Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients.
BACKGROUND
The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis.


METHODS
The data were collected within the framework of an ongoing prospective multicenter study carried out by the Lapa roscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30-100 procedures; Group III, < 30 procedures).


RESULTS
Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I-IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates.


CONCLUSIONS
An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable ntraoperative and postoperative complication rates, operating time, and mortality rates.
Scheidbach
Hubert
H
Department of Surgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany. scheidbach@t-online.de
Schneider
Claus
C
Rose
Jörg
J
Konradt
Jochen
J
Gross
Eberhard
E
Bärlehner
Eckhard
E
Pross
Matthias
M
Schmidt
Uwe
U
Köckerling
Ferdinand
F
Lippert
Hans
H
D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D004238:Diverticulitis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012810:Sigmoid Diseases / Q000401:mortality / Q000601:surgery*