Emergency laparoscopic-assisted versus open right hemicolectomy for complicated cecal diverticulitis: a comparative study.
BACKGROUND
Emergency open colectomy is generally agreed, by most surgeons, to be the treatment of choice for complicated cecal diverticulitis. However, the literature on the use of laparoscopy in treating this surgical emergency is scanty. This study aimed to evaluate the feasibility and safety of emergency laparoscopic-assisted right hemicolectomy for complicated cecal diverticulitis and to compare its operative and short-term clinical outcomes with the open approach.


METHODS
Between September 2001 and June 2006, 18 consecutive patients with an intraoperative diagnosis of complicated cecal diverticulitis underwent emergency right hemicolectomy at our institution, 6 with the laparoscopic-assisted approach and 12 with the open approach. Clinical data were retrospectively collected and compared between the two groups.


RESULTS
The demographic data of the two groups were comparable. The operative time was similar between the two groups, but the laparoscopic-assisted group had significantly less blood loss (35 vs. 100 mL; P = 0.041). Although the time to first bowel motion was significantly shorter in the laparoscopic-assisted group (3.5 vs. 5 days; P = 0.041), the time to full ambulation and the duration of hospital stay were not different between the two groups. More patients in the open group developed postoperative complications (50 vs. 33.3%), but the difference was not statistically significant.


CONCLUSIONS
With the availability of experienced laparoscopic surgeons, emergency laparoscopic-assisted right hemicolectomy can be safely performed in patients with complicated cecal diverticulitis. Compared with the open approach, the laparoscopic-assisted approach is associated with less blood loss and earlier return of bowel function.
Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
Jimmy C M
JC
Li
Simon S M
SS
Ng
Janet F Y
JF
Lee
Raymond Y C
RY
Yiu
Sophie S F
SS
Hon
Wing Wa
WW
Leung
Ka Lau
KL
Leung
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D004238:Diverticulitis / Q000473:pathology / Q000601:surgery*; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult