Partial colectomy for diverticular disease

Surgery Overview

Surgical treatment of diverticulitis or diverticular bleeding involves removing the diseased part of the colon (partial colectomy) and then joining the remaining sections. Partial colectomy is done under general anesthesia.

In the past, surgery for diverticulitis was always done as an open procedure in which a large incision is made in the abdomen. But as laparoscopic surgery has become more popular, more surgeons are using it for diverticulitis. There are advantages and disadvantages to both surgeries. For example, people who have laparoscopic surgery tend to have shorter stays in the hospital, shorter recovery times, and fewer complications after surgery. But laparoscopic surgery is more expensive and needs to be done by a more experienced surgeon. In some cases of complicated diverticulitis, laparoscopic surgery may not be an option.^{1, 2}

A partial colectomy may be done in one step, or it may require more than one surgery (two-stage operation). In a two-stage operation, the first surgery removes the diseased part of the colon, and the end of the upper section of the colon is attached to an opening in the abdomen wall (colostomy). Until the next surgery, stool passes out of the body at this opening and into a disposable bag. After inflammation and infection from the diverticulitis have cleared up, the second surgery is done to reconnect the ends of the colon.

What To Expect After Surgery

The hospital stay for an open partial colectomy is usually 4 to 7 days, if there are no complications. The hospital stay for laparoscopic surgery is shorter.

When the two-stage operation is done, the time between operations is usually 6 to 12 weeks.

The recovery time after a one-stage operation or after the final operation of a two-stage surgery is usually 6 to 8 weeks.

Why It Is Done

Surgery may be considered if a person with diverticulitis has:

• A partially blocked colon (bowel obstruction) or a narrow spot in the intestine (stricture).
• Repeated attacks of diverticulitis. Surgery often is recommended if a person has had two or more severe attacks.
• A high risk of complications (such as people younger than age 40 who have had an attack of diverticulitis).
• Repeated problems with bleeding from the intestine (diverticular hemorrhage).
• An abnormal opening (fistula) that has formed between the large intestine and an adjacent organ, most commonly the bladder, uterus, or vagina.
• The possibility that cancer is present.

Surgery may be required if a person with diverticulitis has complications, including:

• An infected pouch (diverticulum) that has ruptured into the abdominal cavity, especially if a pocket of infection (abscess) has formed. In some cases, an abscess can be drained without surgery.
• An infection that has spread into the abdominal cavity (peritonitis).
• A completely blocked intestine (bowel obstruction).
• Infection that has spread through the blood to other parts of the body (sepsis).
• Severe bleeding that does not stop with treatment given through angiography or colonoscopy. (This is a separate problem from diverticulitis, but it can happen.)

How Well It Works

Up to 12% of people develop diverticulitis again after having surgery.³ But another surgery is usually not needed.

Some people who have two-stage surgeries may not have the second part of the surgery to reattach the intestine and repair the colostomy. This is often because the intestine does not heal well enough to be rejoined.⁴

Risks

All surgeries have some risks of infection, severe bleeding, or complications from general anesthesia.

After some colectomies, a leak develops between the joined sections of the colon. Or injury may occur to the bladder, ureters, or blood vessels.

The survival rate is 99% for nonurgent (elective) surgery for diverticulitis.⁵ An emergency surgery has more risks.

What To Think About

Going into your surgery, you may not know whether you will need to have a two-stage operation and a colostomy. The surgeon may have to make that decision after the surgery has started. If the surgery is done when you are not having an attack of diverticulitis, the chances that the surgery will be done in one step are higher. Emergency surgery has a higher risk of a two-step surgery, but some emergency surgeries are done in only one step.

If you do not have frequent attacks of diverticulitis and do not develop complications, you may be able to avoid surgery and to control your condition with a high-fiber diet.

People who have colostomies need instructions about caring for the collection bag and about dietary changes that can reduce odor and gas. They also need emotional support, because many people find having a colostomy embarrassing. For more information, see:

Bowel disease: Caring for your ostomy.

Laparoscopic partial colectomy. As laparoscopic surgery has become more popular, more surgeons are using it in surgery for diverticulitis. There are advantages and disadvantages to this surgery. For example, people who have laparoscopic surgery tend to have shorter stays in the hospital, shorter recovery times, and fewer complications after surgery. But laparoscopic surgery is more expensive and needs to be done by a more experienced surgeon. In some cases of complicated diverticulitis, laparoscopic surgery may not be an option.^{1, 2}

• In laparoscopic surgery, several small incisions are made in the abdominal wall through which instruments and a viewing tube (laparoscope) are inserted. A camera attached to the viewing tube sends images of the inside of the abdomen to a television screen. The doctor looks at the screen to see what he or she is doing while using the instruments to perform the surgery.
• Laparoscopic surgery often takes longer to complete than open surgery.
• People who have laparoscopic surgery have shorter recovery times.
• This method of surgery may not be possible if there is scarring from the infection or previous surgeries.
• A larger incision than usual may be necessary to remove part of the bowel from the abdomen.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Monica Rhodes	Last Updated: July 30, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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