Diverticulitis Dilemma: Why Surgery May Not Guarantee Relief

Patients and surgeons navigate murky guidelines about whether to have surgery and what to do if surgery isn’t successful.

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Christin Yeoman’s mind was tormenting her with conflicting emotions as she faced emergency surgery to remove 11 inches of her colon.

She was frustrated that antibiotic treatment hadn’t worked on her diverticulitis, a disease that causes inflammation or infection in diverticula or pouches that can form in the colon. A mom with two young children, she was scared about a long, painful recovery. Despite her fears, she was hopeful that surgery would be a cure for the disease that kept interrupting her life.

Yeoman had no choice, however. Her large intestine had torn. She was hospitalized for nine days during the ordeal.

The surgery worked—at least initially. Recurring diverticulitis plagued her, and she had to confront the harsh reality that surgery isn’t always a permanent solution. Her case highlights a growing concern in the medical community: overreliance on surgery for colon problems.

When Surgery Isn’t a Cure

For a year, Yeoman, now 33, was healthy. Then, she was diagnosed with diverticulitis once again, and this time, it was worse, stirring a fresh mix of emotions.

“My flare-ups before my surgery would last a couple days and the pain would subside, and I’d be back to work,” she told The Epoch Times. “When I have flare ups now, I’m down for the count for a week. I’m in a lot of pain. I can’t move. I’m really exhausted. It’s just crazy and completely different. It’s a rougher recovery, and I don’t know why.”

Understanding the Challenges

Yeoman’s situation is not entirely uncommon. There are several reasons why surgery for diverticular disease may not yield lasting results, potentially stemming from either surgeons’ actions or patients’ choices.

For non-emergent cases of diverticulitis, there’s concern about whether too many patients are going under the knife unnecessarily, according to the American College of Surgeons. The organization noted at its annual meeting in October that an individualized and evidence-based approach should replace traditional surgical treatments for uncomplicated cases.

That is, doctors should help patients decide whether their flare-ups are frequent and severe enough to justify surgical intervention. Typically, surgeries are minimally invasive and may even be robot-assisted.

“There used to be real more regimented guidelines,” Dr. Adam S. Harris, a general surgeon, told The Epoch Times. “But now it’s really just patient-doctor discussion.”

Harris, who specializes in colon surgeries, said he often sees complicated cases, particularly those involving patients who are hospitalized for diverticulitis or experiencing recurrent episodes.

Going the Surgical Route

Sometimes called a sigmoid resection, the surgery for diverticulitis entails removing all or part of the large intestine, usually the section closest to the rectum, where inflamed pouches have hardened due to the disease.

Dr. Emily Steinhagen noted at the American College of Surgeons meeting that suitable candidates for surgery typically include those with:

• A poor quality of life and severe symptoms
• Multiple hospitalizations or interventions
• Frequent attacks
• Concern about future attacks

“The data suggest that surgery improves quality of life for most patients who have diverticular disease, particularly those who have quality of life that’s decreased by their symptoms,” Steinhagen said in a news release. “But the key to doing it is having realistic expectations and partnering with our patients in true shared decision-making.”

Insights From Recent Research

To better understand whether surgery is the best remedy for diverticulitis, a study published in 2023 in JAMA Surgery randomized 85 patients who qualified for elective surgery into two groups—those who would receive surgery and those who would follow a conservative treatment of increasing fiber in their diet and taking a fiber supplement.

Within two years, 18 percent of patients in the conservative treatment group underwent a sigmoid resection.

In that same group and timeframe, 61 percent of patients had disease flare-ups, compared to 11 percent in the surgery group. Approximately 25 percent of those assigned to the surgical group ultimately did not proceed with surgery, yet those who did reported better quality-of-life assessments.

The study highlighted deficiencies in the current case-by-case guidelines for not “clearly defining” parameters for when surgery should be offered. Data from the study suggests when a patient has three or more diverticulitis episodes, doctors should offer surgery as a treatment, the authors said.

“The risk of further episodes of diverticulitis can be predicted and is largely based on the number of earlier episodes of diverticulitis,” the researchers wrote. “While patients with first-time uncomplicated diverticulitis have only a 30% risk of recurrence within 5 years, patients who have had 3 or more earlier cases of diverticulitis have about an 80% chance of another recurrence.”

The Return of Diverticulitis Post-Surgery

Three patients who had surgery in the JAMA study ended up with recurrent diverticulitis afterward, compared to 21 patients in the conservative treatment group.

Harris identified several reasons why some patients may continue to struggle with diverticulitis even after surgery:

1. Inadequate Tissue Removal

A surgeon might not excise enough of the colon. Surgery often involves tactile examination of tissues, but because most procedures are performed laparoscopically, surgeons rely on tools rather than direct touch to identify diseased areas, Harris noted.

Surgeons determine whether tissue needs to be removed based on how the tissue reacts when pinched.

“What we’ve been taught is to take out the areas of the colon that have previously been inflamed,” Harris said. “Generally you can tell in surgery because the affected part of the colon is thickened and harder,” he added. “You don’t take out parts of the colon that are soft, even if they have diverticula.”

2. Low Anterior Syndrome (LARS)

LARS refers to common post-surgery complications, such as difficulty with bowel movements, leakage, urgency, and feelings of incomplete evacuation. These chronic symptoms can be mistaken for diverticulitis flare-ups, leading patients to believe the surgery was unsuccessful, Harris said. Surgeons need to ensure their patients understand this possibility prior to surgery, he noted.

Some patients opt for a colostomy—abdominal surgery to create an external pouch that collects stool in order to divert it from the large intestine—to avoid or treat LARS.

3. Dietary Choices

Patients who revert to a poor diet high in processed foods, excessive meat, and low in fiber risk exacerbating their condition, according to Harris.

“It basically comes down to the consistency of the stool,” he said. “Diverticulitis really depends on diet. You can completely change your diet and eat differently, but that’s not so easy for the majority of people, myself included.”

Debunking Dietary Myths

While some doctors may recommend that patients avoid nuts, seeds, and berries, Harris said that is an outdated advice that has been disproven. It was believed those foods could get trapped in the pouches and create problems. In fact, those foods are all high in fiber and can be protective against diverticulitis, he said.

Yeoman said that this is the only dietary guidance she has received, and despite learning it might be inaccurate, she continues to follow it to be cautious.

She has observed that her body doesn’t seem to tolerate red meat unless it’s organic, grass-fed ground beef eaten in small, occasional servings. She said she experienced flare-ups after attending a backyard cookout with a cheeseburger and another after eating a burger from a fast-food restaurant.

Yeoman’s mother has diverticulitis, too, and just had her first surgery this year. A grandmother and aunt were also diagnosed with the disease. Despite the strong genetic predisposition, Yeoman is convinced that her diet plays a significant role in her health.

While a high-fiber diet appears to be preventative, it’s actually not recommended for patients who are undergoing a diverticulitis episode. Rather, doctors recommend a low-fiber diet consisting of easy-to-digest foods, such as broths and cooked vegetables.

Yeoman believes the standard American diet is aggravating her disease, and she’s hoping to avoid another surgery by tuning into her own symptoms to determine how to eat.

“It definitely has a lot to do with your diet for sure. I try to eat as many vegetables as I can,” Yeoman said. “I stay away from red meat … they’ll tell you it doesn’t matter about red meat. I can feel my body, and I will literally have a flare-up if I eat it and it’s not grass-fed.