[Laparoscopic colon-sigmoid resection with mesenteric artery preservation for diverticular disease].
OBJECTIVE
About 2/3 of the Western population over the age of 80 years are affected by colic diverticulosis; 25% will develop diverticular disease with or without complications: fistula, obstruction, pericolic abscess, free perforation or hemorrhage. Laparoscopic approach for benign diseases of the colon such as diverticulosis, Chrohn's disease, etc. is unanimously considered as a very effective procedure. We have performed a retrospective analysis of 9 years with laparoscopic approach of the diverticular disease. The purpose of this study was to determine the feasibility, safety and benefits of laparoscopic approach.


METHODS
From May 1994 to November 2002, 69 patients affected by non-complicated diverticular disease, were treated laparoscopically, at the Mininvasive Surgery Department of Spoleto. In the same period other 213 patients suffering from cancer of the colon-rectum were operated through laparoscopic surgery. A colosigmoid resection with mesenteric inferior artery preservation was performed in 46 cases (67%).


RESULTS
We have performed only a laparoscopic colectomy technique (no hand-assisted procedures); the convertion rate was of 7.2%, the mean operative time was 145 min, no intraoperative complications were observed and finally the mean hospital stay was of 7.4 days (6-9). The postoperative complications were 1 case of infection of the umbilical scar and 1 case of pleural effusion with bronchopneumonia.


CONCLUSIONS
Elective laparoscopic colectomy for diverticular disease is feasible, safe and gives very good results: minimum postoperative discomfort, rapid recovery, low mobility and postoperative stay, rapid return to normal activities. However, in some cases, this procedure can be extremely difficult because of previous inflammatory complications (adhesions, fistulas or stenosis), therefore, high surgical skills in laparoscopic-colic surgery are required.
Unità di Chirurgia Vascolare e Mininvasiva, ASL 3 Umbria, Spoleto, Perugia, Italy. casciolas@libero.it
L
L
Casciola
G
G
Ceccarelli
M
M
Stefanoni
A
A
Spaziani
D
D
Conti
A
A
Bartoli
L
L
Di Zitti
R
R
Valeri
R
R
Bellochi
M
M
Rambotti
D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D043963:Diverticulosis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008638:Mesenteric Arteries; D008875:Middle Aged; D012189:Retrospective Studies