Laparoscopic treatment of sigmoid diverticulitis: a retrospective review of 103 cases.
BACKGROUND
Laparoscopic treatment of sigmoid diverticulitis is commonly accepted in Hinchey cases I and II, whereas it is debated in the case of purulent peritonitis, and not indicated for fecal peritonitis.


METHODS
A single-center experience of 103 patients treated for Hinchey I-III sigmoid diverticulitis was reviewed. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. Abscesses in patients with Hinchey IIa were drained percutaneously before surgery. Patients with Hinchey III underwent surgery in emergency. A four-trocar approach with left iliac fossa minilaparotomy was used. Fistulas were treated laparoscopically with Harmonic Scalpel dissection.


RESULTS
Laparoscopic treatment was successfully completed for 100 patients. Intraoperative complications occurred in 2.9% of the cases. Postoperative procedure-related morbidity was 8%, occurring mainly in Hinchey I patients. A longer hospital stay was recorded among Hinchey IIb patients treated for colovescical fistula. No mortality was observed.


CONCLUSIONS
Laparoscopic surgery for sigmoid diverticulitis in experienced hands can be a safe and effective gold standard procedure also for patients with fistula or purulent peritonitis.
Pugliese
R
R
Department of General and Emergency Surgery, Hospital Niguarda Ca'Granda Milano Piazza Ospedale Maggiore, 3, 20162, Milano, Italy. raffaele.pugliese@ospedaleniguarda.it
Di Lernia
S
S
Sansonna
F
F
Scandroglio
I
I
Maggioni
D
D
Ferrari
C
C
Costanzi
A
A
Chiara
O
O
D000368:Aged; D000369:Aged, 80 and over; D004238:Diverticulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000601:surgery*