Dr. José María Lloret - Vistahermosa surgery

Diverticulosis It is a disease that fundamentally affects the colon on its left part (Sigma) characterized by the presence of bags or bags that protected the outside of it.

The majority originate from the increase in internal pressure of the colon that makes the internal layers weaken and prolapsen through the weakest points with the consequent dilation.

It is a very frequent pathology in western countries and apart from genetic factors, the poor fiber diet is an important cause for their formation.

It affects 30 % of the population over 60 and more than 70 % from 70 years.

The majority of patients do not have symptoms, only 10% will consult due to vague digestive discomforts such as pain on the left side of the abdomen, gases, swelling and alteration of the frequency of the depositions; These discomforts increase after meals and relieve themselves with defecation or windy.

Established the suspicion of diverticular disease, the diagnosis can be radiological or endoscopic, either with an opaque enema or through a colonoscopy, which will allow us to rule out other pathologies such as tumors, polyps, etc.

If the patient has symptoms, the diet rich in fiber exerts a protective effect on it although the rifaximin diet association (400 mgrs a day, 7 days a month) has demonstrated a clear symptomatic improvement. The use of Lactobacillus type probiotics can also be helpful in the prevention of recurrence.

Diverticulitis It is the inflammation of one or more diverticula and it is its most frequent complication.
It occurs in 10 - 25 % of patients and symptomatology is acute pain on the lower left side of the abdomen (left iliac fossa), it is also known as the "left appendicitis" and is accompanied by fever and alteration of episodes of constipation and diarrhea as well as nausea and vomiting.

Given the suspicion of an acute process, the patient undergoes a study protocol in the emergency department composed of thorough, blood test and abdominal stroke; With these three tests, the diagnostic reliability is very high (92-98%) obtaining the necessary information for the correct treatment. This goes from a mild process (the most frequent) to more serious forms, some of which will require urgent surgical intervention.

If the picture is mild and the patient brings together specific criteria (not applicable in senility, diabetes, renal failure, immunosuppressed, etc.) the treatment is done at home with liquid diet, antibiotics and analgesics, with very clear instructions regarding the follow -up of their process and posterior appointments for strict control of the disease.

The most serious cases require hospital admission with digestive rest, sera, intravenous antibiotics and analgesia until its improvement that allows the reintroduction of the diet and the passage to the oral via the treatment.

When operating?

The criteria for surgical intervention, today, are individualized there is no general recommendation for it.

In our experience, the presence of outbreaks of diverticulitis very often, the age and the presence of associated diseases that can complicate the postoperative period, are a reason for preferential surgical indication.

This intervention is carried out by laparoscopy and consists in the resection of the affected intestinal segment and the suture with mechanical circular stapers of both ends of the sectioned.

The postoperative stay varies from 5 to 8 days with complete recovery from the third postoperative week both dietary and physical and work.