Operation

The duration of diverticulitis surgery depends on the chosen surgical technique, the patient’s condition (pre-operated, obese, etc.) and the severity of the disease. As a rule and without special features, a duration of about 1-3 hours for the operation is realistic.

Stadiums according to Hansen and Stock

The classification of the disease stages of diverticulitis is not binding, however, the classification according to Hansen and Stock has proven to be successful in everyday clinical practice. Here 4 stages, i.e. severity of the disease, including the exact description of the stage of the disease, as well as the respective clinical symptoms are described.

Stage 0 is called uncomplicated diverticulosis, i.e. an inflammation-free change in the large intestine with small intestinal wall protuberances (diverticula).
In diverticulosis there are usually no symptoms of disease.
The so-called acute, uncomplicated diverticulitis represents the 1st stage. Here the inflammation can only be found on the intestinal wall. Clinically, pain in the lower abdomen and fever can occur.
The 2nd stage is called acute, complicated diverticulitis.
This stage is divided into 3 subcategories (IIa, IIb, IIc), depending on the degree to which the inflammation spreads in the intestinal wall. If there is an intestinal perforation of the intestinal wall in the area of the bulges (diverticula), this is an emergency situation, since the entire abdominal cavity can become inflamed by escaping intestinal germs (peritonitis). This clinical picture is clinically known as acute abdomen.

A rapid surgical intervention to prevent the spread of inflammation should be performed at stage IIc.
The last stage (stage III) is the chronic, recurrent form of diverticulitis (chronic recurrent diverticulitis). This stage is characterized by recurrent (recurrent) lower abdominal pain and constipation. The clinical picture of an incomplete intestinal obstruction with very slow food transport (subileus) can also occur.

Preparation for surgery

The most decisive factor for the success of the operation is the quality of the end-to-end connection between the two ends of the intestine, from the middle of which a piece has been removed. If the suture leaks, the abdominal cavity may be contaminated by bacteria-populated stool and serious inflammation may occur. Such an inflammation can be limited to one area of the abdominal cavity or spread throughout the entire abdominal cavity.

An inflammation of the peritoneum (peritonitis) can be fatal under certain circumstances. Abscesses (pus-filled capsule) can, as after a perforation (piercing) of the intestine, result from contamination of the peritoneal cavity. They are usually felt as a painful hardening in the lower abdomen with persistent increase in body temperature and chills.

Fistula ducts (tube-like connections) may remain after the operation. They form a passage from the operated intestine to adjacent organs or the outer edge of the wound (skin). They are caused by incomplete scarring, which means that the tissue does not grow together properly and leaves a wound cavity.

Frequently, a small hole is visible in the area of the surgical incision from which defecation or secretion is running. In case of fistula formation with the urinary bladder, recurrent urinary tract infections often develop. Air admixtures in the urine (pneumaturia) or mixing of the urine with stool (fecaluria) can be signs of such fistula formation.

In 30% of cases, however, the fistulas remain undetected due to minor or non-existent symptoms. Scarring naturally occurs in the abdomen after surgery, which is not visible to us externally. As a result of this scarring, the intestinal lumen can become narrowed and in the worst case, the intestinal obstruction (obstruction of the bridge) can occur. If nerve plexuses are injured during the operation, this can lead to faecal and/or urinary incontinence or in rare cases to erectile dysfunction in men. Other non-specific complications include injury to blood vessels with a loss of blood that may require a blood transfusion, infection of the outer skin/wound edges or injury to other abdominal organs such as the bladder or healthy sections of the intestine.