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Diverticulosis of the colon is a very common disease, occurring in approximately 50% of people by the age of 60, and perhaps in an even higher percentage above that age. However, few of these people will experience symptoms, and even fewer of them will necessarily require surgical intervention.

What are the symptoms of diverticulosis?

Divertulas are small “pouches” that develop in the wall of the colon, usually in the left colon and sigmoid colon, but they can also occur along the entire length of the colon. Diverticulosis describes the presence of diverticula in the intestine, while diverticulitis describes the acute inflammation of these diverticula.

In its simplest form, the disease does not cause symptoms. Symptoms are related to complications of the disease, such as diverticulitis or bleeding. In fact, the presence of diverticula can cause significant bleeding from the large intestine.

Diverticulitis, that is, inflammation of these sacs, can cause symptoms such as the following:

• abdominal pain (mainly in the lower left side of the abdomen),
• fever and
• change in bowel “habits”.

In the case of serious complications of the disease, such as perforation, the formation of an abscess or even a fistula, the symptoms are much more intense with high fevers and intense abdominal pain with contraction, the so-called peritonitis.

Why do diverticula form?

The formation of diverticula is related to the quality of our food and the Western “lifestyle”. A low-fiber diet causes chronic increased pressure on the walls of the colon, resulting in the formation of diverticula.

Can diverticulosis be treated?

Once diverticula form, they are difficult to disappear. What someone can do is reduce the chances of their formation, or avoid complications if they have already formed.

Increasing the amount of fiber (vegetables, seeds, legumes) and limiting specific nutrients reduces intraluminal pressure in the colon and reduces the chances of complications.

What should I do in case of diverticulitis?

Since we are now talking about an acute inflammation, the treatment is completely different. Mild episodes can be treated even at home with antibiotics, dietary restrictions and perhaps a laxative.

More severe cases require hospitalization, intravenous administration of antibiotics and serums.

In any case, in case of similar symptoms, you should definitely be examined by a specialist for a correct diagnosis and assessment of the severity of the symptoms.

In which cases is surgical intervention needed?

In the acute phase, episodes of diverticulitis that do not subside conservatively or that cause serious complications must be operated on immediately. In 99% of cases, of course, we always try to treat the episode conservatively. What happens, of course, when someone has repeated episodes of diverticulitis? Should I have surgery? The evidence here is not clear worldwide.

There are various protocols for treating patients with recurrent episodes of diverticulitis, which are based either on the frequency or severity of the episodes. Analyzing these protocols at this point is excessive. The treatment is targeted and individualized for each patient.

What does the surgery involve?

The surgery can be performed both laparoscopically and robotically.

The section of the colon that carries the diverticula is surgically removed (colectomy) and then an anastomosis is performed, i.e. the union of the intestine before and after, in order to restore the continuity of the gastrointestinal tract.

In colon surgery, we prefer robotic access.

The main advantage of the robotic platform is the surgeon’s three-dimensional vision, the wider axes of movement of the surgical instruments, as well as the clearly better ergonomics for the surgeon.

The combination of these offers the possibility of high surgical precision and detailed surgical manipulations that are not reproducible with other methods. The surgeon can thus approach difficult anatomical areas with more precision and safety.

As a result, the robotic platform offers the best result for the patient, in specific diseases.

Will a colostomy be needed after surgery?

Only in cases of very severe inflammation and urgent surgeries, can the anastomosis be considered unsafe and a colostomy be performed, which is “closed” after 3 to 4 months. In the case of a planned surgery, an anastomosis of the intestine is always performed and a colostomy is avoided.

That is why we advise all patients who have had one or two episodes of diverticulitis to be informed about the tests that need to be done and what dietary changes they should pay attention to, so that they can either avoid surgery or have surgery when the disease is already causing severe symptoms, but without acute inflammation.