title: Recurrence rates at minimum five-year follow-up: laparoscopic versus open sigmoid resection for uncomplicated diverticulitis.
abstract: The aim of the study was to compare the impact of surgical access to sigmoid resection on recurrence rates in patients with uncomplicated diverticulitis of the sigmoid (UDS) at a minimum follow-up of five years. Recurrence after surgery was defined as left lower quadrant pain, fever and leucocytosis with consistent CT and enema findings on admission and at 6 weeks, respectively. Outcome measures included splenic flexure mobilization, specimen length, inflammation at proximal resection margin and presence of teniae coli at distal resection margin. Seventy-nine patients undergoing laparoscopic sigmoid resection (LSR) were compared with 79 matched controls with open sigmoid resection (OSR) operated on at two institutions during the same period. Patients were well matched for age, gender, body mass index, ASA grading and symptoms duration, but not for follow-up length (81.9 vs. 86.9 months, p = 0.046). The rate of splenic flexure mobilization (19 vs. 41, p 0.001), specimen length (16.1 vs. 18.3 cm, p = 0.048), presence of inflammation at proximal resection margin (21 vs. 4, p 0.001), and presence of teniae coli at distal resection margin (4 vs. 53, p 0.001). Three LSR patients and 7 OSR patients had one recurrence (p = 0.19). There were no significant differences in rates of flexure mobilization, specimen length, and rates of inflammation present at proximal resection margin in 10 recurring and 145 non-recurring patients. The rate of teniae coli present at distal resection margin was significantly increased in recurring patients (7 vs. 43, p = 0.03). Surgical access to sigmoid resection for UDS is unlikely to have an impact on recurrence rates provided that the oral bowel end is anastomosed to the proximal rectum rather than to the distal sigmoid.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, USA.
authors.forename: K
authors.initials: K
authors.lastname: Thaler
authors.forename: E G
authors.initials: EG
authors.lastname: Weiss
authors.forename: J J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: J P
authors.initials: JP
authors.lastname: Arnaud
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
authors.forename: R
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012810:Sigmoid Diseases / Q000473:pathology / Q000601:surgery*