Our Summary

This research paper discusses the challenges of treating perforated diverticulitis, a condition where small pouches form and get inflamed or infected in the colon, which is increasing in prevalence due to the growing elderly population. The paper highlights recent improvements in diagnosis methods, attempts to preserve the continuity of the intestine, and drainage procedures that have led to more treatment options for complicated cases. Specifically, the paper discusses two treatment options: laparoscopic lavage (a minimally invasive procedure where the infected area is washed out) and resection with primary anastomosis (where the diseased portion of the colon is removed and the healthy ends are joined together). These options are now being considered instead of diversion (rerouting the colon to allow healing) for certain patients with severe cases of diverticulitis. An additional minimally invasive option for less severe cases, percutaneous drainage (draining abscesses through the skin), is also discussed if the facility has the necessary equipment. The goal of the paper is to update medical professionals on current treatments for perforated diverticulitis, focusing on the pros and cons of the surgical options for the most severe cases.

FAQs

  1. What is the prevalence of colonic diverticular disease and is it expected to increase?
  2. What are the surgical options for the treatment of Hinchey III and IV diverticulitis?
  3. What is the role of percutaneous drainage procedures in the management of perforated diverticulitis?

Doctor’s Tip

A helpful tip a doctor might give a patient about diverticulitis surgery is to follow their post-operative care instructions closely, including taking prescribed medications, avoiding heavy lifting or strenuous activity, and following a special diet to promote healing and prevent complications. It is also important for the patient to attend all follow-up appointments with their healthcare provider to monitor their recovery progress and address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended diverticulitis surgery include those with complicated presentations of diverticulitis, such as Hinchey III and IV diverticulitis. This may include patients with perforated diverticulitis, abscess formation, or other complications that cannot be managed with conservative treatment alone. Patients who are not responding to medical management, have recurrent episodes of diverticulitis, or have a history of severe complications may also be candidates for surgery. Additionally, patients who are at a high risk for complications or have underlying health conditions that may complicate their diverticulitis may be recommended for surgery. Ultimately, the decision to undergo diverticulitis surgery should be made on a case-by-case basis, taking into account the individual patient’s overall health, risk factors, and preferences.

Timeline

Before diverticulitis surgery:

  • Patient may experience symptoms such as abdominal pain, fever, nausea, and changes in bowel habits
  • Diagnosis is typically made through imaging studies such as CT scans or colonoscopy
  • Antibiotics may be prescribed to treat infection and inflammation
  • In some cases, percutaneous drainage may be performed to drain abscesses

After diverticulitis surgery:

  • Patient will undergo surgery to remove the affected portion of the colon
  • Recovery time varies depending on the type of surgery performed (laparoscopic lavage, resection with primary anastomosis, or diversion)
  • Patients may experience pain, discomfort, and changes in bowel habits post-surgery
  • Follow-up appointments with the surgeon will be necessary to monitor healing and ensure there are no complications
  • Dietary changes may be recommended to prevent future episodes of diverticulitis

What to Ask Your Doctor

  1. What are the risks and potential complications associated with diverticulitis surgery?
  2. What is the recovery process like after diverticulitis surgery?
  3. How long will I need to stay in the hospital after surgery?
  4. Will I need to follow a special diet or make any lifestyle changes after surgery?
  5. What are the long-term outcomes and potential risks of not having surgery for diverticulitis?
  6. Are there any alternative treatment options to surgery for diverticulitis?
  7. How often do complications or recurrence occur after diverticulitis surgery?
  8. What is the success rate of laparoscopic lavage and resection with primary anastomosis for Hinchey III and IV diverticulitis?
  9. How experienced are you in performing diverticulitis surgery, and what is your success rate?
  10. Are there any specific post-operative care instructions or follow-up appointments I should be aware of?

Reference

Authors: Zoog E, Giles WH, Maxwell RA. Journal: Am Surg. 2017 Dec 1;83(12):1321-1328. PMID: 29336748