title: Laparoscopic colectomy for complex diverticular disease: a justifiable choice?
abstract: BACKGROUND
  Surgery is increasingly reserved for complicated diverticulitis. The role of laparoscopy in this context is ill defined. This study aimed to evaluate the safety, feasibility, and outcomes associated with the application of laparoscopy to an unrestricted spectrum of diverticular pathologies, with an emphasis on complicated disease.
  
  
  METHODS
  Consecutive patients who underwent elective, urgent, or emergent laparoscopic colectomy for diverticular disease from 1991 to 2007 were analyzed from a prospectively collected database. Laparoscopy was offered to all patients presenting for surgical attention, thus minimizing selection bias. Complicated cases had abscesses, perforations, fistulas, or strictures. Uncomplicated cases had chronic or recurrent diverticulitis. Summary statistics and univariate comparisons were generated.
  
  
  RESULTS
  A total of 183 patients were analyzed, including 39 complicated cases. The complicated cohort included 12 abscesses or perforations (31%), 18 fistulas (46%), and 11 strictures (28%). Intraoperative complications were comparable between the two groups (7.7 vs. 9.7%), although the complicated cases resulted in more conversions (23 vs. 4.2%; p = 0.0007). More than 79% of the complicated patients and 96% of the uncomplicated patients underwent unprotected primary anastomosis. Medical (23 vs. 1.4%; p < 0.0001) and surgical (28 vs. 14%; p = 0.035) complications were more frequent in the complicated group. Leak rates were acceptably low (6.5 vs. 2.2%; p = 0.23). There were no recorded deaths. Finally, the time until discharge from hospital was significantly longer in the complicated group by a median of 1 day.
  
  
  CONCLUSIONS
  The laparoscopic management of complicated diverticular disease is feasible and appears to be safe in the hands of experts. Despite a high rate of conversion to open surgery, laparoscopy was the sole operative intervention for the majority of patients with complicated diverticular disease. Further studies are needed to allow rigorous comparison with an open control group.
authors.affiliation: Minimally Invasive Surgery Research Group, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. gumartel@ottawahospital.on.ca
authors.forename: Guillaume
authors.initials: G
authors.lastname: Martel
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bouchard
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Soto
authors.forename: Eric C
authors.initials: EC
authors.lastname: Poulin
authors.forename: Joseph
authors.initials: J
authors.lastname: Mamazza
authors.forename: Robin P
authors.initials: RP
authors.lastname: Boushey
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D015897:Comorbidity; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome