title: Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis.
abstract: BACKGROUND
  Sigmoid colectomy for diverticulitis can be technically challenging because of severe inflammation in the left-lower quadrant and pelvis. We hypothesized that hand-assisted laparoscopic technique may facilitate laparoscopic completion of this surgery while retaining the short-term benefits associated with "pure" laparoscopic surgery, in which an incision is made only for extracting the specimen. This study was designed to compare the outcomes of patients who underwent totally laparoscopic or hand-assisted laparoscopic sigmoidectomy for diverticulitis.
  
  
  METHODS
  We reviewed our prospectively collected patient database from July 2001 to June 2004 and compared the intraoperative data and postoperative outcomes of patients who underwent elective laparoscopic or hand-assisted laparoscopic sigmoidectomies for diverticulitis. Complicated patients (with abscess or fistulas) also were separately analyzed.
  
  
  RESULTS
  The hand-assisted laparoscopic (mode age, 57 years; 48 percent male) and laparoscopic sigmoidectomy (mode age, 56 years; 90 percent male) groups were similar with regard to age and gender. Overall, patients who underwent laparoscopic (n = 21) vs. hand-assisted laparoscopic (n = 21) sigmoidectomies had a significantly longer operative time (197 +/- 42 vs. 171 +/- 34 minutes, P = 0.04) and shorter incision length (5 +/- 2.1 vs. 9.3 +/- 4.1 cm, P = 0.0001). Patients with complicated diverticulitis (n = 14; abscess, colovesical fistula, enterocolic fistula) who underwent laparoscopic sigmoidectomies (n=4) had a significantly longer operative time compared with hand-assisted laparoscopic sigmoidectomy (n = 10) group (255 +/- 18 vs. 177 +/- 34 minutes, P = 0.001). Conversion rate for the laparoscopic group was significantly higher (3/4 vs. 1/10, P = 0.04, Fisher exact) when complicated diverticulitis was present. There were no differences in postoperative outcomes or incision lengths in the complicated group.
  
  
  CONCLUSIONS
  Outcomes after hand-assisted laparoscopic sigmoidectomy for diverticulitis are similar to those seen in the pure laparoscopic method, with lower conversion rates and shorter operative times. Hand-assisted laparoscopic sigmoid resection for diverticulitis is an attractive alternative to a "pure" laparoscopic method in complicated cases.
authors.affiliation: Department of Surgery, New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York 10021, USA. sal2013@med.cornell.edu
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
authors.forename: James
authors.initials: J
authors.lastname: Yoo
authors.forename: Nadav
authors.initials: N
authors.lastname: Dujovny
authors.forename: Toyooki
authors.initials: T
authors.lastname: Sonoda
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome