Diverticulitis Treatment & Surgery New Jersey
To understand diverticulitis, we must first explore the health of the colon or large intestine. A healthy colon creates a smooth passageway for fecal matter to be expelled from the body. As we age, and usually due to a diet low in fiber, many patients begin to develop diverticula – small pouches that push through the colon. In most cases, these pouches are not painful and do not cause any noticeable problems. However, when these pouches become infected (usually when stool becomes trapped in them) the condition is known as diverticulitis and can be very painful.
Causes of Diverticulitis
While we do not have a complete picture of all the causes of diverticulitis, we do know that age and a low fiber diet play a significant role in developing diverticulosis, which can ultimately lead to diverticulitis.
Symptoms of Diverticulitis
The most common symptom of diverticulitis is pain in the lower left side of the abdomen. However, there are many other signs and symptoms that can manifest with the disease including
- High fever
- Nausea and vomiting
The symptoms may be mild to severe depending on the degree of inflammation in the diverticula. Particularly severe cases of diverticulitis may lead to tears in the colon, bleeding and blockages in the colon. It is important to see a doctor at earliest signs of pain, not only because early-stage diverticulitis, but also because other diseases of the abdomen have similar symptoms and should be evaluated immediately.
How we Diagnose Diverticulitis
A medical history and physical exam is the first step in diagnosing diverticulitis. The location of the pain is often all that we need to suspect diverticulitis, however we typically follow this up with imaging testing to see the extent of problem and determine the best option.
Since the precursor to this condition – diverticulosis – is asymptomatic, older patients usually find out they have the condition when getting their periodic colonoscopy. Once we know that diverticulosis exists, a tailored diet plan is usually created to minimize the chances of infection/diverticulitis.
Treatment for Diverticulitis
The first line of treatment will include antibiotics and pain relievers to reduce inflammation and minimize pain and discomfort resultant from the diverticulitis. Patients will usually start a full liquid diet to take pressure off the colon and allow it to heal.
Severe cases of diverticulitis often put the patient in the hospital and sometimes require surgical intervention.
Colon Resection (Surgery) for Diverticulitis
If the case of diverticulitis is particularly severe, and the patient is not responding well to conservative treatment, a surgical procedure known as a colon resection or colectomy –where part of the colon is removed – is often indicated.
The procedure is performed in a minimally invasive manner using five small incisions in the abdomen through which specially made medical devices are passed, including a high definition camera known as a laparoscope. During the procedure, your surgeon will inspect and remove a portion of the diseased colon. Most patients will have enough healthy surrounding tissue to sew the two ends of the colon back together and keep normal gastrointestinal function.
Some patients, especially those with high surgical risk, or those that have allowed their condition to progress too far, may require a temporary or permanent colostomy. The risk of needing a colostomy will be discussed during consultation with your surgeon.
Recovery after a Colon Resection
Recovery from a colon resection will depend on the extent of the surgical resection as well as the general health of the patient. Since most diverticulitis patients are of advanced age, they will need the additional time in the hospital for observation versus other laparoscopic procedures. Typically, we expect patients to be in the hospital for two to three days.
While recovering from a colon resection, patients will need to avoid strenuous physical activity for up several weeks after surgery depending on their condition. Driving should be avoided until after stopping narcotic pain medication or one week after surgery, whichever is longer. Patients will be placed on a liquid diet for a few weeks to allow the colon to heal. Following this dietary requirement is extremely important for the safety and effectiveness of the procedure.
A Note on Foods to Avoid
While it may seem counterintuitive patients that have had a recent diverticulitis attack or who have recently had surgery should maintain a relatively low fiber diet as they begin to recover. Over time, patients can incorporate more and more fiber into their diet. Very importantly, patient should strive to remain hydrated by drinking eight or more glasses of water per day – About 64 ounces – to ensure that the colon is well-hydrated, and stool can pass more easily.
Exercise is also an important part of colon health. Patients should aim to perform moderate to aggressive exercise 3 to 4 times a week. Exercise actually helps muscle tone in your colon and maintains colon health.
Laxatives should only be used when absolutely necessary. Dependence on laxatives to pass stool can occur with overuse.
Risks of a Colon Resection
As with any surgical procedure, minimally invasive colon surgery comes with inherent risks including the potential for pain, blood loss an infection. The rates of serious complications in the hands of a skilled an experienced surgeon such as those Advanced Surgical Associates is extremely low. Some of the most common procedure-specific risks after colon surgery include leakage of the anastomosis – where the two ends of the colon have been joined, as well as the chance that patients may need a colostomy bag temporarily or permanently.
Is a Colon Resection Always Performed Laparoscopically?
Virtually all of the colon resections we perform are laparoscopic / minimally invasive. There are times, however, when the safety and effectiveness of the procedure requires a conversion to open surgery. This possibility will be discussed during consultation.
The most common reasons for converting to an open procedure include a patient’s excess weight or obesity, excessive bleeding during the procedure, a benign or malignant tumor, or scar tissue in the area of the surgical field.