Your NYU Langone gastroenterologist may recommend surgery if symptoms of diverticulitis haven’t improved after nonsurgical treatment; if a perforation or fistula, a connection that forms between the intestines and another organ, develops in the colon wall; or if a diverticular pouch ruptures. These problems can cause stool or infected material to leak into the abdominal cavity, increasing the risk that the infection spreads to the abdominal cavity or elsewhere in the body.
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If necessary, surgeons perform a procedure to remove the diseased portion of the colon. NYU Langone gastrointestinal surgeons may use a minimally invasive approach or conventional open surgery.
Colorectal surgery can also be performed as an elective procedure to prevent recurrent episodes of diverticulitis. Your doctor can explain the benefits and risks of this option. Elective surgery is usually a minimally invasive procedure, and surgeons use either traditional laparoscopy or robotic-assisted laparoscopy.
Hartmann’s Procedure
If you need emergency surgery, your doctor may perform a surgery called Hartmann’s procedure, in which he or she removes the diseased portion of the colon and cleans out any infected areas in the abdominal cavity. This procedure requires general anesthesia. It can be done using laparoscopy or an open technique.
The infection may make it unsafe for the two ends of the colon to be reconnected immediately after surgery. If so, your surgeon creates what is known as a stoma, an opening that connects your bowel to the abdominal wall, permitting stool to leave the body.
Your surgeon makes an incision in your abdomen and connects part of the intestine to the opening in the skin. The rectum is temporarily sutured closed. An odor-proof container, called a colostomy bag, is attached to the opening in the skin on the outside of the abdomen to collect the bowel contents.
As you recover from surgery, waste leaves your body through the stoma and collects in the bag. Having bowel movements through the stoma enables your colon to rest and heal.
A few weeks later, when the colon has healed, your doctor reconnects the two ends of the colon. He or she closes the stoma and removes the sutures in the rectum. Your bowels then return to their normal function.
What to Expect After Surgery
After a Hartmann’s procedure, you are given antibiotics to clear up the infection. How long you take them depends on your progress and the severity of the infection.
You may remain in the hospital for a few days for observation. NYU Langone pain management specialists and ostomy nurses are available 24 hours a day to help you recover comfortably and adjust to the colostomy bag.
Elective Sigmoidectomy
If you’ve had two or three episodes of diverticulitis, your doctor may recommend an elective procedure called sigmoidectomy, in which the affected part of the colon—called the sigmoid colon—is removed to help prevent a recurrence.
Before choosing elective surgery, you and your doctor discuss the benefits and risks. If you choose to have the procedure, your doctor performs minimally invasive colorectal surgery, which is done using traditional laparoscopy or robotic-assisted surgery. The procedure requires general anesthesia.
During a laparoscopic procedure, the surgeon makes several very small incisions in the abdomen, through which the laparoscopic instruments are inserted. He or she performs the surgery with the help of a two-dimensional image on a video monitor.
During robotic-assisted surgery, surgeons use an advanced surgical system to perform the procedure. It consists of tiny surgical instruments mounted on separate robotic arms. An additional arm contains a video camera, which projects a magnified, high-definition, three-dimensional image on a computer monitor to guide the surgeon. The surgical tools and camera are inserted through tiny incisions in the abdomen. The surgeon controls these instruments and the camera from a console.
In both approaches, the abdomen is inflated with gas, which expands the abdominal cavity, giving the surgeon a better view and more freedom of movement. Your doctor identifies the sigmoid colon and removes it. The two ends of the diseased portion of the colon are attached using a laser, a procedure known as anastomosis. Surgery can take three or more hours.
What to Expect After Surgery
A typical hospital stay after an elective sigmoidectomy is two to four days. After the procedure, you are given liquids and your doctor waits for you to have a bowel movement.
After a period of observation, you are allowed to start eating solid foods and go home. Once home, your doctor recommends avoiding driving or lifting anything heavy. You should also avoid movements or exercises that could strain the abdomen.
Complications of elective sigmoidectomy are rare. You may experience leakage from the ends of the colon that were surgically attached. Treatment for a leak may be as simple as taking antibiotics. With more severe episodes, another operation may be necessary. Bleeding, infection, and blood clots are other potential complications of the procedure.
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