Diverticulitis & Sigmoidectomy Comprehensive FAQ Document

@queenie52 Regarding your question of "If surgery is needed to do a sigmoid colectomy, what will the recovery time be like and will it greatly decrease my chances of reoccurring diverticulitis?" From what I've heard from fellow patients in patient groups, recovery time is different for everyone, and is impacted by the level of complication of the disease, other medical issues involved, age, overweightness (that's not really a word), health and fitness going into the surgery, smoking (before and after), proper preparation for surgery, proper recovery nutrition and actions after the surgery, and probably genetics. As for recurrence, as I said in the FAQ's: "The recurrence rate of diverticulitis after a complete resection is quite low. Data generally shows recurrence rates between 2% and 10% over a 10-year period. While new diverticula can form in the remaining colon (proximal to the resection), the risk of severe, complicated diverticulitis is significantly reduced. [4]" Also, if the diverticulitis occurs in the sigmoid colon, a major impact on recurrence is making sure the entire sigmoid colon is removed, not just the 'diseased part'. This is standard medical practice now but I've heard of people having, and/or hoping, that they only take out as little as possible - just the diseased part. The bottom line is that the sigmoid is the high-pressure zone and that's why diverticulitis happens there. If it happened there before surgery, it'll likely happen there after surgery. So the surgery should involve re-connecting the descending colon to the upper rectum, and that should be because the surgeon removed ALL of the sigmoid colon.

As for your comment of: "I’m 74 years old and active and the surgeon told me that as I get older, the chances of complicated diverticulitis with perforation or rupture of the area increase with each occurrence." I can't speak for how age impacts this but my research shows that 75% of patients presenting for treatment with Free Perforations have no prior history of diverticulitis. It is their first ever episode and primary complication. This came from what I frequently hear referenced as "The Chapman Study", (https://pubmed.ncbi.nlm.nih.gov/16192818/ (Complicated diverticulitis: is it time to rethink the rules?)). That's not saying that you can't have a free perforation (which is what you're calling a rupture), since 25% of the patients in that study with free Perforations apparently did have a history of Diverticulitis. But my research also shows that as you have more diverticulitis episodes, the risk of complications does increase (free perforation is just 1 of multiple complications). And I won't go into all of the complications because they're all in the FAQ document I posted. The bottom line is - if you've had multiple diverticulitis episodes already, the likelihood of more episodes, and greater chance of complications, increases with time. Time also = age. So yes, as you get older your chance of complications increases but not necessarily because you're older but because you will likely continue to have diverticulitis episodes. That's not saying age has nothing to do with it, because like about any medical condition - the earlier you treat it the less severe the condition needing treatment likely is, and the ease of treating it is, and the speed and effectiveness of recovery is. But I am not a doctor and I do not know all there is to know about your condition - that's between you and your doctor. I just hope this gives you some perspective, some additional knowledge, and it all makes your discussions with your surgeon more productive so you can make a decision together sooner vs later.

I waited 12 years from my first episode til surgery (45-57yo) and finally realized it was not going away, it was only going to get worse and more frequent, every episode added a better chance of a complication, and if I was going to do it - the younger I did it the less complicated the surgery would be and the easier/more effective the recovery would be. I also know I'll need an aortic valve replacement since I was born with a bicuspid valve, so the docs said it is better to do the colon now before the heart docs say you have to get the valve fixed before you can do the colon and then I'd be stacking up back-to-back surgeries in my 60/s or 70's vs doing the Colon in my 50's and the heart in my 60's or 70's. Best of luck.

@queenie52 Have you had a CT scan? I'd ask the docs about any concerns with a colovesical fistula. Don't freak out, I'm not trying to make you nervous. But with diverticulitis one of the complications can be a fistula which creates a connection to the bladder (or other organs) and causes bladder infections and UTIs. Again, don't freak - and you probably already discussed this with your doc. I just saw this comment and wouldn't feel right not bringing this up for you to ask about and discuss with your doc if you haven't already.

@jlharsh One additional comment for you, since I see you are a mentor. I'm assuming you have access to colorectal docs and surgeons and the department overall at Mayo. If not, disregard. But if so, I've published this and other tools on patient sites (I'm a bit of a novice research geek) and I get people all of the time saying "This is great! Why don't my doctors explain all of this to me?" I get it, the Docs only have so much time, and they have dealt with these topics for so long that some of the basics of a condition probably seem common sense/common knowledge to them. But I think it would be good for them to work on reverting to a patient's point of view and putting information out like this. I know, liability and all - attorneys - probably won't let them. But it is just an idea to pass along if you have the capability and think it is worthwhile. Thanks.

@bc321
Yes I had a CT scan the last week of July prior to seeing the colorectal surgeon and it was normal. I wondered that myself so I did ask if it showed a fistula and he assured me it did not.

@queenie52

About 20 years ago, in my sixties, I had a sigmoid colon resection along with a bladder repair for a colovesical fistula. What started as a laparoscopic procedure turned into an open surgery due to excess weight.

My short-term recovery was complicated by an ileus. Apparently one's large bowel does not like people poking around down there and sometimes goes into opossum mode. That turned into an extended hospital stay whereby I developed great appreciation for the skill and kindness of the Mayo nurses.

I will gloss over the details but initial recovery included a catheter, liquid diet, walking the corridors and hospital bed rest.

It took several months at home to recover my strength. Loose stool was not a problem for long as my gut adjusted. The great thing is that the cramping and diarrhea I would occasionally experience are a thing of the past and the chance of colon cancer is reduced.

Hope this helps. Good luck!

@queenie52 thanks. This surgeon was recommended by my GI doc and has done 500 of these surgeries. This should be robotic surgery. You caution is appreciated.