Diverticulitis Surgery: Everything You Need to Know

Diverticulitis surgery involves the removal of part of the colon to treat diverticulitis. This is when pouch-like structures develop within weak areas in the wall of the colon and become inflamed or infected. Those with diverticulitis can experience a variety of symptoms, including abdominal pain and constipation.

Most cases of diverticulitis can be treated with medical therapies like a clear liquid diet and antibiotics. Diverticulitis surgery is warranted when the condition becomes persistent, or when complications like a hole in the colon (perforation) or an infection within the abdominal cavity (peritonitis) develop.

What Is Diverticulitis Surgery?

Diverticulitis surgery is performed under general anesthesia by a general surgeon or colon and rectal surgeon.

The surgery may be scheduled or performed urgently, depending on the reason why it's being done.

There are two main types of diverticulitis surgery. The type performed depends on factors like the health status of the patient and surgeon's preference/experience.

The two main types of diverticulitis surgery include:

• Partial colon resection with anastomosis: The diseased portion of the colon is removed. Then, the healthy ends of the colon from either side are sewn together (this often involves the rectum).
• Partial colon resection with a colostomy: The diseased portion of the bowel is removed. The healthy end of the colon is connected to a hole made in the abdomen called a stoma. Stool then empties into an external pouch (ostomy bag) that is attached to the stoma. The colostomy can be permanent or reversed at a later surgical date.

The sigmoid colon, the last section of the bowel, is usually the portion of the colon that is resected in both cases.

There is also a relatively novel type of diverticulitis surgery called laparoscopic lavage and drainage (LLD). This surgery involves washing out the infected fluid and placing a drain.

Some experts remain concerned that an LLD places patients at risk for ongoing or recurrent infection because the inflamed part of the colon remains intact.

As such, LLD is generally reserved for a select group of patients.

Surgical Approaches

 There are two main surgical approaches for diverticulitis surgery:

• Laparoscopic surgery: With this minimally invasive approach, the surgeon makes three to five small incisions in the skin of the abdomen. Tubes called trocars are inserted through the incisions and carbon dioxide gas is passed through one of them to inflate the abdomen. Long, thin instruments (one that has a camera attached to it for visualization purposes) are inserted through the trocars to perform the surgery.
• Open surgery: With this traditional approach, a single large incision is made across the abdomen. The surgeon uses various surgical instruments (e.g., scalpel, retractor) to perform the surgery.

There is still some uncertainty as to whether laparoscopic surgery is better than open surgery for diverticulitis patients. Larger, well‐designed studies are needed to better compare these two approaches.

Contraindications

The two main reasons diverticulitis surgery may not be recommended are:

• The diverticulitis is not complicated
• The diverticulitis can be successfully treated with medical or non-operative therapies

Potential Risks

Besides the general risks of surgery and anesthesia (e.g., wound infection, blood clot, pneumonia, etc.), specific risks associated with diverticulitis surgery include:

• Injury to the bowel or nearby organs like the ureter
• Scarring in the abdominal cavity
• A leak where the ends of the colon are surgically connected
• Narrowing in the large intestine (stricture)
• Abdominal tissues pushing through weakened muscle (incisional hernia)
• A confined pocket of pus (abscess) in the abdomen
• Small‐bowel obstruction
• Abdominal bleeding

Purpose of Diverticulitis Surgery

The purpose of diverticulitis surgery is to treat a complication related to diverticulitis and/or to reduce the symptoms or negative impact the condition is having on a person's quality of life.

Specifically, diverticulitis surgery may be indicated in the following scenarios:

• Perforated diverticulitis
• Signs and symptoms of peritonitis or sepsis
• Diverticular bleeding that cannot be controlled through endoscopy
• Abscess in the abdomen that persists despite intravenous (IV) antibiotics and/or the removal of infected fluid through a needle placed through the skin (percutaneous drainage)
• Diverticular disease with fistula formation (when an abnormal tract forms between the colon and the bladder or vagina)
• Persistent or chronic symptoms related to chronic diverticulitis that interfere with quality of life
• Complete blockage of the colon due to diverticular disease

When diverticulitis surgery is scheduled, various pre-operative tests for medical and anesthesia clearance need to be run.

Such tests may include:

• Blood tests like a complete blood count (CBC) and a coagulation panel (to check for bleeding disorders)
• Chest X-ray
• Electrocardiogram (ECG)

How to Prepare

If diverticulitis surgery is scheduled, your healthcare provider will give you instructions on how to prepare. While this is important, it's obviously not realistic in cases when the surgery is performed on an emergency basis.

Location

Diverticulitis surgery is usually performed in a hospital or surgical center.

What to Wear

On the day of your surgery, wear comfortable, loose-fitting clothes. Avoid wearing makeup, lotions, deodorant, perfume, or cologne. Leave all valuables, including jewelry, at home.

You may be asked to shower with a special antibacterial skin cleanser the night before and on the morning of your surgery.

Avoid shaving or waxing your abdominal area starting two days before your operation.

Food and Drink

Starting 24 hours before your surgery, only drink water or other clear liquids. Avoid drinking anything two hours before your scheduled arrival time.

If you have diabetes, talk with your healthcare provider about how often you should check your blood sugar and if you should stick with sugar-free clear liquids in advance of your surgery.

Medications

Stop taking certain medications, vitamins, or supplements around seven days prior to surgery. This especially includes those that increase your risk for bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and vitamin E.

If you have diabetes and take insulin or another oral or injectable medication, ask your healthcare provider if you need to temporarily stop it or alter the dose before surgery.

You will also be instructed to undergo a mechanical bowel preparation which is usually done with Miralax (polyethylene glycol 3350) the day before your surgery.

You may also be given oral antibiotics to take prior to surgery; many patients are already on them for medical management of their diverticulitis.

What to Bring

On the day of your operation, bring your driver's license, insurance card, and a list of your medications.

Since you will be staying overnight in the hospital, you will want to pack a bag the night before your surgery.

In your bag, be sure to include the following items:

• Personal care items (e.g., toothbrush, comb or hairbrush, lip balm)
• Comfort items (e.g., crossword puzzles, magazine, cell phone and charger)
• Any medical devices you use (e.g., eyeglasses or a CPAP machine for sleep apnea)
• Loose-fitting clothes to go home in, especially pants

Arrange to have someone drive you home after you are discharged from the hospital.

Pre-Op Lifestyle Changes

Since regular alcohol consumption increases your risk for certain complications during and after surgery, including bleeding and infection, it's important to stop drinking before surgery.

That said, stopping suddenly may lead to alcohol withdrawal symptoms, including serious ones, like seizures or delirium. To ensure your safety and a healthy cessation plan, be sure to have a candid conversation with your surgeon about what and how much you drink.

If you smoke, it's important to stop at least a few days prior to surgery (ideally, a few weeks ahead of time). Smoking increases your risk for breathing problems during and after surgery. Your surgeon can refer you to a smoking cessation program for support and guidance if needed.

What to Expect on the Day of Your Surgery

On the day of your diverticulitis surgery, you will arrive at the hospital or surgical center and check-in.

Before the Surgery

You will be taken to a pre-operative room where you will change into a hospital gown.

A nurse will review your medication list, record your vitals, and place an intravenous (IV) line into a vein in your arm.

You may receive an antibiotic through your IV at this time to help prevent infection at the surgical site. The IV will also be used for administering fluids and medications during and after surgery.

Your surgeon and anesthesiologist will then come to greet you and briefly review the operation and anesthesia processes, respectively, with you.

When the team is ready, you will be wheeled on a gurney into the operating room.

During the Surgery

Upon entering the operating room, the surgical team will transfer you onto an operating table.

The anesthesiologist will give you inhaled or intravenous medication to put you to sleep. You will not remember anything that occurs during the procedure after this point.

Next, a breathing tube called an endotracheal tube will be inserted through your mouth and into your windpipe. This tube is connected to a ventilator that takes control of your breathing during the operation.

A Foley catheter will be placed to drain urine from your bladder during the surgery.

The exact next steps will depend on the type of surgery being performed and the approach being used (laparoscopic versus open).

As an example, below are the general steps for a minimally invasive diverticulitis surgery involving resection of the sigmoid colon and anastomosis. This surgery may take three or more hours.

• Incision(s): After the skin of the abdomen is cleaned, the surgeon makes a few small incisions over the abdomen (each about half an inch in size). Trocars are then inserted through the incisions.
• Visualization: Carbon dioxide gas is pumped into the abdomen to make it easier for the surgeon to see everything. A laparoscope, the thin metal instrument with a camera attached to it, is placed through the trocar.
• Removal: Other long, thin surgical instruments controlled by the surgeon are passed through the trocars to cut and remove the affected part of the colon.
• Reconnection: The colon is reconnected to another part of the colon with sutures or staples.
• Closure: The incision(s) are closed with sutures, staples, or surgical glue/tape. A bandage is placed over the incision sites.
• Prep for recovery: Anesthesia is stopped and the breathing tube is removed. You are then wheeled to a post-anesthesia care unit (PACU).

After the Surgery

In the PACU, a nurse will monitor your vital signs as you slowly wake up from anesthesia.

It's normal to experience some pain, nausea, and drowsiness as the anesthesia wears off. Your nurse can give you medication to help control your symptoms.

Once you are fully awake and your pain is under control, usually within a few hours, you will be wheeled on your bed to a hospital room.

You will stay in the hospital for around two to four nights. The precise timeline depends on factors like the type of surgery you had and how well you are healing.

While you are admitted, you can expect the following:

• You will be transitioned from IV pain medication to oral pain medication.
• You will be asked to begin moving and walking to lower your risk of developing blood clots and pneumonia.
• IV fluid administration will be stopped as soon as you can drink.
• You may begin eating solid foods within a few hours after surgery (as tolerated).
• You will shower during your hospital stay with the assistance of a nurse's aide.
• A nurse will encourage you to perform deep breathing exercises with a device called an incentive spirometer.
• Your Foley catheter will be removed as soon as possible to prevent a urinary tract infection.

Recovery

While the recovery process begins in the hospital, it doesn't end there.

Once you are sent home, it's important to carefully follow your surgeon's post-operative instructions. You will likely be told to:

• Avoid heavy lifting, strenuous activities, and contact sports for around six weeks after surgery.
• Refrain from driving until you are off all prescription pain medications.
• Avoid taking a bath or swimming until your surgeon gives you the OK.
• Follow up with your surgeon as advised.

Wound Care

Monitor your incision sites daily for signs of infection.

When showering, carefully remove your bandages(s) and wash your incision sites gently with fragrance-free liquid soap. Pat the sites dry with a clean towel.

Your surgeon may ask you that you reapply a fresh, new bandage over the incision site(s) or leave them uncovered.

If you have surgical glue or tape over your incision sites, these will naturally peel or fall off on their own. If you have non-dissolvable sutures or staples, your surgeon will remove them at a follow-up appointment.

Long-Term Care

While generally very successful, research suggests that diverticulitis may recur after elective surgery in about 1% to 10% of patients. In addition, up to 25% of patients may continue to experience ongoing symptoms like abdominal pain after surgery.

This is why it's so important to continue seeing your gastroenterologist after surgery, especially if you are experiencing persistent symptoms.

Lastly, to prevent diverticula from recurring again, it's sensible to adopt the following practices under the guidance of your healthcare provider:

• Increase the fiber intake in your diet
• Exercise regularly
• Stop smoking (if applicable)
• Lose weight if your body mass index (BMI) is greater than 30

Possible Future Surgeries

Repeat surgery may be indicated in cases of recurrent diverticulitis or if surgical complications develop.

If a colostomy was done, an operation to reverse it may be performed once you are fully healed from the initial diverticulitis surgery. With colostomy reversal surgery, the two ends of the colon are reconnected and the stoma is closed.

Frequently Asked Questions

What are the potential complications of diverticulitis surgery?

In addition to the general risks posed by major surgery, among them post-operative pneumonia, heart attack, stroke, and blood clots in the legs or lungs, there are several unique to any procedure involving the colon:

• Infection of the skin and other tissue surrounding the incision that can spread to deeper areas of the abdomen
• Urinary tract infection, typically due to the placement of a catheter at the time of the procedure

Injury to the left ureter, one of the pair of tubes that connect the kidneys to the bladder. Sometimes a surgeon will place a tube called a stent in one or both ureters to lower this risk.

A Word From Verywell

If you are suffering from severe or recurrent bouts of diverticulitis, it is important to seek care from a board-certified digestive disorders specialist called a gastroenterologist.

Besides confirming your diagnosis, they can help you build a comprehensive treatment plan that may (or may not) include surgery.

If your surgeon does recommend elective surgery, know that it's normal to feel anxious about the idea. Talking with your surgeon about the potential benefits versus risks of the surgery, and reviewing any concerns you have, may ease your mind and help you move forward with your decision.

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