title: Laparoscopic sigmoidectomy for diverticulitis: a prospective study.
abstract: BACKGROUND
  Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of this prospective study was to evaluate the outcome of laparoscopic sigmoid colectomy in patients with diverticulitis. Patients offered laparoscopic surgery presented with acute complicated diverticulitis (Hinchey type I, II, III), chronically recurrent diverticulitis, bleeding, or sigmoid stenosis caused by chronic diverticulitis.
  
  
  METHODS
  All patients who underwent laparoscopic colectomy within a 12-year period were prospectively entered into a database registry. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. A 4-trocar approach with suprapubic minilaparotomy was performed. Main data recorded were age, sex, postoperative pain, return of bowel function, operation time, duration of hospital stay, and early and late complications.
  
  
  RESULTS
  During the study period, 260 sigmoid colectomies were performed for diverticulitis. The cohort included 104 male and 156 female patients; M to F ratio was 4:6. Postoperative pain was controlled by NSAIDs or weak opioid analgesia. Fifteen patients (5.7%) required conversion from laparoscopic to open colectomy. The most common reasons for conversion were directly related to the inflammatory process, abscess, and peritonitis. Mean operative time was 130±54. Average postoperative hospital stay was 10±3 days. A longer hospital stay was recorded for Hinchey type IIb patients. Complications were recorded in 30 patients (11.5%). The most common complications that required reoperation were hemorrhage in 2 patients (0.76) and anastomotic leak in 5 patients (only 3 of them required reoperation). The mortality among them was 2 patients (0.76%).
  
  
  CONCLUSIONS
  Laparoscopic surgery for diverticular disease is safe, feasible, and effective. Therefore, laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis at our institution.
authors: Klinik for Allgemein Vszeral und Unfallchirurgie Klinikum Bremen Ost, Bremen, Germany. khaledelgazwi@yahoo.com
authors: Khaled
authors: K
authors: El Zarrok Elgazwi
authors: Ivo
authors: I
authors: Baca
authors: Leszek
authors: L
authors: Grzybowski
authors: Armin
authors: A
authors: Jaacks
references: Surgery. 1980 Nov;88(5):710-4
references: 7434211
references: Ann Chir. 2002 Jun;127(6):413-5
references: 12122713
references: Surg Endosc. 2002 Sep;16(9):1320-3
references: 11984674
references: Hepatogastroenterology. 2008 Nov-Dec;55(88):2065-71
references: 19260478
references: Dis Colon Rectum. 1996 Oct;39(10 Suppl):S1-6
references: 8831539
references: Ann Chir. 1999;53(10):1023-8
references: 10670152
references: Colorectal Dis. 2006 Jul;8(6):501-5
references: 16784471
references: Ann Surg. 2008 Dec;248(6):1092-7
references: 19092355
references: Br Med J. 1969 Dec 13;4(5684):639-42
references: 5359917
references: Surg Endosc. 2002 Jan;16(1):18-21
references: 11961597
references: Surg Endosc. 1999 Apr;13(4):430-6
references: 10094765
references: Surg Endosc. 1999 May;13(5):457-60
references: 10227941
references: Ann Surg. 1998 Mar;227(3):335-42
references: 9527055
references: Int J Colorectal Dis. 1998;13(1):43-7
references: 9548100
references: Surgery. 1995 Feb;117(2):140-5
references: 7846617
references: Surg Endosc. 1997 Oct;11(10):1021-5
references: 9381341
references: Surg Endosc. 2003 Feb;17(2):242-6
references: 12399854
references: Ann Chir. 2000 Apr;125(3):231-7
references: 10829501
references: Dis Colon Rectum. 1995 Feb;38(2):125-32
references: 7851165
references: Surg Endosc. 1999 Jun;13(6):567-71
references: 10347292
references: Surg Endosc. 2001 Dec;15(12):1427-30
references: 11965459
references: Dis Colon Rectum. 1998 Feb;41(2):180-9
references: 9556242
references: Chirurgie. 1997;122(7):424-9
references: 9588064
references: Adv Surg. 1978;12:85-109
references: 735943
references: Surg Laparosc Endosc Percutan Tech. 2009 Apr;19(2):123-7
references: 19390278
references: Surg Endosc. 2004 Sep;18(9):1344-8
references: 15803234
references: Surg Endosc. 1997 Mar;11(3):264-7
references: 9079606
references: Surg Endosc. 1998 Dec;12(12):1393-6
references: 9822464
references: Am J Surg. 1986 Feb;151(2):269-71
references: 3946763