FAQ About Surgery for Diverticulitis

Diverticula can form anywhere along the digestive tract but frequently cluster near the bottom of the sigmoid and descending colons located on the left of the abdomen. If these tiny pouches in the colon develop abscesses, become infected or lead to bowel perforation, it becomes the condition we know as diverticulitis.

Mild diverticulitis can often be treated with stool softeners, antibiotics, antispasmodic medications, and bed rest. If the infection worsens, or if a perforation develops in the intestines, doctors may advise hospitalization and antibiotics given through an IV. Intravenous feeding is also frequently used by doctors to facilitate the healing of the colon. While in the hospital, doctors will also be able to drain abscesses in the intestines. A temporary colostomy may also help the intestines heal following a draining.

Surgeons perform two types of diverticulitis surgery:

• Bowel resection and primary anastomosis: involves removal of infection colon sections (colectomy) and sewing together the remaining ends of the healthy colon (anastomosis).
• Bowel resection and colostomy: after performing a colectomy, the surgeon connects the bowel through a stoma (opening on the side of the abdomen). A colostomy bag is attached to the stoma to allow for the elimination of stool.

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Surgery for diverticulitis can be done either laparoscopically or as open surgery. Open surgeries require that surgeons make a six-inch-long opening in the abdomen to view the area fully. Laparoscopic procedures involve making small cuts in the abdomen through which a tiny camera is inserted via thin tubes. The laparoscopic method is preferred by most, as surgeons can remove infected bowel sections without making long incisions.

Hospital stays for laparoscopic are much shorter than open surgery hospital stays. Most patients get discharged from the hospital within two or three days of having surgery. However, patients who received open surgery may have to remain for up to seven days, as long as no complications occur.

Recovering fully from laparoscopic surgery for diverticulitis takes about two months while recovering from open surgery can take as long as four months. Recovery times depend on several factors, such as the overall health of the patient and if complications delay recovery.

Immediately after surgery, patients are typically fed intravenously. This keeps the stomach empty so the intestines and colon can heal properly. I.V. feeding will gradually transition into a liquid diet. Eventually, patients transition to eating soft foods such as pudding and soup, before leaving the hospital.

Complications are more common in patients having open surgery than laparoscopic surgery. The most common complication after surgery is an infection. In rare cases, either type of surgery may cause injury to the stomach and other surrounding organs. If ongoing bleeding continues after surgery, a permanent colostomy may be necessary.

All surgeries present shared complications such as the development of blood clots in legs and problems arising from general anesthesia.

To avoid flare-ups of diverticulitis after surgery, follow a high-fiber, low-fat diet consisting of the following:

• Soft/pureed/mashed or cooked fruits: bananas, grapes, applesauce, grapefruit, peaches, apricots. Do not eat dried fruits like prunes, raisins or dates or coconut.
• Soft/pureed/mashed or cooked vegetables: carrots, mushrooms, beets, green beans, tomatoes, lettuce, eggplant, and zucchini. Avoid eating broccoli, cabbage, onions, peas, and other vegetables that tend to produce gas and flatulence.

Eat only grilled or baked meats white meats, such as turkey and chicken.

Doctors may recommend post-surgery fiber supplements such as psyllium or methylcellulose at least once a day. Available as pills or powders, fiber supplements provide up to 3 1/2 grams of fiber per serving. Fiber supplements may also help reduce cholesterol, suppress appetite, and regulate blood sugar levels. However, it is important not to exceed fiber supplement dosage guidelines, as consuming too much fiber can cause diarrhea or constipation.

Risk factors for diverticulitis include:

• Being over 40
• Obesity (BMI of 30 or more)
• Smoking cigarettes
• A sedentary lifestyle (lack of exercise increases the risk)
• Eating too much fatty or red meats and insufficient fiber

People taking steroids, NSAIDs, or prescription opioids for pain relief may also be prone to diverticulitis.