Management of Diverticular Disease

Overview

Diverticular disease means your sigmoid colon (the lower-left section of your large bowel) has developed small pouches called diverticula. When these become inflamed or infected — a condition called diverticulitis — it can cause significant pain, fever, and repeated trips to hospital. In some cases it leads to more serious problems such as an abscess (a pocket of infection), a fistula (an abnormal channel forming between the bowel and another organ like the bladder or vagina), or a perforation (a rupture in the bowel wall).

When surgery is recommended, Mr Nguyen performs a laparoscopic sigmoid colectomy — removing the diseased section and joining the healthy bowel back together. This is done using keyhole (laparoscopic or robotic) techniques, and in most planned cases you'll go home within 3–5 days with your bowel working normally and no permanent bag.

Who needs this procedure?

• You've had two or more episodes of diverticulitis requiring antibiotic treatment — repeated attacks are a sign your body can't manage this conservatively
• Diverticulitis has caused a complication: an abscess (pocket of infection), a fistula (a tunnel from the bowel to the bladder, vagina, or skin), or a stricture (narrowing that blocks the bowel)
• A perforation (rupture) of the bowel has occurred and emergency surgery is needed
• Imaging or a colonoscopy has not been able to fully rule out a bowel cancer — surgery resolves the uncertainty
• You have ongoing diverticular pain or symptoms that are significantly affecting your daily life, even between acute attacks
• You're younger and had a severe first episode — there's a higher chance of recurrence and surgery may be the most sensible long-term plan

Benefits

• Done through keyhole incisions — smaller cuts mean less pain, faster healing, and a quicker return home than open surgery
• Removes the section of bowel causing the problem — so there's nothing left to flare up again
• In most planned operations, the bowel ends are joined back together — you won't need a permanent bag
• Most patients go home within 3–5 days
• Planned surgery carries a much lower risk of complications than emergency surgery performed during an acute attack

Risks & considerations

• Anastomotic leak (the bowel join opening up) — this occurs in about 2–4% of planned sigmoid colectomies. It's one of the more serious complications, and Mr Nguyen monitors you carefully for signs of it in the first few days after surgery. If it does happen, further treatment is usually needed.
• Wound infection — happens in roughly 3–5% of cases. Usually managed with antibiotics or a small wound dressing change, not further surgery.
• Ureteric injury — the ureter (the tube from the kidney to the bladder) runs very close to the sigmoid colon. Injury is uncommon — less than 1% — and in complex cases Mr Nguyen uses ureteric stents (a fine tube placed by a urologist beforehand) to make the ureters visible and protect them.
• Temporary or permanent stoma (bag) — most planned operations don't need a stoma, but emergency cases or very complex anatomy increase that likelihood. If a temporary stoma is needed, closure is usually planned 8–12 weeks later once healing is confirmed.
• Changed bowel habits — it's normal for your bowel to behave differently for the first few months after surgery. Most people find things settle into a comfortable pattern within 3–6 months.
• Diverticulitis coming back in the remaining bowel — uncommon, but your remaining bowel still has diverticula, so it's possible. A high-fibre diet helps reduce the risk.

Before the procedure

• A colonoscopy to rule out cancer if you haven't had one recently
• A CT scan of your abdomen and pelvis so Mr Nguyen can see exactly what needs to be done and plan your surgery
• Bowel preparation — a laxative drink to clear the bowel before surgery, combined with antibiotic tablets as directed
• An ERAS (Enhanced Recovery After Surgery) programme discussion — this covers what to eat, when to move after surgery, and how pain will be managed. Following this plan genuinely helps you recover faster.

On the day

• You'll be completely asleep under general anaesthesia; the operation is done through several small keyhole openings in your abdomen
• Mr Nguyen carefully moves the sigmoid colon (the troublesome section) away from surrounding structures, taking particular care to identify and protect the left ureter — the tube that runs from your kidney to your bladder
• The diseased section is removed and the two healthy ends are joined back together (the anastomosis)
• In emergency situations, or when the bowel anatomy is very complex, a temporary stoma may be needed — your team will let you know if this is a likely possibility for you beforehand
• You'll be encouraged to sit up and take a short walk on the same day as surgery — this is an important part of the recovery programme and makes a real difference
• Your urinary catheter will be removed the following morning, and you'll start eating and drinking on the day of surgery

Recovery & aftercare

• Days 1–2: You'll be up and walking, and your diet will progress from fluids to soft food and then normal meals as your bowel starts working.
• Days 3–5: Most patients having planned surgery are ready to go home within this timeframe — feeling sore but mobile and managing well.
• 4 weeks: You should be comfortable returning to light work (including desk work) and driving, provided you're no longer on strong pain relief.
• 6–8 weeks: You can return to full activity, including exercise, once you feel ready.
• A dietitian review is recommended — eating plenty of fibre long-term is the single best thing you can do to look after the rest of your bowel.
• If a temporary stoma was needed, its reversal is usually planned for 8–12 weeks after your original operation, once healing has been confirmed.
• Mr Nguyen will see you for a follow-up review 2–6 weeks after your surgery — this appointment is provided at no charge.

Related patient guides

Helpful articles written for patients and their families on topics related to this procedure.