Diverticulum Surgery in Ankara, Turkey

Diverticulum surgery is a treatment method applied when pouches formed in the large intestine become inflamed or cause complications. Surgery is preferred in recurrent cases of diverticulitis where medical treatment is insufficient.

The most commonly performed method in diverticulum surgery is colon resection. In this procedure, the diseased segment of the intestine is removed and the healthy ends are joined together. Laparoscopic techniques provide less pain and faster recovery.

The post-operative nutrition plan is important. Initially, liquid foods are preferred, and over time a fiber-rich and balanced diet is introduced. Regular doctor follow-ups play a critical role in preventing complications.

Quality of life increases after diverticulum surgery. The risk of abdominal pain and inflammation decreases, and bowel functions return to normal. A specialist surgical approach both increases the success rate and minimizes the risk of complications.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Diverticulum Surgery in Ankara, to get information about Diverticulum Surgery prices, the process, and the hospital where Diverticulum Surgery is performed.

What is a diverticulum and why does it occur?

We can think of our large intestine like a garden hose that we have used for years. Over time, especially when the pressure inside increases, small bubbles may form outward at the weak points of the hose. Diverticula are just like this; they are small pouches formed by the herniation of the inner lining outward through weak points in the intestinal wall. The most common location of these pouches is the final part of the large intestine, the region we call the “sigmoid colon.” There is a simple physical explanation for this: The narrower the diameter of a tube, the higher the pressure inside it. Since the sigmoid colon is the narrowest part of the large intestine, it is exposed to the highest pressure and is the most prone area for diverticulum formation.

For many years, it was thought that the only cause of diverticula was a low-fiber diet. Insufficient fiber intake hardens the stool and increases intraluminal pressure, facilitating the formation of pouches. Although this information is still valid, it is not the whole picture. Today, we understand that irregularities in bowel movements, an unnoticed chronic and low-grade inflammatory state in the intestinal wall, and genetic factors also play an important role in this process. In other words, we now see diverticular disease not just as a simple mechanical problem but as a more complex condition influenced by the body’s overall inflammatory status. This new understanding directly affects our treatment approaches.

Are there different types of diverticular disease?

Yes, the presence of diverticula does not always mean the same thing and may present with different clinical pictures. The main conditions are as follows:

• Asymptomatic Diverticulosis
• Acute Diverticulitis
• Chronic (Symptomatic) Diverticular Disease
• Diverticular Bleeding

Asymptomatic diverticulosis is the condition in which a person has pouches in the intestine but no complaints, and it is the most common form. It is usually detected incidentally during examinations performed for another reason and does not require treatment. Acute diverticulitis is the inflammation of these pouches and is a painful condition that requires urgent medical intervention. In chronic diverticular disease, symptoms that impair quality of life such as persistent abdominal pain, bloating, and changes in bowel habits are observed. Finally, diverticular bleeding is a serious condition that occurs when a vessel at the base of the pouch ruptures and typically presents with painless but profuse rectal bleeding.

What are the symptoms of a diverticulitis attack?

An acute diverticulitis attack usually begins with quite typical symptoms. The most common complaints include:

• Sudden onset and gradually increasing pain in the lower left part of the abdomen
• High fever or chills
• Nausea and sometimes vomiting
• Change in bowel habits (usually constipation)
• Abdominal bloating and tenderness
• Loss of appetite

The most important of these symptoms is pain in the lower left quadrant of the abdomen. If the inflammation has spread to the peritoneum (peritonitis), the pain spreads throughout the abdomen, the abdominal wall becomes rigid like a board, and the condition becomes much more serious. It should not be forgotten that in elderly individuals or those with a weakened immune system, these symptoms may be very subtle. Even simple complaints such as mild abdominal discomfort or fatigue may be a sign of a serious underlying diverticulitis attack. Therefore, it is necessary to be more careful and suspicious in this patient group.

How is diverticulitis diagnosis confirmed?

In a patient presenting with suspected diverticulitis, blood tests are first performed. Elevated white blood cells (leukocytes) and inflammatory markers such as CRP provide important clues that there is an infection in the body. However, the gold standard method for making a definitive diagnosis, determining the severity of the disease, and planning treatment correctly is contrast-enhanced abdominal tomography (CT).

Tomography provides us with very valuable information. It clearly shows the extent of inflammation in the intestinal wall, whether it has spread to the surrounding fatty tissue, and whether serious complications such as abscess (a pus-filled sac) or perforation have developed. It also allows us to rule out other diseases that may cause abdominal pain (appendicitis, ovarian problems, urinary tract stones, etc.). According to the tomography findings, we stage the disease, and this staging guides us in making critical decisions such as whether the patient will be treated as an outpatient or inpatient, whether antibiotics are needed, or whether emergency surgery is required. During an acute attack, procedures such as colonoscopy are strictly avoided as they may increase the risk of perforation.

In which cases is hospitalization required in diverticulitis treatment?

Not every patient with diverticulitis needs to be hospitalized. Most patients with an uncomplicated, mild attack, good general condition, able to eat orally, and whose pain is under control can be treated at home on an outpatient basis. However, hospitalization is mandatory in some cases. The main conditions requiring hospitalization are:

• Detection of a complicated condition such as abscess, perforation, or obstruction on tomography
• Signs of systemic infection (sepsis) such as high fever and low blood pressure
• Inability to take fluids and food orally due to severe nausea and vomiting
• Inability to control pain with oral medications
• Advanced age
• Presence of serious comorbidities such as diabetes and kidney failure
• Use of immunosuppressive medications (for example, organ transplant patients)

Hospitalized patients are given intravenous fluids, oral intake is stopped to rest the intestines, and strong intravenous antibiotics are started.

Is antibiotic use always necessary in diverticulitis treatment?

The understanding in medicine on this subject has changed significantly in recent years. In the past, antibiotics were reflexively started in every patient diagnosed with diverticulitis. However, scientific studies have shown that simple and uncomplicated diverticulitis attacks are actually more of an inflammatory reaction rather than an infection. Therefore, it has been proven that successful results can be achieved in patients with mild attacks, good general condition, not very high fever, and no significant deterioration in blood values, without using antibiotics, only with bowel rest (liquid diet) and pain control.

Today, we adopt a selective approach in mild uncomplicated diverticulitis cases and do not give antibiotics to every patient. However, in patients with complicated conditions such as abscess detected on tomography, weakened immune system, or signs of sepsis, intravenous antibiotic therapy still forms the basis of treatment.

Can a diverticular abscess be treated without surgery?

Yes, today most abscesses developing due to diverticulitis can be treated without surgery. In the past, patients who developed an abscess were taken directly to emergency surgery, and these surgeries often resulted in a permanent or temporary bowel bag (stoma).

Now, especially for abscesses larger than 3-4 cm and located in a technically accessible position, the first treatment option is percutaneous drainage performed by interventional radiology. In this procedure, under CT or ultrasound guidance, the abscess cavity is accessed through the skin with a thin needle, and the pus inside is drained externally through a catheter (thin tube). This method effectively controls the source of infection and spares the patient from emergency and risky surgery. Approximately 6-8 weeks after the abscess has completely healed and the acute inflammatory condition has regressed, the diseased bowel segment can be removed with a planned surgery under much safer conditions. This “bridging therapy” significantly reduces the risks of emergency surgery and the likelihood of a permanent stoma.

When should surgery be considered after recurrent diverticulitis attacks?

In the past, elective surgery was recommended to everyone who had two attacks to protect against future risks. This “rule” is no longer valid. Because we know that the majority of perforations requiring emergency surgery occur during a person’s first attack. In other words, the risk of experiencing an emergency situation in the future for someone who has had a simple attack is not as high as previously thought.

Therefore, today the decision for elective surgery is made together with the patient based not on the number of attacks but on how much the disease affects the person’s quality of life. The situations in which we strongly consider elective surgery are:

• Frequent recurrent attacks that impair quality of life
• Persistent abdominal pain and discomfort
• History of a complicated attack (abscess, perforation, etc.)
• Development of narrowing in the intestine or fistula (tract) to adjacent organs
• Weakened immune system
• Inability to rule out an underlying suspicion of cancer

The main goal of surgery is to remove the problematic sigmoid colon segment, freeing the person from the cycle of attacks, pain, continuous dietary restrictions, and the anxiety of “it could happen again at any moment.” Studies show that in properly selected patients, surgery significantly improves quality of life.

What are the advantages of closed (laparoscopic) diverticulum surgery?

In planned diverticulum surgeries, the modern standard of today is laparoscopic (closed) surgery. In this technique, instead of making a large incision in the abdomen, a camera and special instruments inserted through several small incisions (0.5-1 cm) are used. The surgery is performed entirely inside the abdomen, and the portion of the intestine to be removed is usually extracted through a small incision made in the groin area.

Laparoscopic surgery has many proven advantages over open surgery:

• Less postoperative pain
• Smaller surgical scars
• Lower risk of wound infection
• Faster return of bowel function
• Shorter hospital stay
• Earlier return to daily life and work

For these reasons, the laparoscopic method should be the first choice for planned diverticulum surgery in every technically feasible case.

What is the role of robotic surgery in diverticulum surgery?

Robotic surgery is the most technologically advanced form of laparoscopic surgery. The surgeon controls the robot’s arms while seated at a console. The most important innovations provided by the robotic system are three-dimensional and high-resolution imaging and instruments that are more flexible and precise than the movement capability of the human wrist. This technology provides great convenience to the surgeon, especially in obese patients with severe intra-abdominal adhesions due to previous attacks or with a narrow pelvic structure. In such challenging cases, it may be difficult to complete the surgery with the standard laparoscopic method, and the risk of conversion to open surgery may increase. Robotic surgery increases the chance of successfully completing the closed surgery in such cases, helping to protect the patient from the disadvantages of open surgery.

What is the ERAS protocol that accelerates the recovery process after surgery?

In modern surgery, ERAS (Enhanced Recovery After Surgery) protocols are applied to help patients get through the postoperative period more easily and recover faster. This is a care package consisting of a series of evidence-based practices. Its main components are:

• Avoiding prolonged fasting before surgery
• Supporting patients with carbohydrate-rich fluids before surgery
• Maintaining body temperature during surgery
• Avoiding unnecessary use of catheters and drains
• Mobilizing the patient as early as possible after surgery
• Starting oral nutrition as soon as possible
• Avoiding morphine-derived medications in pain control as much as possible

Thanks to these protocols, hospital stay is shortened, surgery-related complications are reduced, and the overall recovery process is significantly accelerated.

How should nutrition and lifestyle be after diverticulum surgery?

In the postoperative period, nutrition is gradually adjusted in parallel with the recovery process. During the first few weeks after surgery, a low-residue diet is applied to allow the intestinal sutures (anastomosis) to heal safely. The foods recommended during this period generally include:

• White bread, rice porridge, pasta
• Well-cooked and strained soups
• Peeled and seedless, well-cooked vegetables (potatoes, carrots)
• Fruits such as bananas and peeled apples
• Dairy products such as yogurt and cheese

After the patient has fully recovered, usually 4-6 weeks after surgery, the main goal is to change long-term dietary habits. The aim here is to prevent similar problems in the future. In the long term, nutrition should be based on high-fiber foods.

• Whole grain bread and products
• Grains such as oats and bulgur
• Legumes (chickpeas, lentils, beans)
• Plenty of fresh vegetables (especially leafy greens)
• Fruits that can be consumed with their peels
• Nuts and seeds

In addition to a high-fiber diet, drinking at least 2 liters of water per day is vital to keep the stool soft and facilitate bowel passage. With a properly performed surgery and the adoption of healthy lifestyle habits afterward, the risk of recurrence of diverticular disease-related problems is quite low, and the vast majority of patients return to a healthy and comfortable life.