title: Acute and elective laparoscopic resection for complicated sigmoid diverticulitis: clinical and histological outcome.
abstract: BACKGROUND
  Surgical treatment of acute complicated sigmoid diverticulitis is still under debate while elective treatment of recurrent diverticulitis has proven benefits. The aim of this study was to evaluate the clinical and histological outcome of acute and elective laparoscopic sigmoid colectomy in patients with diverticulitis.
  
  
  METHODS
  A retrospective review was conducted where 197 patients were analyzed undergoing laparoscopic sigmoid resection for acute complicated diverticulitis and recurrent diverticulitis. Single-stage laparoscopic resection and primary anastomosis were routinely performed using a 3-trocar technique. Recorded data included age, sex, American Society of Anesthesiologists (ASA)-score, operative time, duration of hospital stay, complications, and histological results.
  
  
  RESULTS
  Ninety-one patients received laparoscopy for acute diverticular disease (group I) and 93 patients underwent elective laparoscopic sigmoid resection for diverticulitis (group II). M/F ratio was 49:42 for group I and 37:56 for group II. Mean operative time and hospital stay was similar in both groups. Majority of patients were ASA II in both groups. Rate of minor complications was 14.3 % in group I and 7.5 % in group II. Major complications were 2.2 % for acute treatment and 4.3 % for elective resections. No anastomotic leakage and no mortality occurred. In 32.3 % of the patients of elective group II, destruction of the colonic wall with pericolic abscess, fistulization, or fibrinoid purulent peritonitis were identified.
  
  
  CONCLUSIONS
  Laparoscopic surgery for acute diverticular disease is safe and effective. Continuing bowl inflammations in histological specimens justify sigmoid resection in elective patients, but more effective pre-operative parameters need to be found to identify patients that would benefit from surgery during the initial episode.
authors.affiliation: Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany, mzdichavsky@yahoo.de.
authors.forename: Marty
authors.initials: M
authors.lastname: Zdichavsky
authors.forename: Thomas
authors.initials: T
authors.lastname: Kratt
authors.forename: Dietmar
authors.initials: D
authors.lastname: Stüker
authors.forename: Tobias
authors.initials: T
authors.lastname: Meile
authors.forename: Maximilian V
authors.initials: MV
authors.lastname: Feilitzsch
authors.forename: Dörte
authors.initials: D
authors.lastname: Wichmann
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D012809:Colon, Sigmoid / Q000473:pathology / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006304:Health Status; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012008:Recurrence; D012189:Retrospective Studies
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