Laparoscopic sigmoid resections for diverticulitis complicated by abscesses or fistulas.
OBJECTIVE
Treatment of choice in recurrent and complicated diverticulitis is surgical resection of the inflamed bowel. Whereas it is accepted that recurrent diverticulitis (RD) can be handled laparoscopically, this is still not generally recommended for complicated diverticulitis (CD). Therefore, we analysed our results of laparoscopic sigmoidectomies concerning intraoperative course, conversion rate, morbidity and hospital stay in RD and CD.


METHODS
Between 09/2002 and 01/2006, laparoscopic sigmoidectomies were offered to all patients suffering from recurrent or complicated diverticulitis (Hinchey I+II). All resections were performed in a four-port technique with the use of Ultracision and intraabdominal stapler anastomosis. Data were prospectively collected and retrospectively analysed in an intention-to-treat view.


RESULTS
Out of 127 laparoscopic colectomies, 58 were performed for diverticulitis (RD 32; CD 26). Eight patients with colovesical and one patient with colovaginal fistula are included. Three patients with abscesses underwent pretreatment by percutaneous drainage. Operative time was longer in CD than in RD (205+/-41 vs 147+/-34 min; p<0.001) and associated with higher blood loss, but conversion rate was low (RD, 2/32 vs CD, 3/26; p=0.64). There was one intraoperative complication in each group; postoperative major complications occurred in 3.13% (RD) vs 11.5% (CD; p=0.316). One anastomotic leakage occurred in the RD group. Length of hospital stay was shorter for RD than for CD (7.1+/-3.4 vs 10.7+/-6.4 days; p=0.02).


CONCLUSIONS
Laparoscopic resections should not be limited to recurrent diverticular disease but can be safely applied for complicated diverticulitis.
Zapletal
Christina
C
Department of Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany. christina.zapletal@kgu.de
Woeste
Guido
G
Bechstein
Wolf O
WO
Wullstein
Christoph
C
D000038:Abscess / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome