Diverticulitis surgery: Difference between revisions
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===Elective surgery=== | ===Elective surgery=== | ||
Unlike the emergent surgery, elective surgery can be performed after proper responsive treatment. The surgeon decides whether the patient requires to proceed into colon resection or not. It depends on many factors like the age of the patient, the severity score and if there are any persistent symptoms or not. Based on many studies, it was found that around third of the patients will have symptoms of the disease again after the first episode of it and from this point elective surgery may be indicated in some cases and it is a case to case basis | Unlike the emergent surgery, elective surgery can be performed after proper responsive treatment. The surgeon decides whether the patient requires to proceed into colon resection or not. It depends on many factors like the age of the patient, the severity score and if there are any persistent symptoms or not. Based on many studies, it was found that around third of the patients will have symptoms of the disease again after the first episode of it and from this point elective surgery may be indicated in some cases and whatsoever, it is indicated on a case to case basis.<ref name="pmid15685694">{{cite journal| author=Janes S, Meagher A, Frizelle FA| title=Elective surgery after acute diverticulitis. | journal=Br J Surg | year= 2005 | volume= 92 | issue= 2 | pages= 133-42 | pmid=15685694 | doi=10.1002/bjs.4873 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15685694 }} </ref> | ||
==References== | ==References== | ||
Revision as of 19:23, 12 June 2017
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Diverticulitis Microchapters |
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Diverticulitis surgery On the Web |
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American Roentgen Ray Society Images of Diverticulitis surgery |
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Risk calculators and risk factors for Diverticulitis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
If symptoms of diverticulitis are frequent, or the patient does not respond to antibiotics and resting the colon, the doctor may advise surgery. The surgeon removes the affected part of the colon and joins the remaining sections. This type of surgery—called colon resection—aims to prevent complications and future diverticulitis. The doctor may also recommend surgery for complications such as a fistula or partial intestinal obstruction.
Immediate surgery may be necessary when the patient has other complications, such as perforation, a large abscess, peritonitis, complete intestinal obstruction, or severe bleeding. In these cases, two surgeries may be needed because it is not safe to rejoin the colon right away. During the first surgery, the surgeon cleans the infected abdominal cavity, removes the portion of the affected colon, and performs a temporary colostomy, creating an opening, or stoma, in the abdomen. The end of the colon is connected to the opening to allow normal eating while healing occurs. Stool is collected in a pouch attached to the stoma. In the second surgery several months later, the surgeon rejoins the ends of the colon and closes the stoma.
Surgery
Surgical intervention in patients with diverticulitis is not the first line of treatment unlike the medical therapy in such patients. However, surgery is required in the complicated patients with diverticulitis who are unresponsive to the medical therapy and the conservative measures against the disease.[1]
Emergency or urgent surgery
Emergency surgery is performed in life threatening cases of diverticulitis when it is complicated by perforation. Urgent surgery means operation that required to be done immediately in the same hospitalizaiton of the patient.[2][3]
- Indications of the urgent surgery:
- Diverticulitis complicated by peritonitis
- Patient becomes unresponsive to the medical treatment
- Diverticulitis complicated by intestinal obstruction
- Abscess formation and not responsive to the percutanous drainage
- Enterocutaneous fistula formation
- Surgery procedures and techniques:[4]
- Based on the status of the patient and the severity of the disease (according to Hinchey classification of severity), patient undergoes an emergent sigmoid resection with or without anastmosis.
- The most common procedure of operation to be done in these cases is called Hartmann procedure.
- Hartmann technique includes sigmoid colectomy, end sigmoid or descending colostomy, and closure of the rectal stump. These colostomies may not be closed.
- Besides Hartmann technique, resection and anastmosis with ileostomy can be performed. Anastmosis may have a low mortality rate than the operations with no anastomosis.[5][6][7]
A video shows how Hartmann procedure is performed: {{#ev:youtube|v=rVgBZwY4Pt8&t=175s|}}
Elective surgery
Unlike the emergent surgery, elective surgery can be performed after proper responsive treatment. The surgeon decides whether the patient requires to proceed into colon resection or not. It depends on many factors like the age of the patient, the severity score and if there are any persistent symptoms or not. Based on many studies, it was found that around third of the patients will have symptoms of the disease again after the first episode of it and from this point elective surgery may be indicated in some cases and whatsoever, it is indicated on a case to case basis.[8]
References
- ↑ Jacobs DO (2007). "Clinical practice. Diverticulitis". N Engl J Med. 357 (20): 2057–66. doi:10.1056/NEJMcp073228. PMID 18003962.
- ↑ Sheth AA, Longo W, Floch MH (2008). "Diverticular disease and diverticulitis". Am J Gastroenterol. 103 (6): 1550–6. doi:10.1111/j.1572-0241.2008.01879.x. PMID 18479497.
- ↑ Wedell J, Banzhaf G, Chaoui R, Fischer R, Reichmann J (1997). "Surgical management of complicated colonic diverticulitis". Br J Surg. 84 (3): 380–3. PMID 9117315.
- ↑ Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons (2006). "Practice parameters for sigmoid diverticulitis". Dis Colon Rectum. 49 (7): 939–44. doi:10.1007/s10350-006-0578-2. PMID 16741596.
- ↑ Zorcolo L, Covotta L, Carlomagno N, Bartolo DC (2003). "Safety of primary anastomosis in emergency colo-rectal surgery". Colorectal Dis. 5 (3): 262–9. PMID 12780890.
- ↑ Salem L, Flum DR (2004). "Primary anastomosis or Hartmann's procedure for patients with diverticular peritonitis? A systematic review". Dis Colon Rectum. 47 (11): 1953–64. PMID 15622591.
- ↑ Kronborg O (1993). "Treatment of perforated sigmoid diverticulitis: a prospective randomized trial". Br J Surg. 80 (4): 505–7. PMID 8495323.
- ↑ Janes S, Meagher A, Frizelle FA (2005). "Elective surgery after acute diverticulitis". Br J Surg. 92 (2): 133–42. doi:10.1002/bjs.4873. PMID 15685694.