title: [Elective laparoscopic colectomy in uncomplicated diverticulitis: when should surgery be performed].
abstract: BACKGROUND
  Surgical resection in acute diverticulitis is indicated after 2-4 episodes, as well as in patients with associated processes. However, the optimal time to perform elective surgery remains to be determined. Compared with open surgery, elective laparoscopic colectomy is associated with fewer postsurgical complications in patients with uncomplicated acute diverticulitis. Nevertheless, the conversion rate to laparotomy is associated with an increase in postoperative morbidity.
  
  
  OBJECTIVE
  We studied the impact of time interval to surgery on outcome parameters including operative incidents, postoperative complications and pathologic findings.
  
  
  METHODS
  Retrospective analysis of two series of case-matched patients according to the timing of operation after the last episode of NCD: group A (within 90 days) and group B (beyond 90 days). Case matching was performed by a computer program according to age, sex, BMI, number of previous episodes, ASA score and prior abdominal surgery.
  
  
  RESULTS
  Between July 2000 and June 2004, 132 patients had LCR for NCD. 39 patients were included in group A (median: 40 days, range 21-90 days) vs 38 patients in group B (median: 170 days, range 91-375 days). No patient in either group underwent operation in an emergency setting while waiting for elective surgery. Conversion was required in 5 patients in group A (13%) vs 2 patients in group B (5%) (p = 0.11). Overall abdominal morbidity in Group A was 21% vs 5% in group B (p = 0.02). Mean hospital stay was 7.7 days in group A vs 5.0 days in group B (p = 0.08). Residual inflammation was significantly increased in group A (31%) as compared to group B (11%) (p = 0.01).
  
  
  CONCLUSIONS
  Laparoscopic left colonic resection for acute diverticulitis is best performed beyond the third month after the last acute episode.
authors.affiliation: Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, Francia. chouillard@yahoo.com
authors.forename: Elie
authors.initials: E
authors.lastname: Chouillard
authors.forename: Léonor
authors.initials: L
authors.lastname: Benhaim
authors.forename: Toufic
authors.initials: T
authors.lastname: Ata
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Etienne
authors.forename: Eva
authors.initials: E
authors.lastname: Ghiles
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000295:instrumentation*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors