Our Summary

This paper is a review of different surgical treatments for acute diverticulitis, a common and significant public health issue. The authors looked at numerous studies and articles to understand the effectiveness and outcomes of different surgical procedures. They focused on three main interventions: laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure.

The results showed that laparoscopic peritoneal lavage, a minimally invasive procedure, had some worrying outcomes with patients developing deep abscesses and needing unplanned follow-up operations. The Hartmann procedure, on the other hand, was associated with a shorter hospital stay in the short term but resulted in a permanent stoma (an opening in the body for waste removal) and poorer quality of life in the long run.

Despite these results, the authors suggest that the Hartmann procedure can still be a viable option, especially for high-risk patients. They also pointed out the lack of high-quality data supporting the laparoscopic approach and noted that further research is needed, particularly for the most severe cases of diverticulitis.

FAQs

  1. What are the three main surgical interventions for acute diverticulitis reviewed in this paper?
  2. What are the reported outcomes for patients who underwent laparoscopic peritoneal lavage or the Hartmann procedure?
  3. Why do the authors still suggest the Hartmann procedure as a viable option despite the associated drawbacks?

Doctor’s Tip

One helpful tip a doctor might tell a patient about diverticulitis surgery is to carefully consider the pros and cons of each surgical option with their healthcare team. It is important for the patient to understand the potential risks and benefits of each procedure, as well as the potential impact on their quality of life. Additionally, the patient should ask their healthcare team about any alternative treatment options and seek a second opinion if needed. Ultimately, the decision on which surgical procedure to undergo should be individualized based on the patient’s specific medical history and preferences.

Suitable For

In general, patients who may be recommended diverticulitis surgery are those who have recurrent or severe attacks of diverticulitis that do not respond to conservative treatment such as antibiotics or dietary changes. Patients with complications such as perforation, abscess formation, fistula formation, or bowel obstruction may also be candidates for surgery.

Additionally, patients who have recurrent episodes of diverticulitis that significantly impact their quality of life or those with underlying conditions that increase the risk of complications may also be considered for surgery. It is important for patients to discuss the risks and benefits of surgery with their healthcare provider to determine the best course of action for their individual situation.

Timeline

Before diverticulitis surgery, a patient may experience symptoms such as abdominal pain, bloating, changes in bowel habits, fever, and nausea. They may undergo diagnostic tests such as a CT scan or colonoscopy to confirm the diagnosis of diverticulitis.

After surgery, the patient will typically spend a few days in the hospital for monitoring and recovery. They may experience pain, fatigue, and discomfort during this time. Once discharged, they will be given instructions on how to care for their incision site, manage pain, and prevent complications such as infection.

In the weeks following surgery, the patient will gradually resume normal activities and may need to follow a special diet to aid in healing. They will have follow-up appointments with their surgeon to monitor their progress and ensure proper healing. Over time, the patient should experience relief from their diverticulitis symptoms and improved quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about diverticulitis surgery include:

  1. What are the different surgical options available for treating diverticulitis, and which one do you recommend for my specific case?
  2. What are the potential risks and complications associated with each surgical procedure?
  3. How long is the recovery time for each surgical option, and what can I expect during the recovery process?
  4. Will I need to make any lifestyle changes or follow a special diet after surgery?
  5. What are the chances of needing additional surgeries or developing complications in the future after undergoing surgery for diverticulitis?
  6. What is the success rate of the surgical procedure you are recommending, and what are the expected outcomes in terms of symptom relief and quality of life?
  7. Are there any alternative treatments or non-surgical options that I should consider before deciding on surgery?
  8. How experienced are you in performing the recommended surgical procedure, and what is your success rate with this type of surgery?
  9. Can you provide me with any additional resources or information to help me better understand the surgical procedure and what to expect before, during, and after surgery?
  10. Are there any specific pre-operative instructions or preparations I need to follow before undergoing surgery for diverticulitis?

Reference

Authors: Beyer-Berjot L, Maggiori L, Loiseau D, De Korwin JD, Bongiovanni JP, Lesprit P, Salles N, Rousset P, Lescot T, Henriot A, Lefrançois M, Cotte E, Parc Y. Journal: Dis Colon Rectum. 2020 Mar;63(3):397-405. doi: 10.1097/DCR.0000000000001327. PMID: 30694823