Treatment

Preventative

• High fibre diet
• Physical exercise

Conservative

Treatment after a first episode of diverticulitis if treated using conservative methods:

• Liquid diet
• Fasting and IV- treatment (in cases of severe infection)
• Antibiotics
• Pain therapy

Surgical

Indication
After two or more episodes of acute diverticulitis surgery is recommended. Young patients and those with low resistance may be subject to surgery after the first episode to avoid later complications.

Method
The affected bowel segment is removed. Mostly this will be the colon sigmoidum. Ideally, the surgery is performed between episodes of inflammation. Nowadays the operation is usually performed using laparoscopic surgery (minimally invasive "key-hole" surgery). Merely tiny incisions are made with little injury to the abdominal wall are necessary.

Advantages of laparoscopic large bowel surgery:

• Faster post-operative intake of food
• Less pain
• Less complications such as infection or abdominal wall hernia
• Shorter in-patient stay
• Faster convalescence (rapid integration into professional and
  private life)

Surgery is also indicated when certain complications occur such as perforation, fistula, stenosis, abscess.

Minimally invasive surgery techniques
Due to great progress in surgical medicine, almost all forms of diverticular disease can be operated on using laparoscopic surgery. Merely four small incisions are made, each between 5 and 10 cm in length, situated in the naval and lower abdomen. To create space for the operation CO2 is introduced into the abdominal cavity. Then the laparoscopy is performed, by which the entire abdominal cavity is examined. The actual surgical intervention is the removal of the affected bowel segment, usually the colon sigmoidum. The ends of the bowel are then sutured. An artificial anus is not necessary. The operation should ideally be performed in an inflammation-free interval.

The minimally invasive surgery (key-hole surgery) bears many advantages for the patient. For one, very small scars produce less pain. Also the gentle method does not scar as much of the abdomen, making later adhesions less probable. This also minimizes post-operative pain considerably. Because of the reduced post-operative pain, the patient is able to stand up earlier. That in turn reduces post-operative complications such as pneumonia, thrombosis or a lung embolism. These advantages together with the rapid intake of food after the operation (fast-track-concept) lead to a faster integration back into professional and private activities.