Our Summary

The paper studied the rate at which the stoma (an opening made during surgery to divert the flow of waste from the body) was reversed or closed after operations for acute diverticulitis, a severe form of digestive disease. The researchers looked at patients over a 6-year period across 10 hospitals who had undergone emergency surgery for this disease and had a stoma created.

Out of 385 patients, 312 had a stoma created. Over time, around half of these patients had their stoma reversed, usually after about 9 months. The main reasons for not reversing the stoma were other health conditions the patients had and patient death. Older age made it less likely for the stoma to be reversed. Men and patients who hadn’t had a specific type of surgery (Hartmann’s operation) before were more likely to have their stoma reversed.

Although nearly all attempted stoma reversals were successful, the procedure did have risks. Around 36% of patients had complications and around 2% died. About 8% needed another operation and 6% experienced a leak at the surgical site. In the end, 12 patients still had a stoma after the attempt to reverse it.

In conclusion, the researchers found that surgery for acute diverticulitis often results in a stoma that isn’t reversed in almost half the cases. When reversal does happen, it’s often delayed and can come with significant risks.

FAQs

  1. What percentage of patients had their stoma reversed after diverticulitis surgery, according to the study?
  2. What were the main reasons for not reversing the stoma after diverticulitis surgery?
  3. What are the risks associated with the stoma reversal procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about diverticulitis surgery is to discuss the possibility of needing a stoma and the potential risks and complications associated with stoma reversal. It’s important to have a thorough understanding of the procedure and its potential outcomes before undergoing surgery. Additionally, maintaining a healthy diet and lifestyle post-surgery can help prevent future episodes of diverticulitis. Regular follow-up appointments with your healthcare provider are also crucial for monitoring your condition and addressing any concerns.

Suitable For

Patients who are typically recommended diverticulitis surgery are those who have severe acute diverticulitis that has not responded to other treatments, such as antibiotics or dietary changes. These patients may have complications such as abscesses, perforations, or fistulas that require surgical intervention. Additionally, patients who have recurrent episodes of diverticulitis or who have complications such as strictures or bowel obstructions may also be recommended for surgery. Older patients and those with other health conditions may be less likely to have their stoma reversed after surgery, as they may be at higher risk for complications. Men and patients who have not had previous surgery for diverticulitis may be more likely to have their stoma reversed.

Timeline

Before surgery, a patient with diverticulitis may experience symptoms such as abdominal pain, bloating, constipation, diarrhea, and fever. They may undergo diagnostic tests such as CT scans, colonoscopies, and blood tests to confirm the diagnosis.

After surgery, the patient will typically stay in the hospital for a few days to recover. They may experience pain, discomfort, and fatigue following the procedure. They will need to follow a specific diet, take medications as prescribed, and gradually increase their activity level as they heal.

If a stoma is created during surgery, the patient will need to manage it by changing the pouch regularly, monitoring for any signs of infection or complications, and following up with their healthcare provider regularly. The decision to reverse the stoma will depend on various factors such as the patient’s overall health, the severity of the diverticulitis, and the risks associated with the reversal procedure.

Overall, the timeline for a patient before and after diverticulitis surgery involves a period of diagnosis, preparation, surgery, recovery, and potential stoma management before considering reversal. It is important for patients to work closely with their healthcare team to ensure the best possible outcome and quality of life after surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with diverticulitis surgery?
  2. How likely am I to need a stoma created during the surgery?
  3. What factors determine whether a stoma will be reversed after surgery?
  4. What is the typical timeline for stoma reversal after diverticulitis surgery?
  5. What are the success rates for stoma reversal in patients with diverticulitis?
  6. What are the potential long-term effects of having a stoma?
  7. How will having a stoma impact my daily life and activities?
  8. Are there alternative treatments or procedures that could be considered instead of surgery?
  9. What steps can I take to reduce my risk of complications during and after surgery?
  10. How will my recovery process look like after diverticulitis surgery, including stoma reversal if needed?

Reference

Authors: Roig JV, Salvador A, Frasson M, García-Mayor L, Espinosa J, Roselló V, Hernandis J, Ruiz-Carmona MD, Uribe N, García-Calvo R, Bernal JC, García-Armengol J, García-Granero E; en representación del Grupo Cooperativo de la Sociedad Valenciana de Cirugía. Journal: Cir Esp (Engl Ed). 2018 May;96(5):283-291. doi: 10.1016/j.ciresp.2018.02.001. Epub 2018 Mar 9. PMID: 29530275