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MBChB PhD FRCS

FAQs

Consultant Laparoscopic Colorectal and General Surgeon

Laparoscopic colorectal surgery

Keyhole surgery for diverticular disease

How different colon diseases, including diverticular disease affect the large bowelDiverticular disease is relatively common in people over the age of 50. Half of us will have some degree of diverticula by the age of 50 and seven in ten will be affected by the age of 80. The cause of the disease is not fully understood, but it is thought to be related to a western diet that is low in fibre.

What is diverticular disease?

In diverticular disease, multiple small pouches develop on the wall of the large bowel, which then trap tiny pieces of stool inside them. Around 75 % of people have diverticulosis; the pouches are usually small and cause no symptoms.

The other 25 % experience symptoms ranging from intermittent left-sided lower abdominal pain, erratic bowel habits fluctuating between constipation and diarrhoea, abdominal bloating, fresh rectal bleeding and inflammation of the affected segment of colon. Diverticulitis is when the affected segment of colon becomes inflamed. This is the most severe manifestation of the disease.

Changing views on surgery for diverticulitis

“The guidelines have changed in the last few years and surgery is not always recommended, even if you have several bouts of severe diverticulitis. I look at each case individually to assess the balance between the risks of surgery and its potential benefits. Where surgery is necessary, using laparoscopic techniques is preferable because of the faster recovery rates.”

Mr Jonathan Wilson performs laparoscopic surgery in severe cases of diverticulitis.

Symptoms of diverticulitis

Patients classically present to the emergency department with a combination of severe abdominal pain and tenderness (more common on the left side), fever, dehydration and often a sudden change in bowel habit. The diagnosis is confirmed by examination, blood tests, and increasingly with CT scans.

Complications of diverticular disease

  • Severe rectal bleeding that causes dehydration and shock: hospital treatment with antibiotics and a blood transfusion can be necessary.
  • The bowel wall can split (perforate), releasing the faecal contents into the abdomen and causing peritonitis. Emergency surgery is usually needed.
  • Intestinal obstruction: repeated episodes of diverticulitis can cause scarring, narrowing and blockage of the colon. This is also a medical emergency that requires hospitalisation.
  • Abscess development: if the colon perforates due to the diverticulitis, an abscess (collection of pus) can form. This can be drained with a needle guided by ultrasound or CT scan.

Preventing diverticulitis

Even if you have had an attack of diverticulitis, and you are diagnosed with diverticular disease, the best way to keep your colon healthy is to eat a high fibre diet. This means lots of fresh fruit, vegetables, cereals and grains. If you already have a healthy diet, you may be prescribed additional fibre supplement drinks.

Treating diverticulitis

Diverticular disease and mild cases of diverticulitis can be treated with over-the-counter painkillers, oral antibiotics, plenty of fluid and rest for a few days. Severe cases often need hospital treatment to provide stronger pain relief, fluid replacement via the vein, antibiotics by injection, and general supportive measures. Occasionally some severe cases will need surgery; this decision is taken after an assessment and a period of observation.

Keyhole surgery for severe diverticular disease

A colectomy is the most common type of operation available in cases where there are serious complications. The colorectal surgeon completely removes the section of large bowel that is most affected.

Advantages of keyhole surgery

The main benefit is that you will be in less pain in the days following the operation, and therefore you will be back to normal activities much faster because your abdominal muscles remain intact. Not all UK colorectal surgeons have the expertise required to offer keyhole surgery for diverticular disease; you will need referral to a specialist laparoscopic colorectal surgeon who has experience of this technique.

If this is performed in an emergency setting, it is usually done using an open surgical technique called a laparotomy. It may not be safe to join the two healthy ends of colon together and so a colostomy is needed. The end of the colon is brought on to the skin and faecal waste empties into a colostomy bag. Ideally this colostomy can be reversed when the patient has made a full recovery, usually three to six months later.

Planned, non-emergency operations can be performed with keyhole surgery (laparoscopically) using three to four small ports.