Our Summary

This study looked at two types of surgery used to treat serious cases of diverticulitis, a digestive disease. The surgeries are called Hartmann’s procedure and sigmoidectomy with primary anastomosis. Previous research suggested that the second surgery might be better because more patients were able to have their stomas (a hole in the abdomen to allow waste to leave the body) reversed, and fewer people died or had serious health problems. However, this wasn’t certain because the studies might have been biased.

So, the researchers did a new study. They randomly assigned patients to have one of the two surgeries and followed them for a year to see who still had a stoma. They found that patients who had the sigmoidectomy with primary anastomosis were more likely to have their stoma reversed than those who had Hartmann’s procedure. The two surgeries had similar rates of death and serious health problems.

Therefore, they concluded that for patients who are stable and have a good immune system, the sigmoidectomy with primary anastomosis is the better choice for treating serious cases of diverticulitis. The research was funded by the Netherlands Organisation for Health Research and Development.

FAQs

  1. What are the two types of surgery used to treat serious cases of diverticulitis?
  2. Which surgery allows more patients to have their stomas reversed, according to the research?
  3. What were the results of the study comparing Hartmann’s procedure and sigmoidectomy with primary anastomosis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sigmoidectomy is to discuss with them the option of sigmoidectomy with primary anastomosis as a potential treatment for serious cases of diverticulitis. This procedure may have a higher likelihood of stoma reversal compared to Hartmann’s procedure, and similar rates of death and serious health problems. It is important for patients to be stable and have a good immune system for this surgery to be successful. It is recommended to have a thorough discussion with your doctor about the best treatment options for your individual case.

Suitable For

Patients who are stable and have a good immune system are typically recommended sigmoidectomy with primary anastomosis for serious cases of diverticulitis. These patients are more likely to have their stoma reversed and have similar rates of death and serious health problems compared to those who undergo Hartmann’s procedure.

Timeline

Before sigmoidectomy:

  • Patient will have symptoms of severe diverticulitis, such as abdominal pain, fever, and changes in bowel habits.
  • Patient will undergo diagnostic tests, such as a CT scan or colonoscopy, to confirm the diagnosis.
  • Patient will be admitted to the hospital for treatment, which may include antibiotics and bowel rest.
  • If the diverticulitis is severe and does not improve with conservative treatment, surgery may be recommended.

After sigmoidectomy:

  • Patient will undergo the sigmoidectomy surgery, which involves removing the affected part of the colon and reconnecting the healthy sections.
  • Patient may have a temporary stoma created to allow the colon to heal.
  • Patient will recover in the hospital for a few days to a week, depending on the extent of the surgery.
  • Patient will gradually resume normal activities and follow a special diet to aid in the healing process.
  • If a temporary stoma was created, it may be reversed in a few months once the colon has healed.
  • Patient will have follow-up appointments with their surgeon to monitor their recovery and overall health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a sigmoidectomy?
  2. How long is the recovery process after a sigmoidectomy?
  3. Will I need to have a stoma after the surgery, and if so, for how long?
  4. What are the chances of having the stoma reversed after a sigmoidectomy?
  5. How will a sigmoidectomy affect my digestive system and bowel movements?
  6. Are there any dietary or lifestyle changes I should make before or after the surgery?
  7. How experienced are you in performing sigmoidectomies and what is your success rate?
  8. Are there any alternative treatments or surgeries for diverticulitis that I should consider?
  9. How likely is it that my diverticulitis will recur after a sigmoidectomy?
  10. What is the long-term prognosis for patients who undergo a sigmoidectomy for diverticulitis?

Reference

Authors: Lambrichts DPV, Vennix S, Musters GD, Mulder IM, Swank HA, Hoofwijk AGM, Belgers EHJ, Stockmann HBAC, Eijsbouts QAJ, Gerhards MF, van Wagensveld BA, van Geloven AAW, Crolla RMPH, Nienhuijs SW, Govaert MJPM, di Saverio S, D’Hoore AJL, Consten ECJ, van Grevenstein WMU, Pierik REGJM, Kruyt PM, van der Hoeven JAB, Steup WH, Catena F, Konsten JLM, Vermeulen J, van Dieren S, Bemelman WA, Lange JF; LADIES trial collaborators. Journal: Lancet Gastroenterol Hepatol. 2019 Aug;4(8):599-610. doi: 10.1016/S2468-1253(19)30174-8. Epub 2019 Jun 6. PMID: 31178342