Indications For Diverticulitis Surgery: Operation Procedure

Indications For Diverticulitis Surgery: Operation Procedure . Surgery for diverticulitis is recommended after the following conditions.

If the patient does not respond to medical treatment promptly.

Recurrent acute diverticulitis.

Diverticulitis with complications.

When carcinoma cannot be ruled out.

When the disease is not associated with any complication which may require resective surgery, the elective treatment of this condition is sigmoid myotomy.

Muscle coats of the sigmoid colon are longitudinally incised between the two anti-mesenteric teniae.

This operation is technically similar to Heller’s operation done for achalasia of cardia or Ramstedt’s operation done for congenital pyloric stenosis.

Operation Procedure For Diverticulitis Surgery

• A lower midline incision is preferred.
  
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  The sigmoid colon must be carefully separated from the left pelvic wall dividing peritoneal adhesions through a blood-less plane, so that the bowel may be held out through the wound.
• A preliminary incision is made with a scalpel starting from the recto-sigmoid junction and proceeding upwards on the exact anti-mesenteric border of the colon over the thickened bowel between the two anti-mesenteric lines.
• The incision is carried on proximally for 8-12 inches till normal un-thickened bowel is reached and then for an inch or so further.
• It may be necessary to incise up to 24 inches.
  
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• It is important that the bowel should be held straight, so that the incision is on the relatively blood-less midline.
• If bleeding occurs, a wet swab should be applied while the other part of the incision is deepened. It may be of assistance to inject saline with or without adrenaline along the line of incision.
• Diathermy or ligation should be avoided.
• After preliminary incision, the cut is deepened by snipping the circular fibers with the fine scissors till the mucosa bulges throughout the length of the wound. It is better to be conservative than too drastic.
• Accuracy of the division is assisted by maintaining gentle retraction on the lips of the incision by the pairs of fine tissue forceps.
• Perforation of the mucosa should be rare if meticulous dissection is carried out. If it occurs, all that is necessary is to suture the mucosa with fine atraumatic catgut.
• A drain should be inserted as a precaution after closing the rent.
• The sigmoid colon is now replaced inside the abdomen and the incision on the left pelvic wall is closed.
• In case of complications such as perforation and peritonitis proximal colostomy, closure of perforation and drainage should be performed.
• In case of obstruction exploration should be done for the cause. Main surgery for obstruction with diverticulitis is diverting transverse colostomy and primary resection of the bowel with anastomosis.
• In case of fistula the diseased colon is resected with primary anastomosis.