Is laparoscopic surgery applicable to complicated colonic diverticular disease?
BACKGROUND
Expanding upon our experience with laparoscopic surgery for colonic benign and malignant processes and for bowel obstruction, we have reviewed our experience with minimal access laparoscopic surgery for complicated diverticular disease. We propose an approach of surgical care incorporating diagnostic laparoscopy in those not responding to medical therapy alone.


METHODS
Our study includes data from two different surgical teams working in separate hospital-and-patient environments. Our theory that laparoscopy could be widely applicable to this complex disease process is borne out by experience in both locations. One hundred forty-eight patients were managed by laparoscopic or laparoscopically assisted methods with 18 patients requiring drainage only without resection.


RESULTS
Our management of 148 of 164 patients (90%) by laparoscopic approach was successful, with a very acceptable morbidity of 5% in the elective cases and decreased ileus (20% of open vs 7% laparoscopic) in acute complicated cases. Elective resections required hospitalization of 4-5 days, demonstrating the benefits of incorporating laparoscopy in the care of these cases, particularly when compared to standard open procedures requiring 8 days' hospitalization.


CONCLUSIONS
We believe complications of diverticular disease including abscess, perforation, fistula, and bleeding can potentially be managed in this way by minimal access procedures, decreasing postoperative wound problems, decreasing length of hospitalization and overall morbidity, and improving patient care.
Franklin
M E
ME
Texas Endosurgery Institute, San Antonio 78222, USA.
Dorman
J P
JP
Jacobs
M
M
Plasencia
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004239:Diverticulitis, Colonic / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D004241:Diverticulum, Colon / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D016896:Treatment Outcome