title: A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease.
abstract: BACKGROUND
  Laparoscopic colorectal surgery (LAP) has become more prevalent as evidence of its safety and benefits become apparent. However, in difficult cases, hand-assisted instrumentation has facilitated LAP. We examined the impact of hand-assisted laparoscopic surgery (HALS) on the treatment of sigmoid diverticular disease.
  
  
  METHODS
  This is a retrospective study using a prospectively maintained database from January 1, 2000 through November 30, 2005. Patients were divided into 3 groups: open (n = 110), LAP (n = 17), and HALS (n = 98). Data include operative time, length of stay, surgical method, conversion rate, and reasons for conversion.
  
  
  RESULTS
  Surgeries started as LAP were completed in that fashion 59% of the time, with 23% being converted to open and 18% converted to HALS (total 41%). HALS cases showed a 6% conversion rate to open surgery (OS). Duration of surgery and length of stay were similar between LAP and HALS.
  
  
  CONCLUSIONS
  HALS should be considered the optimal approach for surgery for diverticular disease.
authors.affiliation: Ferguson-Blodgett Digestive Disease Institute, Grand Rapids, MI, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Anderson
authors.forename: Martin
authors.initials: M
authors.lastname: Luchtefeld
authors.forename: Nadov
authors.initials: N
authors.lastname: Dujovny
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hoedema
authors.forename: Donald
authors.initials: D
authors.lastname: Kim
authors.forename: Jefferey
authors.initials: J
authors.lastname: Butcher
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D045823:Ileus / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000209:etiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome