title: Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis.
abstract: BACKGROUND
  This prospective study evaluated the technical aspects and microbiological consequences of laparoscopic resection with transanal specimen extraction and per ano transcolonic stapler anvil insertion in patients requiring elective operation for previous diverticulitis.
  
  
  METHODS
  Laparoscopic sigmoid colectomy was performed with three ports, and specimen extraction carried out transanally through a complete opening of the rectal stump. A triple-stapled anastomosis restored colonic continuity. Systematic intraoperative bacteriological sampling was performed. Intraoperative data as well as microbiological and postoperative outcomes were evaluated prospectively.
  
  
  RESULTS
  Sixteen consecutive patients were studied over a 6-month period. All procedures were technically satisfactory, with a mean(s.d.) operating time of 120·9(41·9) min. No conversion or additional access was required. Four of the 16 patients developed complications, but none required intervention. Although polybacterial growth was present in all peritoneal culture samples, no infection-related complications were observed. Two patients had an extended course of perioperative antibiotic cover owing to overt peritoneal cavity contamination during surgery, and in two further patients antibiotics were instituted empirically following the development of postoperative fever alone.
  
  
  CONCLUSIONS
  Transanal specimen extraction in addition to per ano transcolonic stapler anvil insertion allows laparoscopic sigmoid resection to be performed with just three ports. Although intraperitoneal bacterial contamination occurs, this does not appear to translate into infectious morbidity.
authors.affiliation: Institute of Research Against Digestive Cancer-European Institute of TeleSurgery, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France. Joel.leroy@ircad.fr
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: F
authors.initials: F
authors.lastname: Costantino
authors.forename: R A
authors.initials: RA
authors.lastname: Cahill
authors.forename: J
authors.initials: J
authors.lastname: D'Agostino
authors.forename: A
authors.initials: A
authors.lastname: Morales
authors.forename: D
authors.initials: D
authors.lastname: Mutter
authors.forename: J
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D003082:Colectomy / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012810:Sigmoid Diseases / Q000601:surgery*; D013048:Specimen Handling
chemical_list: D000900:Anti-Bacterial Agents