Surgery for diverticular disease

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). See the Diverticular Disease condition page for the broader picture.

Most flare-ups settle with conservative management — bowel rest, fluids, and antibiotics. Many abscesses can be drained through the skin (a percutaneous drain placed by an interventional radiologist under CT guidance) without an operation. Surgery is what comes next when these approaches have not been enough — either because attacks keep recurring, a complication has occurred, or cancer cannot be fully ruled out.

When surgery is recommended, a sigmoid colectomy is performed — removing the diseased section and joining the healthy bowel back together. This is done through keyhole (laparoscopic or robotic) techniques, and in most planned cases you will go home within 3–5 days with your bowel working normally and no permanent bag. The technical approach is essentially the same as for an anterior resection.

Modern guidelines have moved away from a fixed rule like "after two attacks." The decision is now individualised, based on how often attacks come, how severe they are, what complications have occurred, and how much your quality of life is being affected. Common situations where surgery is recommended:

• Recurrent attacks of diverticulitis requiring antibiotics that are significantly disrupting your quality of life
• Diverticulitis has caused a complication: a fistula (a tunnel from the bowel to the bladder, vagina, or skin), a stricture (narrowing that blocks the bowel), or a large abscess that has been drained but keeps coming back
• A perforation (rupture) of the bowel has occurred and emergency surgery is needed — in this setting the operation is sometimes a Hartmann's procedure rather than a primary anastomosis (depending on how unwell the patient is and how much contamination is present)
• Imaging or a colonoscopy has not been able to fully rule out a bowel cancer — surgery resolves the uncertainty
• Ongoing diverticular pain or symptoms between acute attacks (smouldering diverticulitis) that are significantly affecting your daily life
• In selected younger patients with a particularly severe first episode, surgery may be considered earlier — this is an individualised decision rather than a rule

• Done through keyhole incisions — published evidence shows smaller cuts are associated with less pain, faster healing, and a quicker return home than open surgery
• Removes the section of bowel causing the problem — so there is nothing left in that area to flare up again
• In most planned operations, the bowel ends are joined back together — you will not need a permanent bag
• Most patients go home within 3–5 days
• Planned surgery, in published series, carries a lower risk of complications than emergency surgery performed during an acute attack

• Anastomotic leak (the bowel join opening up) — this occurs in about 2–4% of planned sigmoid colectomies. It is one of the more serious complications, and you are monitored carefully for signs of it in the first few days after surgery. If it does happen, further treatment is usually needed.
• Wound infection — in published series, occurs in around 5–10% 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 ureteric stents (a fine tube placed by a urologist beforehand) are used to make the ureters visible and protect them.
• Temporary or permanent stoma (bag) — most planned operations do not need a stoma, but emergency cases or very complex anatomy increase that likelihood. If a temporary loop ileostomy is needed, it is usually closed 8–12 weeks later once healing is confirmed. If a Hartmann's procedure was done as an emergency, the reversal is a larger second operation.
• Changed bowel habits — it is 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 remains possible. A high-fibre diet helps reduce the risk.

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guides above.

• A colonoscopy to rule out cancer if you have not had one recently
• A CT scan of your abdomen and pelvis to show 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 helps you recover faster.

• You will be admitted on the morning of surgery to Warringal Private Hospital or Epworth Eastern, and put to sleep under general anaesthesia. The operation is done through several small keyhole openings in your abdomen.
• The sigmoid colon (the troublesome section) is carefully mobilised 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 will be encouraged to sit up and take a short walk on the same day as surgery — this is part of the ERAS recovery pathway and makes a real difference
• Your urinary catheter will be removed the following morning, and you will start eating and drinking on the day of surgery

• Days 1–2: You will 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 are 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. The What Foods to Avoid With Diverticulitis guide has the detail.
• If a temporary stoma was needed, its reversal is usually planned for 8–12 weeks after your original operation, once healing has been confirmed.
• A post-operative review is routinely arranged 2–6 weeks after your surgery — this appointment is provided at no charge.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.