What is the three-stage surgical approach for diverticulitis?

Updated: Aug 06, 2019
  • Author: Elie M Ghoulam, MD, MS; Chief Editor: BS Anand, MD  more...
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Answer

The classic three-stage surgical approach is rarely indicated at present because of its high associated morbidity and mortality. This procedure is considered only in critical situations in which resection cannot safely be performed. Consider the following:

  • In the three-stage approach, the initial operation is simply drainage of the diseased segment and creation of a proximal diversion colostomy, without resection.

  • The second operation is performed 2-8 weeks later to resect the diseased bowel and perform a primary anastomosis.

  • A third operation, performed 2-4 weeks after the second operation, closes the stoma.

Laparoscopy

Increasing experience with laparoscopic techniques for colon resection suggests that some of its advantages include less pain, a smaller scar, and shorter recovery time. [47]  There is no change in early or late complications, and the cost and outcome are comparable to open procedures. The laparoscopic approach is best suited for patients in whom the episode of acute diverticulitis has resolved and in patients with Hinchey stage I or II disease.


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