cases, lifestyle changes and antibiotics can treat symptoms and reduce the risk of future attacks.
If diverticulitis does not cause symptoms, or if symptoms go away on their own, surgery is not usually recommended.
Surgery is usually a last resort, and it is important to weigh the risks and benefits. Consider consulting several healthcare providers, asking friends and family for input, and gathering as much information as possible before deciding upon surgery.