Diverticulitis is a condition where small, bulging pouches, known as diverticula, form in the wall of the large intestine, or colon. While the presence of these pouches (diverticulosis) often causes no issues, they can become inflamed or infected, leading to diverticulitis. Many instances of diverticulitis are managed with dietary adjustments and medication. However, for some individuals, surgical intervention becomes a necessary and effective treatment option. This procedure aims to address the inflamed areas and prevent further complications, offering relief and improving the patient’s quality of life.
When Surgery is Considered
Surgery for diverticulitis is typically reserved for severe or complicated cases that do not respond to medical management. One common indication is recurrent acute diverticulitis, especially when episodes are frequent, severe, and significantly impact quality of life.
Complications of diverticulitis frequently necessitate surgical intervention. These include an abscess, a collection of pus that may require drainage or surgical removal. Perforation, a tear in the colon wall allowing intestinal contents to leak, is a medical emergency requiring immediate surgery to prevent widespread infection. Fistulas, abnormal connections between the colon and other organs like the bladder or vagina, also generally require surgery. Strictures, or narrowings of the colon from chronic inflammation, can lead to bowel obstruction and may indicate a need for surgical resection.
Surgical Approaches
The primary surgical procedure for diverticulitis is a bowel resection, also known as a colectomy, where the diseased portion of the colon is removed. The most common type is a sigmoid colectomy, as diverticula frequently develop in the sigmoid colon, the lower part of the large intestine. After removing the affected segment, the surgeon typically joins the remaining healthy ends of the colon together, a procedure called primary anastomosis. This allows for normal bowel function to resume.
Surgical techniques vary, with both open and minimally invasive approaches available. Open surgery involves a single, larger incision in the abdomen, providing the surgeon with a direct view. Laparoscopic surgery, a minimally invasive option, uses small incisions for a camera and instruments, often resulting in less pain, smaller scars, and quicker recovery. Robotic-assisted surgery is another minimally invasive method that offers enhanced precision.
In complex or emergency situations, when immediate colon reconnection is unsafe due to severe inflammation or infection, a Hartmann’s procedure may be performed. This involves removing the diseased colon, closing the rectal stump, and bringing the healthy end of the remaining colon through an abdominal opening, creating a colostomy. This temporary opening allows waste to collect in an external bag, giving the colon time to heal. A second surgery may be performed later to reverse the colostomy and reconnect the bowel. Occasionally, an ileostomy, using a section of the small intestine, is created for similar reasons to divert stool.
Before and After Surgery
Preparation for diverticulitis surgery involves several steps. Patients undergo pre-operative tests, including blood work and imaging scans like CT scans, to map the affected colon area. Medication adjustments are common, with instructions to temporarily stop drugs like blood thinners that could increase bleeding risk. Bowel preparation, involving a clear liquid diet and laxatives, thoroughly cleanses the colon before surgery, reducing infection risk.
Following surgery, patients remain in the hospital for a period, typically ranging from two to seven days, depending on the type of procedure and individual recovery. Pain management is a priority, with medications administered to control discomfort. Initial post-operative diet usually begins with clear liquids, gradually progressing to soft foods as the bowel function returns and is tolerated. Patients are encouraged to move and walk shortly after surgery to promote circulation and prevent complications like blood clots.
Wound care instructions are provided to prevent infection at incision sites. Activity restrictions, generally advising against heavy lifting or strenuous activities, are put in place for several weeks to allow internal healing. Full recovery can take a few months, and ongoing dietary modifications, including a high-fiber diet, are recommended to maintain colon health and reduce future diverticulitis episodes.
Understanding Potential Risks
Diverticulitis surgery carries potential risks and complications. Common general surgical risks include infection at the surgical site, bleeding, and anesthesia issues. Anesthesia complications can range from minor effects like nausea to more serious concerns such as allergic reactions or breathing difficulties.
Specific to colon surgery, there is a risk of an anastomotic leak, where the connection between resected colon ends does not heal, leaking intestinal contents into the abdominal cavity. This can lead to serious infection and may require further intervention. Damage to nearby organs, such as the ureters or bladder, is another potential complication.
Other possible outcomes include adhesions, bands of scar tissue that can develop within the abdomen and potentially cause pain or bowel obstruction. Strictures, or narrowings, can sometimes form at the surgical site. There is also a risk of incisional hernia, where abdominal tissue pushes through a weakened area in the surgical incision. In severe cases, a temporary or permanent stoma (colostomy or ileostomy) may be necessary, impacting bowel function and requiring adjustment to a collection bag.