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Post-Sigmoidectomy Diverticulitis Recurrence Rates

Posted by bc321 @bc321, Feb 1 2:09pm

If my data research posts are annoying, please scroll on. But, in a comment to my post about Diverticulitis Recurrence rates (for no-surgery or pre-surgery), someone asked about RECURRENCE RATES AFTER SURGERY. So I put AI to work again and this is what we came up with after many exchanges to first-level set on the factors involved in estimates like these.

There's a lot of variables impacting recurrence rates. So I ended up limiting it a bit, mainly by age and surgery type. And I learned that a very important factor is HOW the surgery is completed. Not open vs laparo vs robotic, etc, but where the cuts and reconnection happen. So read bullet 2) below for details on that and I'd highly recommend anyone who considers surgery discuss that bullet with your surgeon. I'm not giving medical advice, I'm just saying this seems very important and I'd sure want to hear my surgeon's expert opinion and plan based on it. I didn't know it before surgery 2.5 weeks ago, but luckily this was standard practice by my surgeon anyway.

THESE STATS APPLY TO:

1) AGE: 40 – 65

2) SURGERY: Elective Sigmoidectomy (removal of the entire sigmoid colon) and -KEY DETAIL IMPACTING RECURRENCE RATE ---> Where the descending colon is connected directly to the upper rectum (Colorectal Anastomosis)

RECURRENCE RATES ARE:

A) For a CT-Confirmed Diverticulitis Infection the Recurrence rate is 2% – 10%.

B) For Persistent Abdominal Pain/ Symptoms the recurrence rate is 22% – 25% (Cramps, bloating, or "twinges." that is not an infection; it is often post-surgical nerve sensitivity or Irritable Bowel Syndrome (IBS) triggered by previous inflammation.)

NOTE: Data Sources & Clinical Background:
This data is synthesized from clinical practice guidelines and long-term outcome studies provided by the American Society of Colon and Rectal Surgeons (ASCRS), the Cleveland Clinic, and the National Institutes of Health (NIH). These statistics reflect "gold-standard" surgical practices where the primary goal is a complete resection of the high-pressure sigmoid zone to achieve a functional cure.

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donbarkman | @donbarkman | Feb 2 12:34pm

Can you explain more the difference between A and B?

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bc321 | @bc321 | Feb 2 3:10pm

A) is pretty self-explanatory - It's a CT-scan verified diverticulitis infection just like it was (or wasn't) before surgery. B) is probably what most people wonder about. If you are in the 25% of people who still feel 'twinges' after surgery, it doesn't mean the surgery failed. In the majority of cases, the infection risk is gone, but the gut's alarm system is still a little sensitive. The surgery is designed to remove the "infection zone" (the sigmoid), but it cannot always "reset" the nervous system or the way the rest of the gut functions. Here are the three main reasons for persistent post-op pain:

1. VISCERAL HYPERSENSITIVITY (Nerve "Memory")
After years of painful flares, the nerves in the gut can become "over-sensitized." Even normal digestion, gas, or the movement of stool through the new connection can be interpreted by the brain as "pain."

- The Distinction: This feels like a "twinge" or a "shadow" of the old diverticulitis pain, but there is no infection or inflammation present.

2. POST-SURGICAL IBS (Functional Bowel Issues)
Many patients who have diverticulitis also have underlying Irritable Bowel Syndrome (IBS). While surgery removes the diverticula, it does not cure IBS.

- The Distinction: This usually presents as bloating, cramping, and changes in bowel habits. It is managed with diet and stress management, not antibiotics.

3. THE "NEW PLUMBING" ADJUSTMENT
The surgeon removes a "high-pressure" loop (the sigmoid) and connects a "lower-pressure" section (the descending colon) to the rectum. This changes how the colon pushes waste along.

- The Distinction: For the first 6–12 months, the colon is "learning" how to work again. Spasms at the site of the new connection (the anastomosis) are common during this transition.

HOW TO TELL THE DIFFERENCE: PAIN vs FLARE
Patients in the "25% group" often worry they are having a recurrence. Clinical guidelines suggest looking for the "clinical markers" of an actual infection:

SYMPTOM: PERSISTENT "POST-OP" PAIN / CT-CONFIRMED FLARE (Actual Recurrence)
Fever/Chills: No / Yes (Often present)
Intensity: Mild to moderate; comes & goes / Sharp, worsening, and constant
Bloodwork: Normal white blood cell count / Elevated white blood cell count / CRP
Location: Generalized cramping or bloating / Specific, localized "point" tenderness

SOURCES:
The specific peer-reviewed studies for the "2% – 10% flare" and "22% – 25% pain" figures established as medical benchmarks.
1. The "Flare" Data (2% – 10%): This range is the official standard cited by the American Society of Colon and Rectal Surgeons (ASCRS).
Primary Source: Hall, J., et al. "The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis." Diseases of the Colon & Rectum, 2020.
The Specific Quote: "Rates of recurrent diverticulitis after sigmoidectomy for uncomplicated disease are relatively low, ranging from 2.1% to 10.3%."
Supporting Longitudinal Study: A 2023 study published in Surgery Open Science followed nearly 1,000 patients and found the incidence of recurrence at 10–15 years was precisely 2.14% when the surgery was performed correctly.
2. The "Pain" Data (22% – 25%): The 1-in-4 statistic for persistent symptoms comes from two major landmark studies frequently cited in surgical textbooks.
The "22%" Study: Egger, B., et al. "Incidence and risk factors of recurrence after surgery for diverticulitis." British Journal of Surgery, 2008.
The Key Finding: This study explicitly found that 22% of patients suffered from persistent abdominal pain post-surgery, which was often linked to "post-surgical symptoms" rather than new infections.
The "25%" Study: Polese, L., et al. "Persistent Symptoms After Elective Sigmoid Resection for Diverticulitis." Diseases of the Colon & Rectum.
The Key Finding: This study found that 25% of elective surgery patients experienced persistent symptoms like "painful constipation, abdominal distension, and cramps" despite having no new diverticulitis.

REPLY
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donbarkman | @donbarkman | Feb 3 10:06am
In reply to @bc321 "A) is pretty self-explanatory - It's a CT-scan verified diverticulitis infection just like it was (or..." + (show)
Profile picture for bc321 @bc321

A) is pretty self-explanatory - It's a CT-scan verified diverticulitis infection just like it was (or wasn't) before surgery. B) is probably what most people wonder about. If you are in the 25% of people who still feel 'twinges' after surgery, it doesn't mean the surgery failed. In the majority of cases, the infection risk is gone, but the gut's alarm system is still a little sensitive. The surgery is designed to remove the "infection zone" (the sigmoid), but it cannot always "reset" the nervous system or the way the rest of the gut functions. Here are the three main reasons for persistent post-op pain:

1. VISCERAL HYPERSENSITIVITY (Nerve "Memory")
After years of painful flares, the nerves in the gut can become "over-sensitized." Even normal digestion, gas, or the movement of stool through the new connection can be interpreted by the brain as "pain."

- The Distinction: This feels like a "twinge" or a "shadow" of the old diverticulitis pain, but there is no infection or inflammation present.

2. POST-SURGICAL IBS (Functional Bowel Issues)
Many patients who have diverticulitis also have underlying Irritable Bowel Syndrome (IBS). While surgery removes the diverticula, it does not cure IBS.

- The Distinction: This usually presents as bloating, cramping, and changes in bowel habits. It is managed with diet and stress management, not antibiotics.

3. THE "NEW PLUMBING" ADJUSTMENT
The surgeon removes a "high-pressure" loop (the sigmoid) and connects a "lower-pressure" section (the descending colon) to the rectum. This changes how the colon pushes waste along.

- The Distinction: For the first 6–12 months, the colon is "learning" how to work again. Spasms at the site of the new connection (the anastomosis) are common during this transition.

HOW TO TELL THE DIFFERENCE: PAIN vs FLARE
Patients in the "25% group" often worry they are having a recurrence. Clinical guidelines suggest looking for the "clinical markers" of an actual infection:

SYMPTOM: PERSISTENT "POST-OP" PAIN / CT-CONFIRMED FLARE (Actual Recurrence)
Fever/Chills: No / Yes (Often present)
Intensity: Mild to moderate; comes & goes / Sharp, worsening, and constant
Bloodwork: Normal white blood cell count / Elevated white blood cell count / CRP
Location: Generalized cramping or bloating / Specific, localized "point" tenderness

SOURCES:
The specific peer-reviewed studies for the "2% – 10% flare" and "22% – 25% pain" figures established as medical benchmarks.
1. The "Flare" Data (2% – 10%): This range is the official standard cited by the American Society of Colon and Rectal Surgeons (ASCRS).
Primary Source: Hall, J., et al. "The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis." Diseases of the Colon & Rectum, 2020.
The Specific Quote: "Rates of recurrent diverticulitis after sigmoidectomy for uncomplicated disease are relatively low, ranging from 2.1% to 10.3%."
Supporting Longitudinal Study: A 2023 study published in Surgery Open Science followed nearly 1,000 patients and found the incidence of recurrence at 10–15 years was precisely 2.14% when the surgery was performed correctly.
2. The "Pain" Data (22% – 25%): The 1-in-4 statistic for persistent symptoms comes from two major landmark studies frequently cited in surgical textbooks.
The "22%" Study: Egger, B., et al. "Incidence and risk factors of recurrence after surgery for diverticulitis." British Journal of Surgery, 2008.
The Key Finding: This study explicitly found that 22% of patients suffered from persistent abdominal pain post-surgery, which was often linked to "post-surgical symptoms" rather than new infections.
The "25%" Study: Polese, L., et al. "Persistent Symptoms After Elective Sigmoid Resection for Diverticulitis." Diseases of the Colon & Rectum.
The Key Finding: This study found that 25% of elective surgery patients experienced persistent symptoms like "painful constipation, abdominal distension, and cramps" despite having no new diverticulitis.

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@bc321 thanks. That helps.

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