Diverticulitis Surgery

Diverticulitis surgery removes parts of your large intestine (colon) affected by diverticulitis, an inflammation or infection of small pouches (diverticula). This procedure aims to treat severe complications like abscesses or perforations, or to prevent recurring painful episodes. It helps restore bowel health and improve your quality of life.

What is Diverticulitis Surgery?

Diverticulitis surgery involves removing a diseased section of your large intestine (colon) that contains inflamed or infected pouches called diverticula. This procedure, often called a bowel resection or colectomy, aims to eliminate the source of infection and prevent serious complications. Sometimes, a temporary or permanent opening (colostomy) is created to allow the bowel to heal.

Diverticulitis is a condition where small, bulging pouches (diverticula) form in the lining of your digestive tract, most often in the large intestine. When these pouches become inflamed or infected, it's called diverticulitis. Surgery becomes necessary when the condition is severe or causes complications that cannot be managed with medication or other non-surgical treatments. The most common type of surgery is a bowel resection (colectomy). During this procedure, the surgeon removes the affected part of your colon. The two healthy ends of the colon are then usually reconnected, a process called anastomosis. This allows your bowel to function normally again. In some cases, especially during emergency surgery or if there's significant inflammation or infection, the surgeon may not be able to reconnect the colon immediately. Instead, they create an opening (stoma) in your abdomen, bringing a part of your colon through it. This is called a colostomy, and it allows waste to pass into an external bag. A colostomy can be temporary, reversed in a second surgery, or permanent. Surgeons perform diverticulitis surgery using either an open approach, which involves a single larger incision, or a minimally invasive laparoscopic approach, which uses several small incisions. The choice depends on the severity of your condition and other factors.

Why it's done

Diverticulitis surgery is performed to treat serious complications of the condition, such as a hole in the bowel (perforation), a collection of pus (abscess), or a connection between organs (fistula). It is also considered for people with frequent, severe attacks that significantly impact their life, or for those with a weakened immune system who are at higher risk for complications.

The primary reason for diverticulitis surgery is to address complications that arise from the inflammation or infection of the diverticula. These complications can be life-threatening if not treated promptly. For example, a perforation, where a hole forms in the colon, can lead to a severe infection in the abdominal cavity (peritonitis). Other serious issues include an abscess, which is a pocket of pus that forms near the inflamed diverticula, or a fistula, an abnormal connection that develops between the colon and another organ, such as the bladder or skin. Blockages in the bowel (obstruction) or severe, uncontrolled bleeding are also reasons for surgical intervention. Even without acute complications, surgery may be recommended for individuals who experience recurrent episodes of diverticulitis. If you have frequent, painful attacks that don't respond well to other treatments, or if your quality of life is significantly affected, your doctor might suggest surgery to prevent future problems. People with weakened immune systems, due to conditions like organ transplant or cancer treatment, are also often candidates for surgery because their bodies may struggle to fight off infections effectively.

How to prepare

Preparing for diverticulitis surgery involves several steps to ensure your safety and the best possible outcome. You will meet with your healthcare team to discuss your medical history and medications, undergo tests, and likely follow a special diet and bowel preparation. It's crucial to follow all instructions carefully and ask any questions you have.

Before your diverticulitis surgery, your doctor will conduct a thorough evaluation. This includes reviewing your medical history, performing a physical exam, and ordering blood tests, urine tests, and possibly imaging scans like a CT scan. These tests help ensure you are healthy enough for surgery and help the surgeon plan the procedure. You will need to discuss all medications, supplements, and herbal remedies you are taking with your doctor. You may be asked to stop certain medications, such as blood thinners, several days or weeks before surgery to reduce the risk of bleeding. If you smoke, your doctor will strongly advise you to stop, as smoking can slow healing and increase complication risks. A crucial part of preparation is bowel preparation, which cleans out your colon. This usually involves following a clear liquid diet for a day or two before surgery and taking laxatives or enemas as prescribed. This step is vital to reduce the risk of infection during surgery. You will also be instructed not to eat or drink anything for a certain period before the procedure, typically after midnight the night before.

What happens during

During diverticulitis surgery, you will receive general anesthesia to ensure you are asleep and pain-free. The surgeon will then make incisions to access your abdomen. They will carefully remove the diseased section of your large intestine and either reconnect the healthy ends (anastomosis) or create a temporary or permanent opening (colostomy) for waste to exit your body.

Once you are under general anesthesia, the surgical team will prepare the surgical site. The procedure can be performed in two main ways: open surgery or laparoscopic surgery. In open surgery, the surgeon makes a single, larger incision in your abdomen to directly access the colon. This approach is often used in emergency situations or when there are extensive complications. Laparoscopic surgery is a minimally invasive approach. The surgeon makes several small incisions, usually about half an inch long. They insert a thin tube with a camera (laparoscope) and specialized surgical tools through these incisions. The camera displays images on a monitor, guiding the surgeon as they work. This method often results in less pain and a faster recovery compared to open surgery. Regardless of the approach, the main goal is to remove the inflamed or infected segment of the colon. After removal, the surgeon will typically join the two healthy ends of your colon together (anastomosis). If this isn't possible or safe due to severe inflammation or infection, a colostomy is created. This involves bringing a part of the colon through an opening in the abdominal wall, allowing waste to collect in an external bag. The surgery usually takes a few hours.

Recovery & timeline

After diverticulitis surgery, you will typically spend several days to a week in the hospital. Your recovery will involve managing pain, gradually resuming a normal diet, and slowly increasing your activity level. Full recovery can take several weeks to a few months, depending on the type of surgery and your overall health. Following your doctor's instructions is key.

Immediately after surgery, you will be monitored closely in a recovery room. You will likely have an intravenous (IV) line for fluids and medication, and possibly a catheter to drain urine. Pain medication will be provided to keep you comfortable. The medical team will encourage you to move around as soon as possible, often by sitting up or taking short walks, to help prevent complications like blood clots. Your diet will gradually progress from clear liquids to soft foods, and then to a regular diet as your bowel function returns. This process usually takes a few days. If you had a colostomy, a wound care specialist (ostomy nurse) will teach you how to care for your stoma and change your ostomy bag. Once you return home, it's important to continue to rest and avoid heavy lifting or strenuous activities for several weeks, typically 4 to 6 weeks for laparoscopic surgery and longer for open surgery. Your doctor will provide specific guidelines for activity and diet. Most people can return to their normal daily activities within a few weeks to a few months. Regular follow-up appointments will be scheduled to monitor your healing and address any concerns.

Risks & side effects

Like any major surgery, diverticulitis surgery carries potential risks and side effects. These can include general surgical complications such as bleeding, infection, or adverse reactions to anesthesia. More specific risks involve a leak at the reconnected bowel (anastomotic leak), bowel obstruction, or issues related to a colostomy, if one was created. Your surgeon will discuss these with you.

General surgical risks apply to diverticulitis surgery. These include bleeding, which may require a blood transfusion, and infection at the surgical site or within the abdomen. There's also a risk of problems related to anesthesia, such as nausea, vomiting, or more serious heart and lung complications. Specific risks related to bowel surgery include an anastomotic leak, which occurs if the reconnected ends of the colon do not heal properly and leak bowel contents into the abdomen. This is a serious complication that often requires further surgery. Another risk is the development of scar tissue (adhesions) inside the abdomen, which can sometimes lead to a bowel obstruction years later. If a colostomy is performed, potential side effects include skin irritation around the stoma, infection, or problems with the stoma itself, such as narrowing or retraction. There is also a risk of developing a hernia near the stoma. While rare, some people may experience ongoing changes in bowel habits, such as diarrhea or constipation, even after successful surgery.

Success rate

Diverticulitis surgery is generally very effective in treating severe complications and preventing future episodes of diverticulitis. For people who undergo elective surgery for recurrent diverticulitis, the procedure significantly reduces the chance of future attacks and improves quality of life. While recurrence is possible, it is much less common after surgery compared to non-surgical management.

For individuals undergoing surgery for complicated diverticulitis, such as those with perforations or abscesses, the procedure is often life-saving and highly successful in resolving the acute problem. For elective surgery, performed to prevent future attacks, studies show that most people experience a significant improvement in their symptoms and overall quality of life. The goal of elective surgery is to remove the diseased segment of the colon, thereby eliminating the source of inflammation. This greatly reduces the likelihood of future diverticulitis attacks. While surgery does not guarantee that diverticulitis will never recur, the recurrence rate after a successful bowel resection is relatively low. Many people who have surgery report a substantial reduction in pain, discomfort, and the need for repeated hospitalizations. It's important to discuss realistic expectations with your surgeon, as individual outcomes can vary. Factors like the extent of the disease, the presence of complications, and your overall health can influence the long-term success of the procedure.

Frequently asked questions

Can diverticulitis come back after surgery?

While surgery significantly reduces the risk, diverticulitis can potentially recur in other parts of the colon that were not removed. However, the chance of recurrence after a successful bowel resection is much lower compared to managing the condition without surgery. Your doctor can discuss your specific risk.

How long does it take to recover from diverticulitis surgery?

Recovery time varies depending on the type of surgery (laparoscopic versus open) and individual factors. Generally, you can expect to be in the hospital for several days to a week. Full recovery, including returning to normal activities, typically takes anywhere from a few weeks to two or three months.

Will I need a colostomy bag permanently after diverticulitis surgery?

Not usually. In many cases, a colostomy is temporary, especially if performed during an emergency surgery when the colon needs time to heal. A second surgery is then performed to reverse the colostomy and reconnect the bowel. Permanent colostomies are less common and are typically reserved for severe cases or specific circumstances.

What can I eat after diverticulitis surgery?

Your diet will progress gradually. Initially, you'll be on clear liquids, then advance to soft foods, and eventually a regular diet. Your medical team will guide you on when and how to introduce different foods. It's often recommended to avoid very fibrous or hard-to-digest foods initially and slowly reintroduce them as tolerated.

Is laparoscopic surgery always an option for diverticulitis?

Laparoscopic surgery is often preferred due to its benefits like smaller incisions and faster recovery. However, it may not be suitable for everyone. In emergency situations, or if there are extensive complications like large abscesses or severe perforations, open surgery might be necessary. Your surgeon will determine the best approach for your specific condition.

What are the long-term effects of having part of my colon removed?

Most people adapt well to having a section of their colon removed. You may experience some changes in bowel habits, such as more frequent bowel movements or changes in stool consistency, especially in the initial months. These changes usually improve over time. Your doctor can offer advice on managing any persistent symptoms.

Sources

• MedlinePlus — Diverticulitis Surgery
• Mayo Clinic — Diverticulitis Surgery
• Cochrane Library — Diverticulitis Surgery