Lessons learned from the analysis of 200 laparoscopic sigmoid resections for diverticulitis.
BACKGROUND
Since the beginning of laparoscopic surgery indications for laparoscopic colon resections are still discussed controversively. In the latest studies benefit for laparoscopic approach is reported. The aim of this study was to evaluate the feasibility of laparoscopic sigmoid resections for diverticulitis regarding conversion rate, operation time and intraoperative and postoperative complications, and defining strategies to prevent complications.


METHODS
Out of a prospective database with all laparoscopic colon resection between May 1999 and January 2008 the patients with laparoscopic sigmoid resection for diverticulitis were analyzed. Preoperative diagnosis was made by abdominal computed tomography with irrigoscopy and/or endoscopy. Indications for laparoscopic sigmoid resections were diverticulitis as an early elective or elective operation and selected cases with perforated diverticulitis.


RESULTS
Between May 1999 and January 2008, 200 patients (97 women, 103 men) were operated by laparoscopy for diverticulitis. Mean age at surgery was 59 years (range: 27 to 86); mean preoperative body mass index was 27.2 kg/m2 (range: 20 to 38). Mean operating time was 121 minutes (range: 60 to 239). Operating time was reduced due to experience and dropped from a mean of 150 minutes for the first 50 patients, 115 minutes for the second, 110 minutes for the third, and 107 minutes for the last 50 patients (P<0.05). Conversion rate was 1.5%, total morbidity rate was 19%, and reoperation rate was 6%.


CONCLUSIONS
Laparoscopic sigmoid resections for diverticulitis can be performed with great safety and low conversion rate. Several adjustments in operation technique and perioperative management had to be done to achieve a complication rate and conversion rate at an acceptable low level.
Zehetner
Jörg
J
II Surgical Department, Ludwig Boltzmann Institute for Operative Laparoscopy, AKH Linz, Academic Teaching Hospital, Linz, Austria. zehetner@hotmail.com
Szabo
Kornel
K
Wayand
Wolfgang
W
Shamiyeh
Andreas
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D012809:Colon, Sigmoid / Q000601:surgery*; D003113:Colonoscopy; D019992:Databases as Topic; D004238:Diverticulitis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome