Our Summary

This research paper discusses a study on the outcomes of surgery for diverticular disease (a digestive condition usually involving the large intestine) in patients under 40, an age group in which this disease is becoming increasingly common.

The study looked back at the medical records of 147 patients who had surgery for this condition between 2010 and 2017. The majority of these patients were male and the average age was around 35. The most common reason for surgery was uncomplicated diverticulitis (inflammation of the diverticula, the small pouches that can form in the digestive tract), followed by rupture of these pouches.

Most of the surgeries were planned in advance and more than half were performed laparoscopically (a less invasive surgery using a small camera). The most common procedure was primary anastomosis without diversion, which essentially means that the surgeon removed the diseased part of the intestine and then reconnected the healthy sections.

The average hospital stay was 5 days. There were no deaths, but about a quarter of the patients experienced complications after surgery. The most common complication was leakage from the area where the intestine was reconnected. This was more likely to happen after planned surgeries.

In addition, two patients (1.3% of the group) were found to have abnormal growths in their intestine, one of which was cancerous. Over an average follow-up of about 8 years, only two patients (1.3%) had a recurrence of the disease.

The study concludes that recurrence and the discovery of abnormal growths are rare in young patients who have surgery for diverticular disease. However, the possibility of leakage at the reconnection site, even in planned surgeries, suggests that surgeons might need to consider a temporary measure (a defunctioning ileostomy) to divert waste away from the area to allow it to heal.

FAQs

  1. What is the most common surgical indication for diverticular disease in patients under 40?
  2. What is the rate of recurrence after resection for diverticular disease in younger patients?
  3. What are the most common complications experienced after surgery for diverticular disease in younger patients?

Doctor’s Tip

A helpful tip a doctor might tell a patient about diverticulitis surgery is to be aware of the potential risk of anastomotic leaks after primary anastomosis, especially in the elective setting. Patients should carefully consider the option of a defunctioning ileostomy to reduce this risk. Additionally, it is important to note that both neoplasia and recurrence after surgery for diverticular disease in young onset patients are rare, providing reassurance for the long-term outcomes of the procedure.

Suitable For

Patients < 40 years old undergoing resection for diverticular disease are typically recommended surgery if they have severe symptoms or complications such as perforation or recurrent episodes of diverticulitis. Surgery may also be recommended for younger patients who have not responded well to conservative management or who have a high risk of developing complications. In this study, the most common surgical indication for young patients undergoing resection was uncomplicated diverticulitis. Overall, the study found that both neoplasia and recurrence after resection for diverticular disease in young onset patients are rare, with only 2 patients experiencing a recurrence over a mean follow-up of 96 months. It is important for healthcare providers to carefully consider the individualized approach to surgical resection in young patients with diverticular disease.

Timeline

Before diverticulitis surgery:

  • Patient may experience symptoms such as abdominal pain, bloating, constipation, and changes in bowel habits
  • Diagnosis is typically made through imaging studies such as CT scans or colonoscopy
  • Non-surgical treatments such as antibiotics and dietary changes may be prescribed to manage symptoms
  • In cases of recurrent or severe diverticulitis, surgery may be recommended

After diverticulitis surgery:

  • Surgery is typically performed laparoscopically, with the majority of cases being elective
  • Most common surgical outcome is primary anastomosis without diversion
  • Median length of hospital stay is around 5 days
  • Complications such as anastomotic leaks may occur, especially after elective surgery
  • Neoplastic lesions are rare, with only 2 cases found in the study
  • Surgical or radiological recurrence is rare, with only 1.3% of patients experiencing recurrence over a mean follow-up of 96 months

What to Ask Your Doctor

  1. What are the risks and benefits of surgery for diverticulitis in young patients like myself?
  2. What is the likelihood of recurrence after surgery for diverticulitis in young patients?
  3. What is the typical recovery process like after surgery for diverticulitis in young patients?
  4. Are there any specific dietary or lifestyle changes I should make after surgery for diverticulitis?
  5. How often should I follow up with you after surgery for diverticulitis?
  6. Are there any long-term effects or complications I should be aware of after surgery for diverticulitis?
  7. What alternative treatment options are available for diverticulitis in young patients?
  8. How many similar surgeries have you performed for diverticulitis in young patients, and what is your success rate?
  9. Are there any specific factors about my case that may affect the outcome of surgery for diverticulitis?
  10. Are there any additional tests or evaluations I should undergo before deciding on surgery for diverticulitis?

Reference

Authors: Connelly TM, Cheong JY, Lincango EP, Foley N, Duraes LC, Kessler H. Journal: Int J Colorectal Dis. 2023 Jul 15;38(1):195. doi: 10.1007/s00384-023-04479-6. PMID: 37452913