title: Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis.
abstract: BACKGROUND
  The role of laparoscopy in the management of diverticular disease is evolving. Concerns were raised in the past because laparoscopic resection for diverticulitis is often difficult and occasionally hazardous. This study was undertaken to evaluate the difference in overall outcomes between elective open and laparoscopic surgery with or without anastomosis for diverticulitis.
  
  
  METHODS
  Using the National Inpatient Sample (NIS) database, clinical data of patients who underwent elective open and laparoscopic surgery (lap) for diverticulitis from 2002 to 2007 were collected and analyzed. Patients who underwent emergent surgery were excluded.
  
  
  RESULTS
  A total of 124,734 patients underwent elective surgery for diverticulitis: open, 110,172 (88.3%); lap, 14,562 (11.7%). The overall intraoperative complication rate was significantly lower in the laparoscopy group (0.63% vs. 1.15%, P < 0.01). However, there was no significant difference observed in ureteral injury between groups (open, 0.17%; lap, 0.12%, P = 0.15). All evaluated postoperative complications (ileus, abdominal abscess, leak, wound infection, bowel obstruction, urinary tract infection, pneumonia, respiratory failure, venous thromboembolism) were significantly higher for the open procedures. The laparoscopy group had a shorter mean hospital stay (lap, 5.06 days; open, 6.68 days, P < 0.01) and lower total hospital charges (lap, $36,389; open, $39,406, P < 0.01) than the open group. Also, mortality was four times higher in the open group (open, 0.54%; lap, 0.13%, P < 0.01).
  
  
  CONCLUSIONS
  The laparoscopic operation was associated with lower morbidity, lower mortality, shorter hospital stay, and lower hospital charges compared to the open operation for diverticulitis. Elective laparoscopic surgery for diverticulitis is safe and can be considered the preferred operative option.
authors: Department of Surgery, University of California Irvine Medical Center, 333 City Boulevard West, Suite 850, Orange, CA 92868, USA.
authors: Hossein
authors: H
authors: Masoomi
authors: Brian
authors: B
authors: Buchberg
authors: Brian
authors: B
authors: Nguyen
authors: Vicrumdeep
authors: V
authors: Tung
authors: Michael J
authors: MJ
authors: Stamos
authors: Steven
authors: S
authors: Mills
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D016208:Databases, Factual; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010149:Postoperative Pain / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome