Diverticulitis is a painful condition where small pouches of the colon (diverticula) become inflamed and infected. It is one of the leading reasons for elective colon resection—the surgical removal of part or all of the large intestine (colon). But in recent years this practice has been called into question. In a new manuscript, “Rethinking elective colectomy for diverticulitis: A strategic approach to population health,” CERTAIN authors Drs. Vlad Simianu and David Flum examine the current landscape of diverticulitis treatment and offer a new perspective on the treatment approach.
Traditionally, surgeons have been trained to offer elective colon resection after a few episodes of diverticulitis. In this case, the colon resection is a non-emergency surgery that is conducted in order to prevent future recurrences of diverticulitis and avoid potential emergency surgeries. However, evidence suggests that the risk of recurrence of diverticulitis is low and happens at a similar rate with or without surgery. At the same time, there has been a substantial but unexplained rise in elective colon resection, despite the evidence that this does not prevent future emergency surgery.
In this publication, Drs. Simianu and Flum explain some of the potential causes of this disconnect and offer suggestions for rethinking which patients will truly benefit from an operation. Recommending elective surgery based on the number of prior episodes of diverticulitis is no longer supported. Rather, a patient-centered approach should consider the risks of recurrence, quality of life burden, patient wishes and experiences about surgical and medical treatment options, and potential health impact or risks of surgery. Looking ahead, studies that consider these areas instead of just the number of prior episodes of diverticulitis should be performed and incorporated into new decision-making guidelines aimed at providing more patient-centered and clinically appropriate care.
Looking Ahead - Making Diverticulitis Treatment Relevant to Patients
CERTAIN partners with people who have experienced diverticulitis, called Patient Advisors, to help surgeons, clinicians, and researchers in our network provide top-notch care and conduct research that is meaningful to patients. Over the next few years, CERTAIN Patient Advisors and researchers will be undertaking several studies to:
- Understand important differences between younger and older patients having surgery for diverticulitis
- Compare how patients and providers make decisions around surgery for diverticulitis
- Determine how patients' lives are impacted by diverticulitis whether or not they have surgery, by checking on them regularly over several years
For more information on the Diverticulitis Patient Advisory Group or our ongoing work in diverticulitis, contact Dr. Vlad Simianu at firstname.lastname@example.org or (206) 616-5536. You can also visit our Diverticulitis Care webpage and read the Diverticulitis Patient Advisory Group recruitment letter.
Help Inform Our Work
If you are someone who has diverticulitis, whether or not you have had surgery, we invite you to tell us about your experience and help inform our work by taking this brief survey: becerta.in/divsurv.