Sigmoid colectomy for diverticular disease

What is diverticular disease?

Diverticular disease is the name given to a condition where bulges form in the lining of the colon (large bowel). It is more common with older people, affecting six in 10 people who are over 70. Most people with diverticular disease have few, if any, symptoms, and won’t need surgery. Some, however, will experience problems (see symptoms, below) and their surgeon will recommend a sigmoid colectomy to remove part of their bowel.

What causes diverticular disease?

This disease is probably caused by years of not having enough fibre in the diet. As the bowel tries to squeeze a relatively small amount of solid matter towards the back passage, pressure causes the wall of the bowel to weaken, causing bulges (diverticulae) of the lining of the bowel through the muscle wall.

What are the symptoms? 

Diverticular disease can cause pain in the lower left side of the abdomen. The openings of the diverticulae are small and so can become blocked, leading to infection and inflammation. You may have:

• A painful lump in the abdomen, which requires antibiotics
• Pain passing solid matter through the narrowing
• A hole through the wall of the bowel. The pus will need to be drained. If the infection spreads, peritonitis (inflammation of the peritoneum) will develop and emergency surgery will be required
• Inflamed diverticulae can stick onto other organs in the abdomen (usually the bladder), causing an abnormal passageway (fistula) between them
• The inflamed diverticulae may wear down a nearby blood vessel, causing bleeding through the back passage.

What are the benefits of a sigmoid colectomy?

Your surgeon will discuss with you the suitability of surgery. If the affected part of your bowel is removed, these symptoms should disappear. If you don’t have the operation your symptoms will probably continue and may get worse.

Are there any alternatives?

Possible alternatives are:

• Repeated courses of antibiotics for painful episodes of diverticular disease
• More fibre in the diet may help, but the diverticulae will not go away. If a fistula has developed this will probably not improve without an operation.

What does the operation involve?

You need to make sure you empty your bowels beforehand – you may be given medicine to help you do this the day before the operation.

The operation takes around one and a half hours and is performed under general anaesthetic. Your surgeon will make a cut in the abdomen and remove part of the colon. They will usually join the ends of the bowel back together inside the abdomen. Occasionally they will need to make a stoma (opening of the bowel out through the skin) for safety reasons. Finally, the cut will be closed with stitches.

After the operation a drip will be placed in a vein in your arm. A catheter will also be placed in your bladder to help you pass urine.

For more information, and if you have any queries about the procedure, speak to your consultant.

Continue your normal medication unless you are told otherwise.

The following can help make the operation a success:

• Giving up smoking. This may reduce your chances of recovery after an operation and will improve your long-term health
• Eating healthily. If overweight, you have a greater chance of developing complications
• Exercising regularly. Your GP can recommend exercises

Possible complications

• Bleeding after surgery
• Some pain is common with most operations
• Developing a hernia in the scar caused by the deep muscle layers not healing properly – this may require further surgery
• Anastomotic leak, which is a rare but serious complication that may happen if the join between the ends of the bowel don’t heal properly, leaving a hole. Further surgery may be required
• Abnormal joining together of tissue can lead to bowel obstruction.

This is not a definitive list and symptoms will vary with each patient. Please ask your consultant for more information.

What does the recovery involve?

It is usual for the bowel to stop working for a few days after the operation. As it starts to work again, you will be given more fluid to drink and you will be allowed to eat food. If you have a temporary stoma the stoma nurse will show you how to change the bag.

You should be able to go home five to seven days after the operation, however your surgeon may recommend you stay at hospital longer. It may take up to three months to fully recover from surgery. Your bowels may be looser than they were before the operation and you may find you need to open your bowels more every day. This is normal and should improve with time. Speak to your consultant if you have any questions.

How to pay for your operation

Sigmoid colectomy for diverticular disease costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own treatment the cost of the operation will be explained and confirmed in writing when you book the operation. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.