Diverticulitis Surgery

What is diverticulitis surgery?

Diverticulitis surgeries are procedures that remove a part of your colon that diverticulitis affects. Diverticulitis happens when infection or inflammation damages small pouches (diverticula) that may develop in your colon. You may need diverticulitis surgery if:

• Medication and other or nonsurgical treatments aren’t effective
• The condition comes back many times after you have nonsurgical treatment (recurrent diverticulitis)
• A fistula forms between your colon wall and nearby organs like your bladder or vagina

Surgery to treat diverticulitis involves removing the part of your colon (partial colectomy) that diverticulitis affects.

The most common diverticulitis surgery is a sigmoid colectomy. Your sigmoid is the last part of your colon. Removing that section of your colon will eliminate your symptoms.

In some cases, your surgeon may do an ostomy after completing the colectomy. An ostomy is a surgical opening of intestine connected to the skin of your abdomen. You’d need an ostomy because surgery removes part of your colon. That means there’s no way for poop to move through your colon to your rectum and out of your body. An ostomy reroutes how poop leaves your body.

Types of diverticulitis surgeries

Your colorectal surgeon may perform one of the following surgeries:

Sigmoid colectomy

Your surgeon will remove the unhealthy part of your sigmoid colon. Then, they’ll connect the healthy parts of your colon. Your surgeon may make a large, vertical incision (cut) on your belly (open colectomy). They may also do a sigmoid colectomy by making small incisions (cuts) that are scattered across your belly. This is minimally invasive surgery.

Laparoscopic or robotic partial colectomy

In this procedure, your surgeon makes several small cuts on your belly. They use a laparoscope (a tiny video camera) with small tools to remove the part of your colon that diverticulitis affects. They may also do this with a robotic device (robotic surgery). Laparoscopic surgery typically causes less pain, and the incision heals more quickly than an open surgery.

Ostomy

An ostomy is a surgical opening of intestine connected to the skin of your abdomen. It changes how your body gets rid of poop. For diverticulitis, your surgeon may do a colostomy or an ileostomy if they can’t connect the healthy sections of your colon after removing the section that diverticulitis affects.

Colostomy

In a colostomy, your surgeon makes an opening through your belly wall and brings a section of your colon up to the skin. They open your colon and stitch it to the skin. Your poop goes out through the ostomy into a colostomy bag that’s on the outside of your belly. Usually, colostomies are temporary and can be reversed several months later.

Ileostomy

An ileostomy involves using a section of your small intestine (the ileum) to create a temporary way for poop to leave your body. Your surgeon may do an ileostomy as part of diverticulitis surgery if they need to connect a section of your colon to your rectum. The temporary ileostomy keeps poop from going through that connection.

In this procedure, your surgeon takes a section of your small intestine from an area above the new connection between your colon and rectum. They pull that part of your small intestine up through your belly wall. Then, they open your small intestine and stitch it to your skin. Your poop moves through your small intestine into a bag that’s on the outside of your belly.

How should I prepare for diverticulitis surgery?

You’ll go through the same steps to get ready for an open or laparoscopic/robotic colectomy. Your surgeon will give you specific instructions. In general, you’ll:

• Have additional imaging tests: Your surgeon may order a computed tomography (CT) scan or other types of special X-rays.
• Have a health screening: You may have blood tests, a colonoscopy, an EKG (electrocardiogram) and/or X-rays. You may meet with the anesthesia team.
• Bowel prep: You may need to stop eating and only drink clear liquids for several hours before your surgery. You’ll also need to clean out your bowels.

What happens during this surgery?

You’ll receive general anesthesia for all diverticulitis surgeries. If you have open surgery, your surgeon will make a vertical incision on your belly to get to the unhealthy part of your colon.

If you have laparoscopic or robotic surgery, they’ll make a small incision to insert a thin, long camera into your belly. The camera projects images of your colon on a computer screen. Your surgeon will make three to five ½-inch incisions to insert tiny surgical tools.

In the next steps for both surgeries, your surgeon will:

• Remove the section of your colon that diverticulitis affects.
• Use staples or sutures to connect the healthy sections of your colon.
• If necessary, do a colostomy or ileostomy and connect part of your intestine to your skin.
• Close the incisions (cuts) in your belly area.

How long does diverticulitis surgery take?

This surgery usually takes three to four hours. The length of time depends on factors like the surgery type — open versus laparoscopic or robotic surgery — and if you have a colostomy or ileostomy.

What happens after this surgery?

You’ll stay at the hospital for a few days. How long you stay depends on how quickly you recover from surgery. While you recover, your care team will:

• Explain what you should do to care for your surgical wound
• Give you information about taking care of the ostomy and bag if you had a colostomy or ileostomy
• Work with a dietitian so you know what you can eat while your colon heals

What are the benefits of diverticulitis surgery?

The main benefit is reducing your risk of painful diverticulitis attacks or complications from diverticulitis.

How successful is diverticulitis surgery?

Diverticulitis is typically very successful. Most patients (as high as 98%) don’t have any more diverticulitis episodes.

What are the risks or complications of diverticulitis surgery?

Complications may include:

• Anastomotic leak
• Bleeding
• Surgical site infection

What is the recovery time for diverticulitis surgery?

It can take a few months to completely recover from diverticulitis surgery. You’ll:

• Eat a soft diet for the first few weeks after surgery
• Avoid lifting heavy objects for six to eight weeks
• Wait until your incisions heal before soaking in water like hot tubs or pools
• Hold off on driving yourself until you stop taking pain medication

Will this surgery affect what I can eat?

You’ll probably need to stick to low-fiber meals for the first month after surgery. After this time, you can usually eat whatever you want (including vegetables, fruits, popcorn, seeds, nuts, berries). It may be a few months before your appetite comes back.

What is life like after diverticulitis surgery?

The goals of diverticulitis surgery are to keep the condition from coming back or to treat a complication that diverticulitis causes. Usually, people’s quality of life improves after having surgery for diverticulitis.

If you have a temporary colostomy or ileostomy, you’ll need another surgery to reconnect your intestine (close the ostomy).

When should I call my surgeon?

You should call your surgeon if you:

• Have pain around your belly that medication doesn’t help or gets worse over time
• Don’t poop
• Have signs of infection like swelling or redness around the surgical wound site, fever or vomiting

You may have diverticulitis surgery because other treatments don’t help, or diverticulitis comes back several times. You may want to ask your surgeon questions like:

• What type of surgery do you recommend to treat my diverticulitis?
• Will I need a colostomy or ileostomy?